Dear All,
I need help in terms on understanding whether my mother has multiple myeloma.
All tests done last week
haemoglobin - 10.4
TLC - 7900
platelet - 248000
creat - 1.1
calcium - 9.0
B2 Microglobuline - 5500
m band - 0.27
lg Level lgG - 1649
lgA - 221
lgM - 30
BM aspiration (test done around 3 months back) - 6% plasma cells
FLC Kappa - 44.75
Lambda - 417.21
ration - 0.11
she does not have much problem as of now apparently apart from bit of pain in the hip area
pls advise/guide...
Thanks,
Vivek
Forums
Re: Does my mother have multiple myeloma?
Hi Vivek,
A doctor is the best person to determine whether your mother has myeloma. However, my initial read of your mother's test results -- and I'm not a doctor -- suggests that she doesn't have multiple myeloma. Instead, it looks to me like she has what is called monoclonal gammopathy of undetermined significance (MGUS), which is not unusual in older people.
The criteria for a diagnosis of multiple myeloma, MGUS, and other related conditions are described very precisely in Table 2 of this publication,
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2627786/pdf/nihms80531.pdf
which describes the internationally accepted criteria for the diseases.
Your mother's plasma cell percentage is less than 10 percent and her hemoglobin, kidney function, and calcium levels are below the cutoffs for establishing a myeloma diagnosis. A full bone survey is necessary to determine whether your mother has any bone lesions, so that is something your mother should have done.
But, given that the bone plasma cell percentage is less than 10 percent, by definition your mother does not have myeloma, since a plasma cell percentage higher than 10 percent is required for a diagnosis of myeloma.
A doctor is the best person to determine whether your mother has myeloma. However, my initial read of your mother's test results -- and I'm not a doctor -- suggests that she doesn't have multiple myeloma. Instead, it looks to me like she has what is called monoclonal gammopathy of undetermined significance (MGUS), which is not unusual in older people.
The criteria for a diagnosis of multiple myeloma, MGUS, and other related conditions are described very precisely in Table 2 of this publication,
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2627786/pdf/nihms80531.pdf
which describes the internationally accepted criteria for the diseases.
Your mother's plasma cell percentage is less than 10 percent and her hemoglobin, kidney function, and calcium levels are below the cutoffs for establishing a myeloma diagnosis. A full bone survey is necessary to determine whether your mother has any bone lesions, so that is something your mother should have done.
But, given that the bone plasma cell percentage is less than 10 percent, by definition your mother does not have myeloma, since a plasma cell percentage higher than 10 percent is required for a diagnosis of myeloma.
-
JimNY
Re: Does my mother have multiple myeloma?
Hi Vivek,
Like Jim said, this is likely MGUS, which may very well mean that your Mom may never progress to symptomatic multiple myeloma during her lifetime and would just need to get re-checked once a year or so.
However, the Beta2 Microglobulin (B2M) seems pretty high (I assume this is in ug/L? The normal ranges can vary from lab to lab, but for my lab it is 1010 - 1730 ug/L. Other labs may show it as 1.21-2.70 mcg/mL or different reference ranges). B2M can possibly be an indicator of overall cancer activity, but it can also be elevated due to infection, etc...so you want to discuss this with your doc. You also want to review the other indicators such as albumin and BUN and ask your doc if all is looking well with her kidney function.
Also, what was her M-Spike? (maybe this is what you already called M-Band on your test, but if so, what then were the units of measure? Is this expressed in g/dL or something else?) This would show up on the test that is called the Serum Protein Electrophoresis (SPEP) and may be called something else like the paraprotein or M-Protein level.
Like Jim said, I would also definitely get a full body xray survey or MRI to determine if there are any bone lesions present, especially if there is some hip pain involved. But more than likely with these values, the hip pain is probably due to just getting older
If bone lesions are present, the > 10% plasma cell in-the-bone-marrow rule for having symptomatic multiple myeloma doesn't apply, so you definitely want to follow up on that point just to be safe.
Again, it is likely she has MGUS, but I would follow up on all these items and make sure that you are working with an oncologist that really knows multiple myeloma.
