Hi All,
I am tentatively diagnosed as having smoldering myeloma (only thing pending is MRI results). Looking at the only two tests I have done, the free light chain level and free light chain ratio doesn't behave the same way as my M spike.
My M-spike when I was diagnosed was 2.1 g/dl (IgG lambda). My lambda free light chain level was 12.9 mg/l , kappa 8.1, which results in 0.62 ratio, all in normal range.
Three month after, my M spike increased to 2.5 g/dl, while my lambda free light chain level was reduced to 11.7 mg/l, kappa 7.2, which results in 0.62 ratio, all in normal range as well.
In theory, can it be that my M-spike will continue to grow, and my free light chain level and ratio will remain steady (normal). If this were to happen, does it say anything on my specific disease?
Thanks,
Anna
Forums
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Anna721 - Name: Anna
- Who do you know with myeloma?: I
- When were you/they diagnosed?: Nov, 2017
- Age at diagnosis: 40
Re: Can M-spike and free light chain lab results diverge?
Hi Anna,
It's always been my understanding that this disease can manifest itself with just about any combination of a serum M-spike and an involved serum free light chain marker. That is, these these two markers can move in tandem, be completely absent (true nonsecretory multiple myeloma), have only an involved free light chain marker be present without an M-spike showing up (light chain multiple myeloma), have only an M-spike marker with a normal or only slightly involved free light chain marker (e.g. your situation), or have each of these markers fall independently anywhere on the spectrum.
In cases where one or more of the serum markers aren't fully manifesting themselves in a blood sample, it's important to get a bone marrow biopsy to really see what's going on with the disease. Have you had a bone marrow biopsy, and do you know what your bone marrow plasma cell percentage is?
Also, since your disease isn't producing much in the way of free light chains, you might also consider asking your doctor about the relatively new "Hevylite assay", which tracks heavy / light chain pair levels in your blood and therefore may be a useful test to help track your disease over time.
In any case, this is a great question to discuss further with your oncologist.
It's always been my understanding that this disease can manifest itself with just about any combination of a serum M-spike and an involved serum free light chain marker. That is, these these two markers can move in tandem, be completely absent (true nonsecretory multiple myeloma), have only an involved free light chain marker be present without an M-spike showing up (light chain multiple myeloma), have only an M-spike marker with a normal or only slightly involved free light chain marker (e.g. your situation), or have each of these markers fall independently anywhere on the spectrum.
In cases where one or more of the serum markers aren't fully manifesting themselves in a blood sample, it's important to get a bone marrow biopsy to really see what's going on with the disease. Have you had a bone marrow biopsy, and do you know what your bone marrow plasma cell percentage is?
Also, since your disease isn't producing much in the way of free light chains, you might also consider asking your doctor about the relatively new "Hevylite assay", which tracks heavy / light chain pair levels in your blood and therefore may be a useful test to help track your disease over time.
In any case, this is a great question to discuss further with your oncologist.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Can M-spike and free light chain lab results diverge?
Hi Multibilly,
Thanks so much for answering back. Actually, I have learned a lot from your comments and discussion while searching the forum.
Three months ago I did a bone marrow biopsy, which showed 13%-15% in biopsy and ~15% in aspiration, in FISH 100% plasma cells with del 13q and 10% with Iq21, rest are ok. I also had to get second opinion on my biopsy as 15% of the cells were strongly colored to CD20, so the first pathologist though it's Waldenstrom's macroglobulinemia.
Another risk factor is that I have immunepheresis.
Like many others, I was diagnosed accidentally, I was hospitalized with pneumonia after neglecting my health, carried many days with what I thought to be the flu, as I was very busy taking care of my new baby.
In the hospital, they saw I had high total protein, and everything kind of rolled from there. Looking at my old test results, I had high total protein as of 2009 ranging from 84-87 g/dl, I am still on the same levels now.
