"Monoclonal paraproteinemia" is another way of saying monoclonal gammopathy. One of gammaglobulins has cloned and has created an excessive amount of itself through cloning. When we ask you if they tested for a paraprotein to check for an m-spike, this is the measurement of the specific gammaglobulin which has cloned.
So, basically, it confirms that they found a monoclonal gammopathy. I don't remember your quoting which one it might be or what the test result was (if it was included in your lab work). This would be something like IgG 1.5 g/dL.
Does that make sense?
Forums
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Toni - Name: Toni
- Who do you know with myeloma?: self - MGUS
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 51
Re: Doctor found signs of myeloma - help with lab results
krogers,
I have been thinking about you and wondered how you were doing? Were you able to get an appointment for a second opinion?
Would be very interested to hear.
Kindly,
Toni
I have been thinking about you and wondered how you were doing? Were you able to get an appointment for a second opinion?
Would be very interested to hear.
Kindly,
Toni
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Toni - Name: Toni
- Who do you know with myeloma?: self - MGUS
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 51
Re: Doctor found signs of myeloma - help with lab results
I am now going to MUSC (Medical University of South Carolina) seeing an oncologist who specializes in myeloma, so I am going to give some of my results and ask for feedback.
I have had many blood test, urine test, full skeleton X-rays, bone marrow biopsy, MRI, PET scan, another MRI, and bone density test. My blood work showed abnormal numbers of course for all the other test to be done.
Here is notes from the bone marrow biopsy:
The bone marrow biopsy is 50% cellular and adequate for evaluation. The myeloid and erythroid series progress through the full maturation sequence. Megakaryocytes are present in adequate numbers.
IMMUNOHISTOCHEMICAL STAINS:
CD138: Highlights scattered plasma cells, comprising 10% of the cellularity
Kappa: Technically inadequate
Lambda: Technically Inadequate
FISH COMMENT:
5 multiplex probes
1p/1q -- Normal
5 -- Normal
t(11;14) -- Abnormal
13q14 -- Abnormal
TP53 -- Normal
INTERPRETATION
FISH with probes for multiple myeloma-related genetic abnormalities revealed abnormal signal patterns consistent with CCND1/IGH fusion and loss of chromosome 13. No loss of 1p or TP53, no gain of 1q or 5 were evidenced above the normal reference ranges. The 11;14 translocation (which gave an atypical pattern with a single fusion) and loss of 13 have typically been associated with a diagnosis of multiple myeloma.
Here is BONE DENSITY:
TECHNIQUE: Bone mineral density (BMD) testing of the right hip, the left hip, the lumbar spine was performed using Dual Energy X-Ray Absorptiometry on a Hologic Discovery A scanner utilizing software version 13.2.
COMMENTS: The technical quality of this study is good.
FINDINGS:
IMPRESSION:
The patient has OSTEOPOROSIS based on the patient's T-score being less than or equal to -2.5 according to World Health Organization (WHO) criteria. This meets 2008 National Osteoporosis Foundation (NOF) guidelines for receiving pharmacological treatment for osteoporosis, if clinically indicated.
The Z-score is less than or equal to -2.0 thus consideration for secondary causes of bone loss should be given.
Component Standard Range Your Value
Kappa free light chains 0.33 - 1.94 mg/dL 0.72
Lambda free light chains 0.57 - 2.63 mg/dL 16.52
K/L free lt chains ratio 0.26 - 1.65 ratio 0.04
MUSCULOSKELETAL:
Mildly increased diffuse FDG activity is seen in the lower thoracic and lumbar spine, and a focal area of intense uptake in the L-5 vertebral body (max SUV 5.6) without corresponding lytic lesions noted on the CT.
IMPRESSION
The mildly increased diffuse FDG activity seen in the lower thoracic and lumbar spine with a focal area of intense uptake in the L-5 vertebral body are suspicious for myeloma involvement. No corresponding lytic lesions are noted on the CT. MRI is recommended for further evaluation.
Sorry for the long post ...
I was told I had myeloma after the PET scan and between myself, my wife, and 1 of my 4 children crying once the 2 doctors came in the room to give us that diagnosis, they then did another MRI to see if the could biopsy around L-5 vertebrae where the PET showed the cancer. They then told us that after the MRI, they were not sure if it was myeloma.
I have always thought the PET scan was a better test than the MRI, so we are frustrated and scared now, not knowing. The doctor told me he is trying to rule out other causes of my osteoporosis and I am going to a endocrinology for the osteoporosis to rule out any other causes of that before he could give the final myeloma diagnosis. I have had osteoporosis for 4 years.