Hope this helps...
Like Jim said, this is likely MGUS, which may very well mean that your Mom may never progress to symptomatic multiple myeloma during her lifetime and would just need to get re-checked once a year or so.
However, the Beta2 Microglobulin (B2M) seems pretty high (I assume this is in ug/L? The normal ranges can vary from lab to lab, but for my lab it is 1010 - 1730 ug/L. Other labs may show it as 1.21-2.70 mcg/mL or different reference ranges). B2M can possibly be an indicator of overall cancer activity, but it can also be elevated due to infection, etc...so you want to discuss this with your doc. You also want to review the other indicators such as albumin and BUN and ask your doc if all is looking well with her kidney function.
Also, what was her M-Spike? (maybe this is what you already called M-Band on your test, but if so, what then were the units of measure? Is this expressed in g/dL or something else?) This would show up on the test that is called the Serum Protein Electrophoresis (SPEP) and may be called something else like the paraprotein or M-Protein level.
Like Jim said, I would also definitely get a full body xray survey or MRI to determine if there are any bone lesions present, especially if there is some hip pain involved. But more than likely with these values, the hip pain is probably due to just getting older
If bone lesions are present, the > 10% plasma cell in-the-bone-marrow rule for having symptomatic multiple myeloma doesn't apply, so you definitely want to follow up on that point just to be safe.Again, it is likely she has MGUS, but I would follow up on all these items and make sure that you are working with an oncologist that really knows multiple myeloma.
Hope this helps...
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Does my mother have multiple myeloma?
Multibilly - I'm not sure your statement that
"If bone lesions are present, the > 10% plasma cell in-the-bone-marrow rule for having symptomatic multiple myeloma doesn't apply"
is strictly true.
For a diagnosis of multiple myeloma, you have to meet ALL of the following three criteria:
1. > 10 percent plasma cells in the bone marrow
2. Presence of a monoclonal protein (except in cases of non-secretory myeloma)
3. Evidence of end-organ damage (CRAB criteria).
If you have end-organ damage, but do not have more than 10 percent plasma cells, then strictly speaking you don't have multiple myeloma.
Now, it may be that end-organ damage, particularly bone damage, may be a sign that the plasma cell percentage test was an anomaly and re-testing should be done. But if testing repeatedly shows a plasma cell percentage lower than 10 percent, then the diagnosis isn't multiple myeloma.
"If bone lesions are present, the > 10% plasma cell in-the-bone-marrow rule for having symptomatic multiple myeloma doesn't apply"
is strictly true.
For a diagnosis of multiple myeloma, you have to meet ALL of the following three criteria:
1. > 10 percent plasma cells in the bone marrow
2. Presence of a monoclonal protein (except in cases of non-secretory myeloma)
3. Evidence of end-organ damage (CRAB criteria).
If you have end-organ damage, but do not have more than 10 percent plasma cells, then strictly speaking you don't have multiple myeloma.
Now, it may be that end-organ damage, particularly bone damage, may be a sign that the plasma cell percentage test was an anomaly and re-testing should be done. But if testing repeatedly shows a plasma cell percentage lower than 10 percent, then the diagnosis isn't multiple myeloma.
-
JimNY
Re: Does my mother have multiple myeloma?
I'm citing the IMWG guidelines. I realize that there are inconsistencies in the various sources for staging and classification of multiple myeloma that ones gets on the web, but the IMWG is what I have used as my reference point and what my doc shared with me. Note the "and/or" in bullet #1 below.
http://myeloma.org/ArticlePage.action?tabId=1&menuId=334&articleId=3462&aTab=-1
Table 1 - Multiple Myeloma Diagnostic Criteria: All Three Required
1. Monoclonal plasma cells in the bone marrow > 10% and/or presence of a biopsy-proven plasmacytoma
2. Monoclonal protein present in the serum and/or urinea
3. Myeloma-related organ dysfunction (1 or more)b
[C] Calcium elevation in the blood (serum calcium > 10.5 mg/l or upper limit of normal)
[R] Renal insufficiency (serum creatinine > 2 mg/dl)
[A] Anemia (hemoglobin < 10 g/dl or 2 g < normal)
[B] Lytic bone lesions or osteoporosisc
In any case, I want to be sure that Vivek isn't caught in the crossfire here. I think we can agree that the bottom line is for Vivek to follow up with imaging and to discuss those results and the other items with a specialist.
