Hello everybody,
When i was diagnosed with multiple myeloma, i had positive immunofixation for K-Bence Jones monoclonal protein in both serum and urine.
Lately, the last months, while my exams are good, and while the urine immunofixation is negative, the serum immunofixation is positive for a monoclonal IgG Kappa with an oligoclonal background. Could that be bad? Is it possible somebody to relapse with a different monoclonal band?
Best regards
Niki
Forums
10 posts
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Re: Different mococlonal band than in diagnosis
Hi Niki,
I think there is some evidence that what you are seeing can actually be a good sign.
I don't remember what your treatment history is. But, in this study of patients who have had a transplant, patients experiencing what I think is similar to what you're experiencing had better outcomes than other patients:
"Different M-Spike After Stem Cell Transplantation Linked To Improved Survival (ASH 2012)"
https://myelomabeacon.org/news/2013/01/16/different-m-spike-after-stem-cell-transplantation-linked-to-improved-survival-ash-2012/
"Results of a Canadian retrospective analysis indicate that multiple myeloma patients who develop one or more new monoclonal proteins (M-spikes) after stem cell transplantation may have improved progression-free and overall survival compared to those without a new M-spike."
A year or so before this study came out, though, Dr. Shain mentioned that he wasn't convinced that oligoclonal bands were necessarily good or bad. Here's a thread where he posted a response:
https://myelomabeacon.org/forum/oligoclonal-bands-t564.html
"My experience with oligoclonal bands has not yet yielded any correlation between their presence and improved (or poor) response. Typically, oligoclonal bands do represent a reconstituting immune system are noted several months after transplant, can be present for for multiple months, and resolve spontaneously."
But his opinion may be different now based on some of the new evidence on the subject.
You should check these references just to make sure they are relevant to your situation.
I think there is some evidence that what you are seeing can actually be a good sign.
I don't remember what your treatment history is. But, in this study of patients who have had a transplant, patients experiencing what I think is similar to what you're experiencing had better outcomes than other patients:
"Different M-Spike After Stem Cell Transplantation Linked To Improved Survival (ASH 2012)"
https://myelomabeacon.org/news/2013/01/16/different-m-spike-after-stem-cell-transplantation-linked-to-improved-survival-ash-2012/
"Results of a Canadian retrospective analysis indicate that multiple myeloma patients who develop one or more new monoclonal proteins (M-spikes) after stem cell transplantation may have improved progression-free and overall survival compared to those without a new M-spike."
A year or so before this study came out, though, Dr. Shain mentioned that he wasn't convinced that oligoclonal bands were necessarily good or bad. Here's a thread where he posted a response:
https://myelomabeacon.org/forum/oligoclonal-bands-t564.html
"My experience with oligoclonal bands has not yet yielded any correlation between their presence and improved (or poor) response. Typically, oligoclonal bands do represent a reconstituting immune system are noted several months after transplant, can be present for for multiple months, and resolve spontaneously."
But his opinion may be different now based on some of the new evidence on the subject.
You should check these references just to make sure they are relevant to your situation.
-
JimNY
Re: Different mococlonal band than in diagnosis
I guess I'm not understanding your post Niki.
You say you were Kappa Light Chain in urine at diagnosis. You don't say what your excess immunoglobulin type is at the time. Were you non-secretory at diagnosis?
Now you show Kappa light chains again and are saying it is coupled with excess IgG. Was your initial diagnosis IgA Kappa and now it is IgG Kappa? Or are you saying that you were originally diagnosed with non-secretory multiple myeloma and are now showing IgG Kappa that is oligoclonal in nature?
You say you were Kappa Light Chain in urine at diagnosis. You don't say what your excess immunoglobulin type is at the time. Were you non-secretory at diagnosis?
Now you show Kappa light chains again and are saying it is coupled with excess IgG. Was your initial diagnosis IgA Kappa and now it is IgG Kappa? Or are you saying that you were originally diagnosed with non-secretory multiple myeloma and are now showing IgG Kappa that is oligoclonal in nature?
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Different mococlonal band than in diagnosis
Dear Multibilly,
Originally i was diagnosed with a stage 2, oligo-secretory, kappa light chain Myeloma.