As for my question, searching the web ,I didn't see many cases with a relatively high M-spike and normal free light chain results, but maybe I am still in denial phase and searching other explanations for my results.
Thanks so much for answering back. Actually, I have learned a lot from your comments and discussion while searching the forum.
Three months ago I did a bone marrow biopsy, which showed 13%-15% in biopsy and ~15% in aspiration, in FISH 100% plasma cells with del 13q and 10% with Iq21, rest are ok. I also had to get second opinion on my biopsy as 15% of the cells were strongly colored to CD20, so the first pathologist though it's Waldenstrom's macroglobulinemia.
Another risk factor is that I have immunepheresis.
Like many others, I was diagnosed accidentally, I was hospitalized with pneumonia after neglecting my health, carried many days with what I thought to be the flu, as I was very busy taking care of my new baby.
In the hospital, they saw I had high total protein, and everything kind of rolled from there. Looking at my old test results, I had high total protein as of 2009 ranging from 84-87 g/dl, I am still on the same levels now.
As for my question, searching the web ,I didn't see many cases with a relatively high M-spike and normal free light chain results, but maybe I am still in denial phase and searching other explanations for my results.
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Anna721 - Name: Anna
- Who do you know with myeloma?: I
- When were you/they diagnosed?: Nov, 2017
- Age at diagnosis: 40
Re: Can M-spike and free light chain lab results diverge?
Hi Anna,
Multibilly's feedback is spot on, as usual. Theoretically, untreated, relapsing, or partially responsive multiple myeloma can occur with any of the four possible combinations of paraprotein (M-spike) and free light chain levels:
1. Presence of a paraprotein (M-spike), abnormal free light chain results
2. No paraprotein, abnormal free light chain results
3. Presence of a paraprotein, normal free light chain results
4. No paraprotein, normal free light chain results
However, the type of case you may have, which is type #3 in the list above, is rare. You hardly ever hear of myeloma patients with relatively high paraprotein (M-spike) levels, but completely normal free light chain results.
So I would make sure to check with your doctor, as Multibilly suggested, to confirm that you understand your situation correctly.
Are you sure, by the way, that your paraprotein level is 2.1 or 2.5 grams per decilitre (g/dL), rather than, say 2.1 or 2.5 grams per litre (g/l)? It's my understanding that g/dL are the units usually used in the USA for paraprotein (M-spike) levels, but g/l are used in most other countries. The units matter, as 2.1 g/l, for example, are 0.21 g/dL.
Cheers!
Multibilly's feedback is spot on, as usual. Theoretically, untreated, relapsing, or partially responsive multiple myeloma can occur with any of the four possible combinations of paraprotein (M-spike) and free light chain levels:
1. Presence of a paraprotein (M-spike), abnormal free light chain results
2. No paraprotein, abnormal free light chain results
3. Presence of a paraprotein, normal free light chain results
4. No paraprotein, normal free light chain results
However, the type of case you may have, which is type #3 in the list above, is rare. You hardly ever hear of myeloma patients with relatively high paraprotein (M-spike) levels, but completely normal free light chain results.
So I would make sure to check with your doctor, as Multibilly suggested, to confirm that you understand your situation correctly.
Are you sure, by the way, that your paraprotein level is 2.1 or 2.5 grams per decilitre (g/dL), rather than, say 2.1 or 2.5 grams per litre (g/l)? It's my understanding that g/dL are the units usually used in the USA for paraprotein (M-spike) levels, but g/l are used in most other countries. The units matter, as 2.1 g/l, for example, are 0.21 g/dL.
Cheers!
Re: Can M-spike and free light chain lab results diverge?
Thanks for your feedback Ian. Yes , based on the labs, its 2.5 g/dl. Wish it was g/l.
I am currently tracking my results in one lab, when I was diagnosed the hospital lab showed 1.9 g/dl, versus the lab I do my routine checks, which was 2.1 g/dl. Pretty close, so I guess no lab mistake
When I raised this point to my doctor in our last appointment, she said I guess we will have to track mainly your M-spike as it's more representative than your free light chain results.
