Can anyone help me interpret some of these results?
I was diagnosed with smoldering multiple myeloma a month ago and have had a bone marrow biopsy (BMB) and skeletal survey done. I am heading to a local university to see a specialist in a few weeks but wonder what it all means as far as progression. I feel good, no lytic lesions, just a little tired.
Serum electrophoresis was 2.8 and concentrated in the gamma region.
IgG - 4754
IgA - 22
IgM - 31
LFLC - 1725
B2 Micro - 4
Creatinine - 0.73
Bone marrow biopsy - positive for deletion of MAF gene, positive for monosomy chromosome 13, and positive for CCND1/IGH gene rearrangement. The cytometry was 11% abnormal CD 56-positive plasma cell population identified, monoclonal lambda.
Forums
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loveparis - Name: loveparis
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: June, 2015
- Age at diagnosis: 61
Re: Confused by my lab results
Hello: LP
My non-scientific, non-medical opinion is that smoldering multiple myeloma often turns to multiple myeloma when the M-spike reaches somewhere in the 3's (g/dL -- so 30 g/L).
You are close, but in some cases, it takes many, many years to move up. Some people stay at smoldering myeloma up to about a 5 level of M-spike (I think that is sort of rare).
If you get your M-spike tracked every 3 months, and it goes up say 0.1 per year, and you stay without symptoms, you could be in good shape for many, many years.
If the M-spike goes up at a higher rate (say 0.4 or 0.5 per year), then you are probably looking at starting treatment. If this is the case, then be sure to get a myeloma specialist, and with the medicines available today and in the pipeline, there is still plenty of hope in dealing with it.
Best of luck to you,
My non-scientific, non-medical opinion is that smoldering multiple myeloma often turns to multiple myeloma when the M-spike reaches somewhere in the 3's (g/dL -- so 30 g/L).
You are close, but in some cases, it takes many, many years to move up. Some people stay at smoldering myeloma up to about a 5 level of M-spike (I think that is sort of rare).
If you get your M-spike tracked every 3 months, and it goes up say 0.1 per year, and you stay without symptoms, you could be in good shape for many, many years.
If the M-spike goes up at a higher rate (say 0.4 or 0.5 per year), then you are probably looking at starting treatment. If this is the case, then be sure to get a myeloma specialist, and with the medicines available today and in the pipeline, there is still plenty of hope in dealing with it.
Best of luck to you,
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JPC - Name: JPC
Re: Confused by my lab results
Thank you for the encouragement. I really need it right now, this is a scary thing!
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loveparis - Name: loveparis
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: June, 2015
- Age at diagnosis: 61
Re: Confused by my lab results
I'd welcome any insight anyone has on this. I want to make sure I ask the right questions when I visit the specialist in a few weeks.
Thank you
Thank you
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loveparis - Name: loveparis
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: June, 2015
- Age at diagnosis: 61
Re: Confused by my lab results
Loveparis,
You need to be looking at all of your light chain values (lambda, kappa and the free light chain ratio), not just your lambda level. You should also track your hemoglobin level (especially if you are feeling tired) and your calcium level.
If you've never had a PET/CT or whole body MRI, I would be asking about having one instead of a skeletal survey, as those are really the new standards in imaging for multiple myeloma.
Please also include the units of measure with all of your measurements when you post on this forum.
You need to be looking at all of your light chain values (lambda, kappa and the free light chain ratio), not just your lambda level. You should also track your hemoglobin level (especially if you are feeling tired) and your calcium level.
If you've never had a PET/CT or whole body MRI, I would be asking about having one instead of a skeletal survey, as those are really the new standards in imaging for multiple myeloma.
Please also include the units of measure with all of your measurements when you post on this forum.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Confused by my lab results
Thank you for the suggestions. I did have the PET scan / MRI on my list of questions. I have have osteoporosis for several years and have been on Atelvia (risedronate), so hopefully that has helped. No broken bones in the past! I also have hyperthyroidism, which has been normalized for a few years now, but does add to the puzzle.
I did find out that my serum protein was starting to elevate back in 2013, but the nurse practitioner was not worried. Perhaps I have been smoldering or MGUS for 2 years already. I'm new to the site and am just about to complete my profile. I'm happy to know I'm not alone and there is a huge knowledge base among the users. Thank you
Serum electrophoresis was 2.8 g/dL,and concentrated in the gamma region.
IgG - 4754 mg/dL
IgA - 22 mg/dL
IgM - 31 mg/dL
Kappa Light Chain -5.87 mg/L
Lambda Light Chain- 1725 mg/L
Kappa/Lambda - 0 mg/L
B2 Micro - 4 mg/L
Creatinine - 0.73 mg/dL
Calcium - 9.1 mg/dL
Total Protein - 9.1 g/dL
Hemoglobin - 12.6 g/dL
Hematocrit - 37%
I did find out that my serum protein was starting to elevate back in 2013, but the nurse practitioner was not worried. Perhaps I have been smoldering or MGUS for 2 years already. I'm new to the site and am just about to complete my profile. I'm happy to know I'm not alone and there is a huge knowledge base among the users. Thank you
Serum electrophoresis was 2.8 g/dL,and concentrated in the gamma region.