At diagnosis: Urine immunofixation: K-Bence Jones paraprotein (1200mg/l) , Serum immunofixation K-Bence Jones paraprotein(no detectable with SPEP) , Bone marrow aspirate:74% infiltration
Now: Urine immunofixation negative, Serum immunofixation positive for monoclonal IgG Kappa with oligoclonal background, Bone marrow < 5% of plasma cells , 4 colour flow cytometry negative for minimal residual disease, 8 colour flow cytometry positive for minimal residual disease with 0.58%.
Best regards
Niki
Originally i was diagnosed with a stage 2, oligo-secretory, kappa light chain Myeloma.
At diagnosis: Urine immunofixation: K-Bence Jones paraprotein (1200mg/l) , Serum immunofixation K-Bence Jones paraprotein(no detectable with SPEP) , Bone marrow aspirate:74% infiltration
Now: Urine immunofixation negative, Serum immunofixation positive for monoclonal IgG Kappa with oligoclonal background, Bone marrow < 5% of plasma cells , 4 colour flow cytometry negative for minimal residual disease, 8 colour flow cytometry positive for minimal residual disease with 0.58%.
Best regards
Niki
Re: Different mococlonal band than in diagnosis
Sorry, maybe I'm missing something here. If you were diagnosed as being oligosecretory at the onset, wouldn't you have had some measurable level of paraprotein in in your blood, albeit at a lower level than what you might expect? Isn't the distinction between oligosecretory and non-secretory the presence of some (but at a level lower than what would be normally expected) pararaprotein in your blood (oligosecretory) versus no paraprotein showing up in your blood (non-secretory)?
That's why I'm confused.
Anyway, it rocks that you are at < 5% plasma cells after being at 74%!
That's why I'm confused.
Anyway, it rocks that you are at < 5% plasma cells after being at 74%!
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Different mococlonal band than in diagnosis
Dear Multibilly,
I was told that i am oligosecretory because the paraprotein was identified by the serum immunofixation which has a lower sensitivity. I wa told that i would be a non secretory if the serum immunofixation was negative. I just don't know if i am relapsing because of the positive immunofixation of the last months.....
Best regards
Niki
I was told that i am oligosecretory because the paraprotein was identified by the serum immunofixation which has a lower sensitivity. I wa told that i would be a non secretory if the serum immunofixation was negative. I just don't know if i am relapsing because of the positive immunofixation of the last months.....
Best regards
Niki
Re: Different mococlonal band than in diagnosis
Hi Niki, It sounds like your treatments were a great success in eliminating most if not all of your paraproteins To have less than 5% of plasma cells in the marrow is normal , since some plasma cells are needed in our immune system.
I can appreciate why you are worried, since it's nicer not to have any trace of 'M' protein, a.k.a. paraprotein, visible on the immunofixation. To have more than one band is puzzling too.
Did you have readings of no M protein at all for a while, and also is the amount of paraprotein increasing from one check up to the next? For example, if you had no 'M' protein for a few checkups, then a small trace on more than one band, then those amounts increasing.
If that were the case, I think it could be a relapse, but your myeloma specialist would be the best person to interpret the results.
One intriguing fact that I have been told, is that the amounts of the 'M' protein in separate bands can be added up to produce a total amount. This amount would be the total 'M' protein. A low amount of protein present, such as occurs in MGUS, does not always warrant treatment though. Hope that helps.
I can appreciate why you are worried, since it's nicer not to have any trace of 'M' protein, a.k.a. paraprotein, visible on the immunofixation. To have more than one band is puzzling too.
Did you have readings of no M protein at all for a while, and also is the amount of paraprotein increasing from one check up to the next? For example, if you had no 'M' protein for a few checkups, then a small trace on more than one band, then those amounts increasing.
If that were the case, I think it could be a relapse, but your myeloma specialist would be the best person to interpret the results.
One intriguing fact that I have been told, is that the amounts of the 'M' protein in separate bands can be added up to produce a total amount. This amount would be the total 'M' protein. A low amount of protein present, such as occurs in MGUS, does not always warrant treatment though. Hope that helps.