I have had many blood test, urine test, full skeleton X-rays, bone marrow biopsy, MRI, PET scan, another MRI, and bone density test. My blood work showed abnormal numbers of course for all the other test to be done.
Here is notes from the bone marrow biopsy:
The bone marrow biopsy is 50% cellular and adequate for evaluation. The myeloid and erythroid series progress through the full maturation sequence. Megakaryocytes are present in adequate numbers.
IMMUNOHISTOCHEMICAL STAINS:
CD138: Highlights scattered plasma cells, comprising 10% of the cellularity
Kappa: Technically inadequate
Lambda: Technically Inadequate
FISH COMMENT:
5 multiplex probes
1p/1q -- Normal
5 -- Normal
t(11;14) -- Abnormal
13q14 -- Abnormal
TP53 -- Normal
INTERPRETATION
FISH with probes for multiple myeloma-related genetic abnormalities revealed abnormal signal patterns consistent with CCND1/IGH fusion and loss of chromosome 13. No loss of 1p or TP53, no gain of 1q or 5 were evidenced above the normal reference ranges. The 11;14 translocation (which gave an atypical pattern with a single fusion) and loss of 13 have typically been associated with a diagnosis of multiple myeloma.
Here is BONE DENSITY:
TECHNIQUE: Bone mineral density (BMD) testing of the right hip, the left hip, the lumbar spine was performed using Dual Energy X-Ray Absorptiometry on a Hologic Discovery A scanner utilizing software version 13.2.
COMMENTS: The technical quality of this study is good.
FINDINGS:
- The BMD of the left femoral neck is 0.599 g/cm2, corresponding to a T-score of -2.4 and a Z-score of -1.6.
- The BMD of the left total hip is 0.795 g/cm2, corresponding to a T-score of -1.6 and a Z-score of -1.2.
- The BMD of the right femoral neck is 0.626 g/cm2, corresponding to a T-score of -2.2 and a Z-score of -1.4.
- The BMD of the right total hip is 0.761 g/cm2, corresponding to a T-score of -1.8 and a Z-score of -1.4.
- The average BMD of the lumbar spine from L1-L4 is 0.751 g/cm2, corresponding to a T-score of -3.1 and a Z-score of -2.6.
IMPRESSION:
The patient has OSTEOPOROSIS based on the patient's T-score being less than or equal to -2.5 according to World Health Organization (WHO) criteria. This meets 2008 National Osteoporosis Foundation (NOF) guidelines for receiving pharmacological treatment for osteoporosis, if clinically indicated.
The Z-score is less than or equal to -2.0 thus consideration for secondary causes of bone loss should be given.
Component Standard Range Your Value
Kappa free light chains 0.33 - 1.94 mg/dL 0.72
Lambda free light chains 0.57 - 2.63 mg/dL 16.52
K/L free lt chains ratio 0.26 - 1.65 ratio 0.04
MUSCULOSKELETAL:
Mildly increased diffuse FDG activity is seen in the lower thoracic and lumbar spine, and a focal area of intense uptake in the L-5 vertebral body (max SUV 5.6) without corresponding lytic lesions noted on the CT.
IMPRESSION
The mildly increased diffuse FDG activity seen in the lower thoracic and lumbar spine with a focal area of intense uptake in the L-5 vertebral body are suspicious for myeloma involvement. No corresponding lytic lesions are noted on the CT. MRI is recommended for further evaluation.
Sorry for the long post ...
I was told I had myeloma after the PET scan and between myself, my wife, and 1 of my 4 children crying once the 2 doctors came in the room to give us that diagnosis, they then did another MRI to see if the could biopsy around L-5 vertebrae where the PET showed the cancer. They then told us that after the MRI, they were not sure if it was myeloma.
I have always thought the PET scan was a better test than the MRI, so we are frustrated and scared now, not knowing. The doctor told me he is trying to rule out other causes of my osteoporosis and I am going to a endocrinology for the osteoporosis to rule out any other causes of that before he could give the final myeloma diagnosis. I have had osteoporosis for 4 years.
Re: Doctor found signs of myeloma - need help with lab resul
Hi Krogers,
Sorry to see that this is such a tough journey for you getting a diagnosis.
Going back to one of the earlier posts, did they ever run a serum protein electrophoresis (SPEP) test and a serum Immunofixation (IFE) test? Do you know what the results of those tests are? I have to believe they must have run both of these tests at some point before you had a bone marrow biopsy test and all of this imaging done.
