On my first bone marrow, the FISH test revealed 3 different cytogenic abnormalities, all consistent with multiple myeloma. I also had 10% plasma cells, M-spike 1.4.
To confirm things, 4 weeks later I had a repeat bone marrow biopsy in which the FISH test revealed no cytogenic abnormalities?? They also found 15% plasma cells with a large cluster containing 37%, M-spike 1.5
Was there a mistake or can deletions grow back, abnormalities be corrected?
If the first FISH test was wrong, how could it be 3 different abnormalities that are usual with myeloma? I am confused. Also, the first test placed me in high risk. Any suggestions?
Heather
Forums
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dishevelled - Name: Heather Trimnell
- Who do you know with myeloma?: me
- When were you/they diagnosed?: 4/1/2011
- Age at diagnosis: 36
Re: Cytogenetic abnormalities gone?
Sounds bizarre. I know that myeloma can be "patchy" throughout one's bone marrow. Some areas can appear "clean" and others have a much higher abnormal plasma cell infiltration. Two BMB's done on the same day in different areas can produce much different results.
What did your doctors say?
What did your doctors say?
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terryl1 - Name: Terry
- Who do you know with myeloma?: self
- When were you/they diagnosed?: August 10, 2011
- Age at diagnosis: 49
Re: Cytogenetic abnormalities gone?
I have had this conversation with a couple of folks and I tend to agree with Terry that it might be the luck of the draw on your sample and what part of that sample they are measuring. This can affect the measured concentrations and which cell clusters one happens to be measuring. I "believe" (but not positive) that deletions, gains and translocations just don't fix/mend themselves (but treatment obviously does help wipe out or diminish the mutated cells).
However, additional, new mutations definitely do evolve that favor the continued existence of the mutated myeloma cells and you can also get additional mutations over time. Many folks just don't realize that this can be an evolving game of a "whack-a-mole" as new mutations pop up, but again I haven't heard of mutations just fixing themselves and disappearing on their own.
As far as deletions or mutations growing back, this is one of the key issues with this disease. If you treat the disease and knock down all the nasties, have you in fact got every last one of these cells? If, after treatment, there is a residual amount of the affected cells in your system (including those with any cytogenetic abnormalities), they have the possibility to grow back all over again and/or start a new process whereby new abnormal cells with either new or some of the old mutations pop up.
Bottom line is your doc really needs to weigh in on this as we aren't experts. Note that the labs often hold on the bone marrow samples for awhile if you need to re-run the test (again, you can get different results with exactly the same sample).
Let us know what you find out.
However, additional, new mutations definitely do evolve that favor the continued existence of the mutated myeloma cells and you can also get additional mutations over time. Many folks just don't realize that this can be an evolving game of a "whack-a-mole" as new mutations pop up, but again I haven't heard of mutations just fixing themselves and disappearing on their own.
As far as deletions or mutations growing back, this is one of the key issues with this disease. If you treat the disease and knock down all the nasties, have you in fact got every last one of these cells? If, after treatment, there is a residual amount of the affected cells in your system (including those with any cytogenetic abnormalities), they have the possibility to grow back all over again and/or start a new process whereby new abnormal cells with either new or some of the old mutations pop up.
Bottom line is your doc really needs to weigh in on this as we aren't experts. Note that the labs often hold on the bone marrow samples for awhile if you need to re-run the test (again, you can get different results with exactly the same sample).
Let us know what you find out.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Cytogenetic abnormalities gone?
The variation in numbers of plasma cells is not uncommon. The term posted previously of patchy disease is a good description.
The discrepancy in the FISH is a bit more odd. May have been something regarding the performance of the test or, more likely, quality of the aspirate in the second sample.
The discrepancy in the FISH is a bit more odd. May have been something regarding the performance of the test or, more likely, quality of the aspirate in the second sample.
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Dr. Jason Valent - Name: Jason Valent, M.D.
Beacon Medical Advisor
Re: Cytogenetic abnormalities gone?
I have never had treatment as I am smoldering.
Thank you all. The doctor said she is going to look at it. Are you saying one sample could show abnormalities and another not? I didn't think chromosomes varied, I knew the plasma cell % could.
Thank you all. The doctor said she is going to look at it. Are you saying one sample could show abnormalities and another not? I didn't think chromosomes varied, I knew the plasma cell % could.
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dishevelled - Name: Heather Trimnell
- Who do you know with myeloma?: me
- When were you/they diagnosed?: 4/1/2011
- Age at diagnosis: 36
Re: Cytogenetic abnormalities gone?
dishevelled wrote: "I didn't think chromosomes varied, I knew the plasma cell % could."
This is a common misconception. The abnormal plasma cells have a different genetic makeup than the other cells in your body. And you can have different lines of plasma cells with different genetic mutations. And these can evolve.
This is a common misconception. The abnormal plasma cells have a different genetic makeup than the other cells in your body. And you can have different lines of plasma cells with different genetic mutations. And these can evolve.
Last edited by Multibilly on Tue May 21, 2013 12:26 pm, edited 1 time in total.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Cytogenetic abnormalities gone?
Wow!! Thank you!! That makes much more sense. Everybody here is so knowledgeable. I am also thankful for expert advice.
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dishevelled - Name: Heather Trimnell
- Who do you know with myeloma?: me
- When were you/they diagnosed?: 4/1/2011
- Age at diagnosis: 36
Re: Cytogenetic abnormalities gone?
dishevelled wrote:
I'm hardly an expert and I'm also not always right
Take all the advice from non-doctors on this site with a grain of salt and verify everything with your doc.
Wow!! Thank you!! That makes much more sense. Everybody here is so knowledgeable. I am also thankful for expert advice.
I'm hardly an expert and I'm also not always right
Take all the advice from non-doctors on this site with a grain of salt and verify everything with your doc.-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Cytogenetic abnormalities gone?
What I meant was, everybody is very knowledgeable. I am ALSO thankful for the expert advice (meaning Dr. Jason Valent)
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dishevelled - Name: Heather Trimnell
- Who do you know with myeloma?: me
- When were you/they diagnosed?: 4/1/2011
- Age at diagnosis: 36
Re: Cytogenetic abnormalities gone?
Indeed. All the docs that monitor and post on this site rock.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
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