Another point maybe worth mentioning, all my exams including the bone marrow biopsy were done while I was still with pneumonia as was shown in the CT. Also, I had to take another cycle of antibiotics after my release, wonder if can impact bone marrow results.
I am going to a myeloma specialist to get another opinion. I will update in the forum as I see Ian like you mentioned it's quiet rare.
I am currently tracking my results in one lab, when I was diagnosed the hospital lab showed 1.9 g/dl, versus the lab I do my routine checks, which was 2.1 g/dl. Pretty close, so I guess no lab mistake
When I raised this point to my doctor in our last appointment, she said I guess we will have to track mainly your M-spike as it's more representative than your free light chain results.
Another point maybe worth mentioning, all my exams including the bone marrow biopsy were done while I was still with pneumonia as was shown in the CT. Also, I had to take another cycle of antibiotics after my release, wonder if can impact bone marrow results.
I am going to a myeloma specialist to get another opinion. I will update in the forum as I see Ian like you mentioned it's quiet rare.
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Anna721 - Name: Anna
- Who do you know with myeloma?: I
- When were you/they diagnosed?: Nov, 2017
- Age at diagnosis: 40
Re: Can M-spike and free light chain lab results diverge?
Hi Anna -
My husband's light chains have always been low; my understanding is that his monoclonal plasma cells do not secrete free light chains. In fact, when his light chains increase, his healthy immunoglobulins also have increased, and this has been the case with every SPEP/IFE. In his case, his free light chains are from his healthy plasma cells and immunoglobulins, not his cancer.
I hope this helps.
Laurie
My husband's light chains have always been low; my understanding is that his monoclonal plasma cells do not secrete free light chains. In fact, when his light chains increase, his healthy immunoglobulins also have increased, and this has been the case with every SPEP/IFE. In his case, his free light chains are from his healthy plasma cells and immunoglobulins, not his cancer.
I hope this helps.
Laurie
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lwem - Name: Laurie
- Who do you know with myeloma?: husband
- When were you/they diagnosed?: April 2015
- Age at diagnosis: 68
Re: Can M-spike and free light chain lab results diverge?
Hi Anna,
The possibility of Waldnestroms macroglobulinemia (WM) occurred to me when I was first writing back to you. But WM is almost always limited to patients with an IgM isotype (instead of an IgG isotype), so I didn't mention it. In fact, I believe that in order to have a diagnosis of WM, that your isotype needs to be of the IgM variety.
If you had a bone marrow biopsy, there are molecular tests that they can do to distinguish WM from multiple myeloma. If they didn't run those tests and only looked at your cellular immunophenotypes (i.e., the test that said you had a lot of CD20 cells) when determining if you may have WM, they still likely have some of your biopsy sample that they can test further.
By the way, I think you meant to say "immunoparesis" in your earlier post. That is, your IgA and / or IgM may also be suppressed?
The possibility of Waldnestroms macroglobulinemia (WM) occurred to me when I was first writing back to you. But WM is almost always limited to patients with an IgM isotype (instead of an IgG isotype), so I didn't mention it. In fact, I believe that in order to have a diagnosis of WM, that your isotype needs to be of the IgM variety.
If you had a bone marrow biopsy, there are molecular tests that they can do to distinguish WM from multiple myeloma. If they didn't run those tests and only looked at your cellular immunophenotypes (i.e., the test that said you had a lot of CD20 cells) when determining if you may have WM, they still likely have some of your biopsy sample that they can test further.
By the way, I think you meant to say "immunoparesis" in your earlier post. That is, your IgA and / or IgM may also be suppressed?
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Can M-spike and free light chain lab results diverge?
Thanks, Laurie, for your reply. Did your doctor mention anything in terms of disease behavior / prognosis related to the fact that his plasma cells do not secrete free light chains? Also, tracking wise, is the M-spike the only factor your husband's doctor considers?
