Good afternoon,
I was diagnosed with IgA kappa light chain smoldering myeloma in 2010. I think I may have to start treatment soon based on some changes from my last blood work in January.
My main concern is that there is an upward trend of my IgA, which is now at 2354, but kappa is at 86.4 mg/L with lambda 14.8 mg/L and a ratio of 5.87. My IgA a few months ago was at 1736.
No lesions as of this point though. Also, my IgG, which is normally between 754-793, took a stark jump to 1002.
My eGFR also dropped from 92 to about 79, and creatinine, which is usually at 0.7 moved to 0.9. Hemoglobin is at 12, and calcium levels at about 9.2.
I have not had a bone marrow biopsy recently, but the last one I had a couple of years ago was about 10% - 15% plasma cells.
I am not sure if I would still be considered to be in the smoldering phase or if my numbers warrant treatment.
Thank you for reading my post, and I look forward to hearing from everyone.
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• Page 1 of 1
Re: Is my multiple myeloma still smoldering?
Hi Salma,
Why do you think that you no longer should be classified as having smoldering myeloma? Which of your lab results do you think switches your diagnosis to symptomatic myeloma?
I looked over your lab results quickly, so I may have missed something, but I don't see any results that suggest that you have any of the classic "CRAB" symptoms that would lead to a multiple myeloma diagnosis. Nor does it seem to me that you have any of the new "myeloma defining events" mentioned in this recent article,
SV Rajkumar, "New Criteria For The Diagnosis Of Multiple Myeloma And Related Disorders," The Myeloma Beacon, Oct 26, 2014.
I'm guessing from your user name (Salma5k) that you are female, so your hemoglobin is just slightly below the normal range, but not so low to clearly signal anemia as the basis for a myeloma diagnosis. Your calcium level is within the normal range, as is your creatinine level. And you don't have any bone lesions.
Yes, your kappa free light chain level is elevated, but your kappa-lambda ratio is less than far below 100.
So, as I said before, I'm wondering why you feel your diagnosis should be changed and you should start treatment?
You may find it helpful to go through some of the other recent discussions here in the smoldering myeloma section of the forum,
There have been a couple of postings just recently that ask questions similar to the one you are asking, and it may help you to see the feedback those people got.
Hope this helps a bit. Let us know if you have more questions.
Why do you think that you no longer should be classified as having smoldering myeloma? Which of your lab results do you think switches your diagnosis to symptomatic myeloma?
I looked over your lab results quickly, so I may have missed something, but I don't see any results that suggest that you have any of the classic "CRAB" symptoms that would lead to a multiple myeloma diagnosis. Nor does it seem to me that you have any of the new "myeloma defining events" mentioned in this recent article,
SV Rajkumar, "New Criteria For The Diagnosis Of Multiple Myeloma And Related Disorders," The Myeloma Beacon, Oct 26, 2014.
I'm guessing from your user name (Salma5k) that you are female, so your hemoglobin is just slightly below the normal range, but not so low to clearly signal anemia as the basis for a myeloma diagnosis. Your calcium level is within the normal range, as is your creatinine level. And you don't have any bone lesions.
Yes, your kappa free light chain level is elevated, but your kappa-lambda ratio is less than far below 100.
So, as I said before, I'm wondering why you feel your diagnosis should be changed and you should start treatment?
You may find it helpful to go through some of the other recent discussions here in the smoldering myeloma section of the forum,
There have been a couple of postings just recently that ask questions similar to the one you are asking, and it may help you to see the feedback those people got.
Hope this helps a bit. Let us know if you have more questions.
Re: Is my multiple myeloma still smoldering?
Good afternoon Cheryl,
Thank you for replying to my posting and providing additional references.
I am not sure where I came across some information that stated treatment is sometimes initiated when IgA levels reach 2500 or greater. I think I may have also read in a multiple myeloma support group where a few members also commented that their doctors had recommended treatment begin when IgA levels reached 2500 +. Another reason why I am a bit concerned is because my IgG seemed a bit high compared to previous values and not sure what caused the stark increase. I was also concerned about the drop in my eGFR levels.
Thank you for replying to my posting and providing additional references.
I am not sure where I came across some information that stated treatment is sometimes initiated when IgA levels reach 2500 or greater. I think I may have also read in a multiple myeloma support group where a few members also commented that their doctors had recommended treatment begin when IgA levels reached 2500 +. Another reason why I am a bit concerned is because my IgG seemed a bit high compared to previous values and not sure what caused the stark increase. I was also concerned about the drop in my eGFR levels.
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salma5k - Name: salma5k
- When were you/they diagnosed?: 35
Re: Is my multiple myeloma still smoldering?
Salma,
You are IgA kappa type multiple myeloma, right? Do any of your tests say you have monoclonal IgG as well? I wouldn't call your change in IgG "stark", especially if you haven't been diagnosed with a bi-clonal gammopathy (two different involved immunoglobulins).
Also, what is your M-spike (aka monoclonal protein, paraprotein) level from your Serum Protein Electrophoresis (SPEP) test? SPEP tests are more sensitive than quantified immunoglobulin tests.