IgG - 4754 mg/dL
IgA - 22 mg/dL
IgM - 31 mg/dL
Kappa Light Chain -5.87 mg/L
Lambda Light Chain- 1725 mg/L
Kappa/Lambda - 0 mg/L
B2 Micro - 4 mg/L
Creatinine - 0.73 mg/dL
Calcium - 9.1 mg/dL
Total Protein - 9.1 g/dL
Hemoglobin - 12.6 g/dL
Hematocrit - 37%
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loveparis - Name: loveparis
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: June, 2015
- Age at diagnosis: 61
Re: Confused by my lab results
Loveparis,
If your free light chain numbers are correctly stated (kappa light chain - 5.87 mg/L, lambda light chain- 1725 mg/L), the ratio of your involved free light chain to your uninvolved free light chain (lambda/kappa) is ~ 293. That's a pretty high free light chain ratio and would be something to discuss with the multiple myeloma specialist at UCSF (they have a great team of multiple myeloma specialists there).
Technically, a free light chain ratio over 100 qualifies as a "myeloma defining event" (MDE). See:
SV Rajkumar, "New Criteria For The Diagnosis Of Multiple Myeloma And Related Disorders," The Myeloma Beacon, Oct 26, 2014.
It's also important to remember Dr. Rajkumar's closing statement in the above article:
I would also keep an eye on your hemoglobin level. Depending on your specific lab and it's normal range of lab values for hemoglobin, it is a bit low. You would get concerned about anemia (that is, the "A" in "CRAB") if your hemoglobin was 2 g/dL under the lower normal range on your lab test (that is, if it was at 11.4 g/dL or lower, given a normal range of 13.4 - 18.0 g/dL). When you see your specialist, you might want to also discuss getting some blood iron tests and discuss taking an iron supplement or increasing your dietary iron intake.
If your free light chain numbers are correctly stated (kappa light chain - 5.87 mg/L, lambda light chain- 1725 mg/L), the ratio of your involved free light chain to your uninvolved free light chain (lambda/kappa) is ~ 293. That's a pretty high free light chain ratio and would be something to discuss with the multiple myeloma specialist at UCSF (they have a great team of multiple myeloma specialists there).
Technically, a free light chain ratio over 100 qualifies as a "myeloma defining event" (MDE). See:
SV Rajkumar, "New Criteria For The Diagnosis Of Multiple Myeloma And Related Disorders," The Myeloma Beacon, Oct 26, 2014.
The revised IMWG criteria will allow, in addition to the classic CRAB features, the following three markers as “myeloma defining events” (MDEs) ...
Serum involved / uninvolved free light chain ratio of 100 or greater, provided the absolute level of the involved free light chain is at least 100 mg/L (a patient’s “involved” free light chain – either kappa or lambda – is the one that is above the normal reference range; the uninvolved light chain is the one that typically is in, or below, the normal range).
It's also important to remember Dr. Rajkumar's closing statement in the above article:
Finally, no written criteria can substitute clinical judgment. In many cases, physicians will need to continue to use judgment in making decisions on which patients need immediate therapy, and in deciding when continued observation will be in the patients’ best interests.
I would also keep an eye on your hemoglobin level. Depending on your specific lab and it's normal range of lab values for hemoglobin, it is a bit low. You would get concerned about anemia (that is, the "A" in "CRAB") if your hemoglobin was 2 g/dL under the lower normal range on your lab test (that is, if it was at 11.4 g/dL or lower, given a normal range of 13.4 - 18.0 g/dL). When you see your specialist, you might want to also discuss getting some blood iron tests and discuss taking an iron supplement or increasing your dietary iron intake.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Confused by my lab results
Thank you for your thoughtful reply. After reading the linked article, it seems the "writing is on the wall", but I will have to wait and discuss with the specialist in a few weeks. The dilemma I keep reading about is starting treatment too early and reducing options later on.
I have a lot to think about, but keep going back to the idea that treating before organ damage makes more sense than waiting until sometimes irreversible damage has happened. I am adding some iron supplement to my diet today. Can't hurt, and my diet may not be enough .
I have a lot to think about, but keep going back to the idea that treating before organ damage makes more sense than waiting until sometimes irreversible damage has happened. I am adding some iron supplement to my diet today. Can't hurt, and my diet may not be enough .
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loveparis - Name: loveparis
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: June, 2015
- Age at diagnosis: 61
Re: Confused by my lab results
A couple of things.
While I take supplements, I always first clear their use through my specialist. I only started taking an iron supplement and eating red meat after getting some iron/ferritin tests done and discussing it with my specialist (I am smoldering and my hemoglobin was down around your level when I did this).
It is a very personal decision on when to start treatment and not all specialists agree on when to do this. You therefore may want to consider getting a couple of different opinions from two different specialists. But in any case, starting out at UCSF is a good move.
While I take supplements, I always first clear their use through my specialist. I only started taking an iron supplement and eating red meat after getting some iron/ferritin tests done and discussing it with my specialist (I am smoldering and my hemoglobin was down around your level when I did this).
It is a very personal decision on when to start treatment and not all specialists agree on when to do this. You therefore may want to consider getting a couple of different opinions from two different specialists. But in any case, starting out at UCSF is a good move.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Confused by my lab results
Hi Loveparis,
Am glad that you have found this forum as there are many here with great advice and experience.
I remember how scary and confusing it was at the beginning. I also have smoldering multiple myeloma and live in the Bay Area.
Blee
Am glad that you have found this forum as there are many here with great advice and experience.
I remember how scary and confusing it was at the beginning. I also have smoldering multiple myeloma and live in the Bay Area.
Blee
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Blee - Name: Blee
- Who do you know with myeloma?: me
- When were you/they diagnosed?: Oct 2013
- Age at diagnosis: 58
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