[Tsukuba82]

Do my test results indicate MGUS or myeloma?

by Tsukuba82 on Tue Sep 30, 2014 11:56 am

I'm 32 years old and have a history of ulcerative colitis and, after going for a colonoscopy, they found some unusual cells in a section of my colon. So they sent me to an oncologist to test for possible lymphoma / myeloma

These were the results I got:

Total protein: 7.1 g/dl
Albumin: 3.9 g/dl
Globulin: 3.2 g/dl

IgA: 179 mg/dl
IgG: 1279 mg/dl
IgM: 372 mg/dl

Beta2Microglobulin,S: 2.2 mg/L

Immunofixation (IFE) Serum: Trace band of IgG lambda in far gamma region. No evidence of monoclonal disorder (gammopathy)

Protein, SPEP: 7.2 g/dl
A/G Ratio: 1.6
Albumin Absolute: 4.4 g/dl
Alpha-1 Absolute: 0.2 g/dl
Alpha-2 Absolute: 0.5 g/dl
Beta Absolute: 0.7 g/dl
Gamma Absolute: 1.3 g/dl
SPEP interpretation: monoclonal paraproteinemia

Monoclonal Band Percent: 3.1%
Monoclonal Band Absolute: 0.2 g/dl

Free kappa light chains: 21.67 mg/L
Free lambda light chains: 24.82 mg/L
Kappa / lambda ratio: 0.87

Bone Marrow biopsy:
- <0.2% plasma cells
- Normocellular bone marrow with active trilineage hematopoiesis
- No morphologic or immunophenotypic evidence of involvement by a plasma cell neoplasm
- Decreased reticuloendothelial iron; no ring sideroblasts identified

FISH: no consistent structural or numerical chromosomal anomalies were detected in this GTG-banding analysis. This result is in agreement with the findings of the FISH studies, which were also within normal limits.

Bone survey:
- Small 1 cm sclerotic lesion of the left Iliac wing, probably a bone island.
- No lytic lesion is identified in the visualized portions of the skeleton.

CT scan:
-No lymphadenopathy detected in chest or neck.
-Lymph nodes scattered in colon not enlarged and may be related to history of colitis

I'm not sure if some of the abnormalities are due to my colitis. I do have iron deficiency anemia with a Hgb of ~10.7, so I don't think that would fit into the CRAB criteria because it's been like this for the past few years due to my colitis actively bleeding.

Any insight would be great! Thanks!

[Multibilly]

Re: Do my test results indicate MGUS or myeloma?

by Multibilly on Tue Sep 30, 2014 2:54 pm

Tsukuba,

What do your lab reports show for your your calcium and creatinine levels? I am asking you this because you need to verify if you have any of the other CRAB issues (the "R" and "C" in CRAB) to figure out if you have MGUS or symptomatic multiple myeloma. You can't make that determination from just the numbers you put up here.

I suggest you read this to get a better idea about what I'm talking about here.

http://myeloma.org/pdfs/Patient_Handbook_2013.pdf

[Toni]

Re: Do my test results indicate MGUS or multiple myeloma?

by Toni on Tue Sep 30, 2014 2:57 pm

With a cursory view of your results, I actually see no sign of either MGUS or multiple myeloma.

1) No evidence of monoclonal disorder (gammopathy)

2) Bone marrow biopsy: <0.2% plasma cells

There is no plasma cell dyscrasia.

Unless I am mistaken, I see no evidence of a monoclonal gammapathy.

I understand you have some symptoms, but they seem to be attributable elsewhere. The bone scans appear normal with one exception, possibly a bone island.

Is there something I am missing?

[Multibilly]

Re: Do my test results indicate MGUS or multiple myeloma?

by Multibilly on Tue Sep 30, 2014 3:06 pm

In spite of my previous questions, I tend to agree with Toni. The IFE is more sensitive at detecting the presence of paraproteins than an SPEP is, but I was a little confused by the SPEP line "SPEP interpretation: monoclonal paraproteinemia". Was this just a standard lab entry placeholder that had no supporting data because no value was measured?

[Tsukuba82]

Re: Do my test results indicate MGUS or myeloma?

by Tsukuba82 on Wed Oct 01, 2014 10:19 am

Yes as far as the other letters of CRAB, my calcium is actually on the low side (~8.7) due to being on prednisone for so long and my renal function is completely normal.

My oncologist is already talking about me possibly starting Revlimid and doing one day of intense chemotherapy followed by a BMT which at this point I do not agree with.

Do I even need to do a PET scan?

[Multibilly]

Re: Do my test results indicate MGUS or myeloma?

by Multibilly on Wed Oct 01, 2014 11:42 am

Based on your current lab results that you've posted here, I am at a loss to think why a doctor would want to start you on treatment (unless I'm missing something??). It doesn't even appear that you have MGUS, let alone symptomatic multiple myeloma (i.e. there is nothing here that suggest a monoclonal gammopathy). I would highly recommend getting a second opinion from a multiple myeloma specialist. If you let us know where you live, we can likely recommend an institution and/or a specific doctor.

[Tsukuba82]

Re: Do my test results indicate MGUS or myeloma?

by Tsukuba82 on Wed Oct 01, 2014 12:11 pm

This is a finding of a biopsy from the portion of my colon:

While there is no epithelial dysplasia, a plasma cell neoplasm was identified on further review of the case, necessitating additional work-up.

I am now scheduled for a PET scan next week. I am located in Richmond ,VA.

[bluemountain]

Re: Do my test results indicate MGUS or myeloma?

by bluemountain on Wed Oct 01, 2014 12:33 pm

I believe their is a Myeloma specialist at MCV in Richmond. Of course you also have very well respected specialist at Johns Hopkins in Baltimore, Duke Univeristy and UNC Chapel Hill

Best wishes...I am at Duke and I think they are great!

[Grizlump]

Re: Do my test results indicate MGUS or myeloma?

by Grizlump on Wed Oct 01, 2014 12:40 pm

From what little I know based on my chemotherapy experience, RUN- do not walk to another doctor who has a track record of dealing with this condition. Why do I say this? Revlimid is a wonderful drug when used for the purpose for which it is intended. But, if you don't need it, I would stay as far away from it as I possibly could. You do realize that you could be looking at a hundred grand a year just for that one medication, right?? Perhaps too much information is being thrown at you too quickly. It sure seems like it is awful early to be talking about intense chemo therapy and BMT. You have come to the right place to get some good advice and an assortment of opinions based on personal experiences.
Charlie

[Multibilly]

Re: Do my test results indicate MGUS or myeloma?

by Multibilly on Wed Oct 01, 2014 3:03 pm

Given the statement "While there is no epithelial dysplasia, a plasma cell neoplasm was identified on further review of the case, necessitating additional work-up", I'm going to defer on this one to others more knowledgeable about these sorts of things. I honestly don't know what to make of the combination of the finding in the colon and your negative serum and BMB lab results.

Did they biopsy the neoplasm (I assume that is how they knew it was such)?