http://myeloma.org/ArticlePage.action?tabId=1&menuId=334&articleId=3462&aTab=-1
Table 1 - Multiple Myeloma Diagnostic Criteria: All Three Required
1. Monoclonal plasma cells in the bone marrow > 10% and/or presence of a biopsy-proven plasmacytoma
2. Monoclonal protein present in the serum and/or urinea
3. Myeloma-related organ dysfunction (1 or more)b
[C] Calcium elevation in the blood (serum calcium > 10.5 mg/l or upper limit of normal)
[R] Renal insufficiency (serum creatinine > 2 mg/dl)
[A] Anemia (hemoglobin < 10 g/dl or 2 g < normal)
[B] Lytic bone lesions or osteoporosisc
In any case, I want to be sure that Vivek isn't caught in the crossfire here. I think we can agree that the bottom line is for Vivek to follow up with imaging and to discuss those results and the other items with a specialist.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Does my mother have multiple myeloma?
Thanks, Multibilly, for pushing us to look more carefully at the criteria for diagnosis.
Before I go any further, I want to agree that imaging is probably a good idea for Vivek's mother, and that seeing a myeloma specialist (or well-versed hematologist/oncologist) is also a good idea.
The reason I'm going to post the rest of the information I've included below is simply for reference purposes. I think it would be good to have here in the forum some links to authoritative, published documents on the criteria for diagnosis and recommended testing for (potential) myeloma patients. I suspect they'll be useful in many later discussions.
All that having been said, I have to admit now that I made a mistake with the link in my earlier posting. I actually wanted to post a link to the actual IMWG guidelines, but ended up posting a different link. My bad.
On the issue of whether the official International Myeloma Working Group (IMWG) guidelines include the "and/or presence of a biopsy-proven plasmacytoma" statement mentioned on the IMF webpage Multibilly linked to ...
As best I can tell, that statement has never been in the IMWG criteria for diagnosis. Instead, if you read the fine print on the IMF webpage, you'll see that the listed criteria are ones that were recommended by the "Scientific Advisors of the International Myeloma Foundation" back in 2003.
The most recent IMWG statement related to diagnosis (and not other subjects, such as maintenance or bone disease) that I've been able to find is this one:
http://bloodjournal.hematologylibrary.org/content/117/18/4701.full.pdf
IMWG "Consensus recommendations for standard investigative workup" (2011)
It does not include the "and/or presence of a biopsy-proven plasmacytoma" statement.
Also, the original 2003 IMWG consensus statement on diagnostic criteria is this one:
http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2141.2003.04355.x/pdf
"Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group"
and it also doesn't include the "and/or" statement. (The criteria in that document also are quite a bit different than the current criteria.)
On the other hand, the European Society of Medical Oncology "Clinical Practice Guidelines
for diagnosis, treatment and follow-up",
http://annonc.oxfordjournals.org/content/early/2013/08/16/annonc.mdt297.full.pdf
do include a "or biopsy proven plasmacytoma" statement like the one at the IMF webpage.
As I mentioned way back at the beginning of this posting, I hope these links will be useful not just for this discussion, but for future discussions as well.
Before I go any further, I want to agree that imaging is probably a good idea for Vivek's mother, and that seeing a myeloma specialist (or well-versed hematologist/oncologist) is also a good idea.
The reason I'm going to post the rest of the information I've included below is simply for reference purposes. I think it would be good to have here in the forum some links to authoritative, published documents on the criteria for diagnosis and recommended testing for (potential) myeloma patients. I suspect they'll be useful in many later discussions.
All that having been said, I have to admit now that I made a mistake with the link in my earlier posting. I actually wanted to post a link to the actual IMWG guidelines, but ended up posting a different link. My bad.