Since they ran a bone marrow biopsy test, the report must have called out somewhere what your bone marrow plasma cell % (BMPC %) is. They mentioned that about 10% of the your cells were CD138-marked plasma cells, so your BMPC may be that 10% value, but I want to be sure...especially since I am not a pathologist. CD-138 is an antigen (a type of protein) that is commonly found on the surface of multiple myeloma plasma cells. A normal plasma cell % is considered to be less than 5%.
t(11;14) translocation is indeed a genetic mutation often associated with multiple myeloma and some other maladies. It is considered to be a "standard risk" mutation by the Mayo, which is good news. A "loss of 13" is also called a "del 13" or "deletion 13". But I believe it is important that the del 13 be detected by what is known as metaphase analysis instead of FISH analysis. The metaphase analysis report would also be part of your bone marrow biopsy test result report. I am picking up this information from the Mayo mSMART guidelines here: http://www.msmart.org/about.html
Also, what was your latest calcium level?
I am not a doc by any stretch of the imagination. But I always thought that imaging such as MRIs and PET/CTs were used primarily to detect any bone-related damage that could result from multiple myeloma and to sometimes track multiple myeloma disease progression in patients that may not secrete the cancerous cells into their blood serum, rather than to make a diagnosis of multiple myeloma itself. But I could be wrong on this point.
When you say they did not think it was multiple myeloma after the MRI, did they in fact do a biopsy of the tissue/bone around the suspected spinal area as part of that overall procedure? Or are they basing their comments on the MRI image alone?
Is the doctor saying what else he might be suspecting as an underlying disease?
While I can totally see that you are anxious and this must be frustrating as all heck, it also sounds like your doc is being pretty careful and thorough.
Sorry to see that this is such a tough journey for you getting a diagnosis.
Going back to one of the earlier posts, did they ever run a serum protein electrophoresis (SPEP) test and a serum Immunofixation (IFE) test? Do you know what the results of those tests are? I have to believe they must have run both of these tests at some point before you had a bone marrow biopsy test and all of this imaging done.
Since they ran a bone marrow biopsy test, the report must have called out somewhere what your bone marrow plasma cell % (BMPC %) is. They mentioned that about 10% of the your cells were CD138-marked plasma cells, so your BMPC may be that 10% value, but I want to be sure...especially since I am not a pathologist. CD-138 is an antigen (a type of protein) that is commonly found on the surface of multiple myeloma plasma cells. A normal plasma cell % is considered to be less than 5%.
t(11;14) translocation is indeed a genetic mutation often associated with multiple myeloma and some other maladies. It is considered to be a "standard risk" mutation by the Mayo, which is good news. A "loss of 13" is also called a "del 13" or "deletion 13". But I believe it is important that the del 13 be detected by what is known as metaphase analysis instead of FISH analysis. The metaphase analysis report would also be part of your bone marrow biopsy test result report. I am picking up this information from the Mayo mSMART guidelines here: http://www.msmart.org/about.html
Also, what was your latest calcium level?
I am not a doc by any stretch of the imagination. But I always thought that imaging such as MRIs and PET/CTs were used primarily to detect any bone-related damage that could result from multiple myeloma and to sometimes track multiple myeloma disease progression in patients that may not secrete the cancerous cells into their blood serum, rather than to make a diagnosis of multiple myeloma itself. But I could be wrong on this point.
When you say they did not think it was multiple myeloma after the MRI, did they in fact do a biopsy of the tissue/bone around the suspected spinal area as part of that overall procedure? Or are they basing their comments on the MRI image alone?
Is the doctor saying what else he might be suspecting as an underlying disease?
While I can totally see that you are anxious and this must be frustrating as all heck, it also sounds like your doc is being pretty careful and thorough.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Doctor found signs of myeloma - need help with lab resul
I just got a call from the nurse at my oncology office and my doctor wants me in as soon as possible for a ... SECOND ... bone marrow biopsy. I had written an email to the nurse giving her some symptoms I have been having and now a sense of urgency for the doctor to get me in as soon as possible. The doctor is off tomorrow, so she will be having me come in on Monday morning at 8 am as a work-in so he can get it done. Also new blood work to be done too.
All this and I just went to an endocrinology doctor who will be doing an " MRI PITUITARY W, WO CONTRAST " and blood work to go along with that as well. So as we all know makes my mind wonder what is next and why the sense of urgency now??
My doctor is having a hard time giving full diagnosis of myeloma now. He sat my wife and I down and told us after the PET scan that the scan showed an area around vertebra L5 that was myeloma. We cried and the doctor told us what the next steps would be. They first told us they wanted to do a bone marrow biopsy in L5 and try get a sample of the area the PET scan showed up cancer. He told us the radiologist would be doing it under camera/TV would need a better picture of it, so they needed an MRI of L5 so they would know how they would proceed into the body for the sample. They tell my wife and I that the MRI showed negative for anything?