Multibilly, regarding the immunoparesis, you are correct; my IgA and IgM are both suppressed.
Multibilly, regarding the immunoparesis, you are correct; my IgA and IgM are both suppressed.
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Anna721 - Name: Anna
- Who do you know with myeloma?: I
- When were you/they diagnosed?: Nov, 2017
- Age at diagnosis: 40
Re: Can M-spike and free light chain lab results diverge?
Hi Anna.
So your monoclonal plasma cells secrete only monoclonal IgG, with no significant amount of monoclonal free light chains. That's interesting.
One reason the serum free light chain test is useful for tracking myeloma is because it's a kind of "early warning system". The half lives of kappa and lambda free light chains are much shorter than the half lives of IgG, IgA, and IgM. So if a myeloma patient's disease is progressing, for example, the progression will be picked up more quickly in the free light chain results than in the patient's paraprotein (M-spike) results.
Since your myeloma isn't producing monoclonal free light chains to any significant extent, you can't take advantage of the free light chain test's "early warning" capability.
I also don't think the Hevylite test can be a substitute "early warning" system. It reports immunoglobulin levels, just the standard paraprotein (M-spike) lab results. It's just that the HevyLite test reports the levels of specific types of immunoglobulin (IgG kappa, IgG lambda, etc.), rather than overall IgG, overall IgA, etc.
Also, some doctors apparently have issues with the accuracy of the Hevylite results; see this forum post:
https://myelomabeacon.org/forum/bone-marrow-biopsy-blood-test-results-t9211.html#p52575
So I think your best bet is to continue using your M-spike to track what's going on with your myeloma. I can't think of any other lab result that is both closely linked with what's going on with your myeloma and will report more quickly than your paraprotein level (M-spike) what is going on with the disease.
Cheers!
So your monoclonal plasma cells secrete only monoclonal IgG, with no significant amount of monoclonal free light chains. That's interesting.
One reason the serum free light chain test is useful for tracking myeloma is because it's a kind of "early warning system". The half lives of kappa and lambda free light chains are much shorter than the half lives of IgG, IgA, and IgM. So if a myeloma patient's disease is progressing, for example, the progression will be picked up more quickly in the free light chain results than in the patient's paraprotein (M-spike) results.
Since your myeloma isn't producing monoclonal free light chains to any significant extent, you can't take advantage of the free light chain test's "early warning" capability.
I also don't think the Hevylite test can be a substitute "early warning" system. It reports immunoglobulin levels, just the standard paraprotein (M-spike) lab results. It's just that the HevyLite test reports the levels of specific types of immunoglobulin (IgG kappa, IgG lambda, etc.), rather than overall IgG, overall IgA, etc.
Also, some doctors apparently have issues with the accuracy of the Hevylite results; see this forum post:
https://myelomabeacon.org/forum/bone-marrow-biopsy-blood-test-results-t9211.html#p52575
So I think your best bet is to continue using your M-spike to track what's going on with your myeloma. I can't think of any other lab result that is both closely linked with what's going on with your myeloma and will report more quickly than your paraprotein level (M-spike) what is going on with the disease.
Cheers!
Re: Can M-spike and free light chain lab results diverge?
Hi Ian,
The myeloma specialist I met with thinks I have normal free lights because I am relatively young and my kidney removes them fast.
It's still strange for me that all labs looks good, normal CRP, normal B2 microglobulin, normal free light change, but relatively high M-spike. But I guess as mentioned by many, each person's disease is different.
The myeloma specialist I met with thinks I have normal free lights because I am relatively young and my kidney removes them fast.
It's still strange for me that all labs looks good, normal CRP, normal B2 microglobulin, normal free light change, but relatively high M-spike. But I guess as mentioned by many, each person's disease is different.
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Anna721 - Name: Anna
- Who do you know with myeloma?: I
- When were you/they diagnosed?: Nov, 2017
- Age at diagnosis: 40
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