On the issue of whether the official International Myeloma Working Group (IMWG) guidelines include the "and/or presence of a biopsy-proven plasmacytoma" statement mentioned on the IMF webpage Multibilly linked to ...
As best I can tell, that statement has never been in the IMWG criteria for diagnosis. Instead, if you read the fine print on the IMF webpage, you'll see that the listed criteria are ones that were recommended by the "Scientific Advisors of the International Myeloma Foundation" back in 2003.
The most recent IMWG statement related to diagnosis (and not other subjects, such as maintenance or bone disease) that I've been able to find is this one:
http://bloodjournal.hematologylibrary.org/content/117/18/4701.full.pdf
IMWG "Consensus recommendations for standard investigative workup" (2011)
It does not include the "and/or presence of a biopsy-proven plasmacytoma" statement.
Also, the original 2003 IMWG consensus statement on diagnostic criteria is this one:
http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2141.2003.04355.x/pdf
"Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group"
and it also doesn't include the "and/or" statement. (The criteria in that document also are quite a bit different than the current criteria.)
On the other hand, the European Society of Medical Oncology "Clinical Practice Guidelines
for diagnosis, treatment and follow-up",
http://annonc.oxfordjournals.org/content/early/2013/08/16/annonc.mdt297.full.pdf
do include a "or biopsy proven plasmacytoma" statement like the one at the IMF webpage.
As I mentioned way back at the beginning of this posting, I hope these links will be useful not just for this discussion, but for future discussions as well.
-
JimNY
Re: Does my mother have multiple myeloma?
Sheesh, thanks Jim. Is nothing ever clear cut with this disease? 
So that folks don't have to read the entire white paper that Jim provided, here is the key comment with regards to <10% plasma cells, but with the presence of bone lesions:
"...When a patient presents with lytic bone lesions, low levels of monoclonal protein, and less than 10% plasma cells in the bone marrow, the presence of monoclonal gammopathy of undetermined significance, and metastatic carcinoma should be considered, and biopsy of a bone lesion may be indicated."
Vivek, sorry to get into a somewhat academic discussion here (your Mom will likely not have any lesions whatsoever). I hope that things work out well for your Mom and I wish you happy holidays!
So that folks don't have to read the entire white paper that Jim provided, here is the key comment with regards to <10% plasma cells, but with the presence of bone lesions:"...When a patient presents with lytic bone lesions, low levels of monoclonal protein, and less than 10% plasma cells in the bone marrow, the presence of monoclonal gammopathy of undetermined significance, and metastatic carcinoma should be considered, and biopsy of a bone lesion may be indicated."
Vivek, sorry to get into a somewhat academic discussion here (your Mom will likely not have any lesions whatsoever). I hope that things work out well for your Mom and I wish you happy holidays!
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Does my mother have multiple myeloma?
I think myeloma is still much of a learning game. I have mgus, with osteoporosis and no clotting factors. Yet, my hemoglobin, platelets are fine. My calcium bouncing around..but not over 10. I am not any medication for either of my osteo or my bleeding condition. Mgus might be treated like arthritis in the furture.. I guess its best never to treat versa to treat..at least for what they know now. Eat hot peppers.. I am a 8 year mguser with good labs and I give credit to hot peppers.
Re: Does my mother have multiple myeloma?
Dear All,
Thanks first of all for taking time out and going through the case. I really appreciate. Being informed is most important for such diseases and you all have been of great help.
We did MRIs and XRAYs about 2 months back, we dont seem to have any abnormality there.
My mother had kidney dysfunction, she was having swollen feet due to accumulation of urine which the doctor said was due to paraprotein and thus the tests confirming presence of myeloma band. Interestingly, she has been on a proper diet ever since and her swollen foot problem (dunno how) has vanished. she does not complain of any issue as of now apart from bit of back pain (for which, a neurologist has been seeing her for past 1.5 years) and some pain around the hip area.