You are IgA kappa type multiple myeloma, right? Do any of your tests say you have monoclonal IgG as well? I wouldn't call your change in IgG "stark", especially if you haven't been diagnosed with a bi-clonal gammopathy (two different involved immunoglobulins).
Also, what is your M-spike (aka monoclonal protein, paraprotein) level from your Serum Protein Electrophoresis (SPEP) test? SPEP tests are more sensitive than quantified immunoglobulin tests.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Is my multiple myeloma still smoldering?
Hello again, Salma.
Multibilly has asked some good questions. I myself was going to ask about your M-spike after seeing your latest posting
Your original question was whether or not you should be reclassified as having symptomatic myeloma. Usually, that is the same question as "should I be treated?", since most doctors will wait to treat a myeloma patient until their diagnosis is symptomatic myeloma rather than smoldering myeloma.
I suspect this will be even more the case now that the definition of "symptomatic" multiple myeloma has been expanded to include more than just the CRAB criteria.
However, prior to the expansion of the definition of multiple myeloma, some doctors might make a treatment decision for a smoldering patient based on whether the patient had several risk factors for very quick progression to symptomatic disease. There were several "models" for risk of progression, the most well known being one from the Mayo Clinic. You can read about the models in this forum discussion that Multibilly started a few years ago:
"Risk of progression classification - smoldering myeloma?", forum disc. started Dec 26, 2012.
One of Mayo Clinic's risk factors was an M-spike of more than 3 g/dL. If someone has an IgA level of more than 2500 mg/dL (2.5 g/dL) – something you mentioned in your posting – then their M-spike is probably between 2 and 2.5 g/dL. That is not far from the Mayo cutoff of 3.
An M-spike of more than 3 g/dL, however, is just one of the Mayo's risk factors for early progression to symptomatic myeloma. You had to have all three to be considered a high risk for progression. Based on your lab results, you have at most one of the risk factors (a slightly elevated plasma cell bone marrow percentage).
So, as best I can tell from a quick look at your lab results, it seems that you are still smoldering based on the current definition of the different "phases" of multiple myeloma (MGUS, smoldering, symptomatic). In addition, it's not clear you are at a very high risk of progressing to symptomatic disease.
You and the others here in the forum should definitely check the logic of what I've just written. I may have missed something. But I think the way I've set things up should be helpful even I missed a detail or two.
The only other thing I would add is that it would be useful to look at how your M-spike, free light chain results, hemoglobin, calcium, and creatinine have varied over the past few years, just to see there are any clear trends. If you haven't already done so, it can be helpful to graph the results.
Let us know if you have any additional questions.
Multibilly has asked some good questions. I myself was going to ask about your M-spike after seeing your latest posting
Your original question was whether or not you should be reclassified as having symptomatic myeloma. Usually, that is the same question as "should I be treated?", since most doctors will wait to treat a myeloma patient until their diagnosis is symptomatic myeloma rather than smoldering myeloma.
I suspect this will be even more the case now that the definition of "symptomatic" multiple myeloma has been expanded to include more than just the CRAB criteria.
However, prior to the expansion of the definition of multiple myeloma, some doctors might make a treatment decision for a smoldering patient based on whether the patient had several risk factors for very quick progression to symptomatic disease. There were several "models" for risk of progression, the most well known being one from the Mayo Clinic. You can read about the models in this forum discussion that Multibilly started a few years ago:
"Risk of progression classification - smoldering myeloma?", forum disc. started Dec 26, 2012.
One of Mayo Clinic's risk factors was an M-spike of more than 3 g/dL. If someone has an IgA level of more than 2500 mg/dL (2.5 g/dL) – something you mentioned in your posting – then their M-spike is probably between 2 and 2.5 g/dL. That is not far from the Mayo cutoff of 3.
An M-spike of more than 3 g/dL, however, is just one of the Mayo's risk factors for early progression to symptomatic myeloma. You had to have all three to be considered a high risk for progression. Based on your lab results, you have at most one of the risk factors (a slightly elevated plasma cell bone marrow percentage).
So, as best I can tell from a quick look at your lab results, it seems that you are still smoldering based on the current definition of the different "phases" of multiple myeloma (MGUS, smoldering, symptomatic). In addition, it's not clear you are at a very high risk of progressing to symptomatic disease.
You and the others here in the forum should definitely check the logic of what I've just written. I may have missed something. But I think the way I've set things up should be helpful even I missed a detail or two.
The only other thing I would add is that it would be useful to look at how your M-spike, free light chain results, hemoglobin, calcium, and creatinine have varied over the past few years, just to see there are any clear trends. If you haven't already done so, it can be helpful to graph the results.
Let us know if you have any additional questions.
Re: Is my multiple myeloma still smoldering?
Thank you, Cheryl G, for providing extensive information. Thank you, Multibilly, for asking about an SPEP. I looked in my records and I don't see a recent SPEP. I will have to ask my oncologist about it.
Thank you again, Cheryl, for replying with additional links I can research, and thank you, Multibilly, for mentioning a biclonal gammopathy.
Thank you again, Cheryl, for replying with additional links I can research, and thank you, Multibilly, for mentioning a biclonal gammopathy.
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salma5k - Name: salma5k
- When were you/they diagnosed?: 35
6 posts
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