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: Different mococlonal band than in diagnosis
Niki,
Thanks for the clarification. Your explanation makes perfect sense as an IFE is exquisitely sensitive at detecting the presence of monoclonal proteins, but doesn't tell you the amts. However, an SPEP is not as accurate in detecting the presence of the monoclonal proteins, but does tell you the amts.
So, I'm not clear that the monoclonal banding that JimNY applies here? It sounds like you may have simply gone from having a non-measurable amt of IgG monoclonal protein (via SPEP) to some measurable amount in your blood, right? (unless I'm misunderstanding something here). It's not necessarily the case that you now have a different type of M-Spike, but rather it is simply being more expressed in your blood serum than it was before. So, maybe the nature of your oligosecretory disease is simply evolving, but this is not necessarily something to worry about (this is just a layman's speculation on my part)?
I'm not a doc, but I am going to guess that a doc is going to say to simply monitor this trend and to see if your M-spike trends up over time before getting concerned. Again, the fact that you are at <5% plasma cell level is great and is something to celebrate. At the end of the day, your bone marrow is the factory where all these nasty multiple myeloma things are occurring, so I would be delighted by your < 5% reading in the heart of the factory (which as Nancy says, is dead-on normal),
Thanks for the clarification. Your explanation makes perfect sense as an IFE is exquisitely sensitive at detecting the presence of monoclonal proteins, but doesn't tell you the amts. However, an SPEP is not as accurate in detecting the presence of the monoclonal proteins, but does tell you the amts.
So, I'm not clear that the monoclonal banding that JimNY applies here? It sounds like you may have simply gone from having a non-measurable amt of IgG monoclonal protein (via SPEP) to some measurable amount in your blood, right? (unless I'm misunderstanding something here). It's not necessarily the case that you now have a different type of M-Spike, but rather it is simply being more expressed in your blood serum than it was before. So, maybe the nature of your oligosecretory disease is simply evolving, but this is not necessarily something to worry about (this is just a layman's speculation on my part)?
I'm not a doc, but I am going to guess that a doc is going to say to simply monitor this trend and to see if your M-spike trends up over time before getting concerned. Again, the fact that you are at <5% plasma cell level is great and is something to celebrate. At the end of the day, your bone marrow is the factory where all these nasty multiple myeloma things are occurring, so I would be delighted by your < 5% reading in the heart of the factory (which as Nancy says, is dead-on normal),
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Different mococlonal band than in diagnosis
Dear Multibilly and Nancy,
Thank you both. I understand your point Multibilly but i was expecting that when the myeloma relapsed or increases then the origincal pattern in the test would be seen again. Also, the fact of the oligoclonal background on the pattern is something that the hematologists are not sure about the exact meaning. Generally, for one more time we see how complex this disease is.
Best regards
Niki
Thank you both. I understand your point Multibilly but i was expecting that when the myeloma relapsed or increases then the origincal pattern in the test would be seen again. Also, the fact of the oligoclonal background on the pattern is something that the hematologists are not sure about the exact meaning. Generally, for one more time we see how complex this disease is.
Best regards
Niki
Re: Different mococlonal band than in diagnosis
I tend to side with Dr. Shain on this. Not exactly sure what to make of this finding.
If you had only kappa light chain disease at diagnosis, the presence now of an intact IgG probably does not indicate relapse although I always wonder if perhaps patients such as yourself have predominantly light chain only disease but still some population of plasma cells making an intact immmunoglobulin (or perhaps this was the "mgus" cells).
I always get more than one time point for the labs to confirm or deny progression of disease. A little time always gives the answer one way or the other.
If you had only kappa light chain disease at diagnosis, the presence now of an intact IgG probably does not indicate relapse although I always wonder if perhaps patients such as yourself have predominantly light chain only disease but still some population of plasma cells making an intact immmunoglobulin (or perhaps this was the "mgus" cells).
I always get more than one time point for the labs to confirm or deny progression of disease. A little time always gives the answer one way or the other.
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Dr. Jason Valent - Name: Jason Valent, M.D.
Beacon Medical Advisor
10 posts
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