How very confusing, I thought the PET scan was a better test than an MRI. If I have written this before, please accept my apology because I am now frustrated and scared they are missing something. Blood work told them to move to the the first bone marrow biopsy which they first said was negative, then another doctor at MUSC read it and broke it down and wrote this on the "EDITED RESULTS""
FISH Comment:
5 multiplex probes
1p/1q -- Normal
5 -- Normal
t(11;14) -- Abnormal
13q14 -- Abnormal
TP53 -- Normal
Interpretation
FISH with probes for multiple myeloma-related genetic abnormalities revealed abnormal signal patterns consistent with CCND1/IGH fusion and loss of chromosome 13. No loss of 1p or TP53, no gain of 1q or 5 were evidenced above the normal reference ranges. The 11;14 translocation (which gave an atypical pattern with a single fusion) and loss of 13 have typically been associated with a diagnosis of multiple myeloma.
I just lost my concentration so I am going to end this post for now. I am all shook up and not sure what I do or do not have. All I know is, I am very tired all the time, I have this stabbing, burning pain all the time in my mid spine area. The muscles in my back do hurt too, but this pain is different, it hurts inside like bone pain all them time. Hard to sit for long periods of time, hard to stand long, cannot lie down without it hurting and I usually get my best sleep at 4 or 5 a.m. for 2-3 hours of fair sleep a night.
All this and I just went to an endocrinology doctor who will be doing an " MRI PITUITARY W, WO CONTRAST " and blood work to go along with that as well. So as we all know makes my mind wonder what is next and why the sense of urgency now??
My doctor is having a hard time giving full diagnosis of myeloma now. He sat my wife and I down and told us after the PET scan that the scan showed an area around vertebra L5 that was myeloma. We cried and the doctor told us what the next steps would be. They first told us they wanted to do a bone marrow biopsy in L5 and try get a sample of the area the PET scan showed up cancer. He told us the radiologist would be doing it under camera/TV would need a better picture of it, so they needed an MRI of L5 so they would know how they would proceed into the body for the sample. They tell my wife and I that the MRI showed negative for anything?
How very confusing, I thought the PET scan was a better test than an MRI. If I have written this before, please accept my apology because I am now frustrated and scared they are missing something. Blood work told them to move to the the first bone marrow biopsy which they first said was negative, then another doctor at MUSC read it and broke it down and wrote this on the "EDITED RESULTS""
FISH Comment:
5 multiplex probes
1p/1q -- Normal
5 -- Normal
t(11;14) -- Abnormal
13q14 -- Abnormal
TP53 -- Normal
Interpretation
FISH with probes for multiple myeloma-related genetic abnormalities revealed abnormal signal patterns consistent with CCND1/IGH fusion and loss of chromosome 13. No loss of 1p or TP53, no gain of 1q or 5 were evidenced above the normal reference ranges. The 11;14 translocation (which gave an atypical pattern with a single fusion) and loss of 13 have typically been associated with a diagnosis of multiple myeloma.
I just lost my concentration so I am going to end this post for now. I am all shook up and not sure what I do or do not have. All I know is, I am very tired all the time, I have this stabbing, burning pain all the time in my mid spine area. The muscles in my back do hurt too, but this pain is different, it hurts inside like bone pain all them time. Hard to sit for long periods of time, hard to stand long, cannot lie down without it hurting and I usually get my best sleep at 4 or 5 a.m. for 2-3 hours of fair sleep a night.
Re: Doctor found signs of myeloma - need help with lab resul
Krogers,
I realize that you've been on a very tough and draining journey trying to get to the bottom of what is going on.
However, I would try to take the fact that you have a doctor that has a sense of urgency and wants to analyze a fresh bone marrow biopsy as a sign that this doctor also really want to get to the bottom of what is proving to be a tough diagnosis. Also, remember that the results of a bone marrow biopsy can often vary quite a bit from sample to sample, so I see this as good news that your doctor is being thorough since he/she wants to get an additional sample for analysis.
Hopefully, you will have some more solid answers in the very near future. Please let us know how things go.
I realize that you've been on a very tough and draining journey trying to get to the bottom of what is going on.
However, I would try to take the fact that you have a doctor that has a sense of urgency and wants to analyze a fresh bone marrow biopsy as a sign that this doctor also really want to get to the bottom of what is proving to be a tough diagnosis. Also, remember that the results of a bone marrow biopsy can often vary quite a bit from sample to sample, so I see this as good news that your doctor is being thorough since he/she wants to get an additional sample for analysis.
Hopefully, you will have some more solid answers in the very near future. Please let us know how things go.
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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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