B2M is at highly elevated levels, which does concern me, but people like us are ill-informed. My mother is on no medication except her neurology prescription. I am reporting her last tests reports with units to clarify some of your queries...
haemoglobin - 10.4 g/dl
PCV - 33.6%
TLC - 7900
platelet - 248000
creat - 1.1 mg/100ml
calcium - 9.0 mg/100ml
B2 Microglobuline - 5500 mcg/L
M Band (serum protein electrophoresis) - 0.27 g/dl (report reads as "M" Band, 3.6% and comments, " M Band present in Gamma Globulin region")
lg Level lgG - 1649 mg/100ml
lgA - 221 mg/100ml
lgM - 30 mg/100ml
BM aspiration (test done around 3 months back) - 6% plasma cells
FLC Kappa - 44.75 mg/L
Lambda - 417.21 mg/L
ratio - 0.11
I am not sure what else to report here...I am seeing a few more doctors locally to seek their opinion. I believe it would be a good idea to do another round of XRAYs and MRIs to check for lesions. Last MRI mentioned something about simple cysts in both kidneys, not sure if thats a good or bad news! MRI report said, " Sacralisation of L5, Mild diffuse posterior bulge of L4-L5. No significant spinal or nerve root canal narrowing". XRAY report says all joints/bones are normal.
Let me know any of your views, if you find anything different from my earlier post. I would keep all of you posted on what opinion my doctor gives on his views on the above test reports.
Thanks a ton once again, I am grateful to each one of you for sharing the above info/knowledge...
Thanks and Regards,
Vivek
Thanks first of all for taking time out and going through the case. I really appreciate. Being informed is most important for such diseases and you all have been of great help.
We did MRIs and XRAYs about 2 months back, we dont seem to have any abnormality there.
My mother had kidney dysfunction, she was having swollen feet due to accumulation of urine which the doctor said was due to paraprotein and thus the tests confirming presence of myeloma band. Interestingly, she has been on a proper diet ever since and her swollen foot problem (dunno how) has vanished. she does not complain of any issue as of now apart from bit of back pain (for which, a neurologist has been seeing her for past 1.5 years) and some pain around the hip area.
B2M is at highly elevated levels, which does concern me, but people like us are ill-informed. My mother is on no medication except her neurology prescription. I am reporting her last tests reports with units to clarify some of your queries...
haemoglobin - 10.4 g/dl
PCV - 33.6%
TLC - 7900
platelet - 248000
creat - 1.1 mg/100ml
calcium - 9.0 mg/100ml
B2 Microglobuline - 5500 mcg/L
M Band (serum protein electrophoresis) - 0.27 g/dl (report reads as "M" Band, 3.6% and comments, " M Band present in Gamma Globulin region")
lg Level lgG - 1649 mg/100ml
lgA - 221 mg/100ml
lgM - 30 mg/100ml
BM aspiration (test done around 3 months back) - 6% plasma cells
FLC Kappa - 44.75 mg/L
Lambda - 417.21 mg/L
ratio - 0.11
I am not sure what else to report here...I am seeing a few more doctors locally to seek their opinion. I believe it would be a good idea to do another round of XRAYs and MRIs to check for lesions. Last MRI mentioned something about simple cysts in both kidneys, not sure if thats a good or bad news! MRI report said, " Sacralisation of L5, Mild diffuse posterior bulge of L4-L5. No significant spinal or nerve root canal narrowing". XRAY report says all joints/bones are normal.
Let me know any of your views, if you find anything different from my earlier post. I would keep all of you posted on what opinion my doctor gives on his views on the above test reports.
Thanks a ton once again, I am grateful to each one of you for sharing the above info/knowledge...
Thanks and Regards,
Vivek
-
Vivek Varma
Re: Does my mother have multiple myeloma?
The creatinine level is normal (which is great), but since you mentioned kidney dysfunction, other things you should look at on your labs are albumin, BUN and the GFR (glomerular filtration rate). These are all associated with kidney health and you probably already have all these lab results. The elevated B2M levels may very well be associated with the kidney dysfunction. The paraprotein level is pretty low, so I'm not sure that this would cause kidney dysfunction, but others on this forum may know better.
The problems with MRIs and X-rays is that they always seem to pick up something extraneous that is not associated with multiple myeloma...in my case they always highlight my arthritis, some non-mm-related skeletal issues, and some other non-life threatening issues that I would just as soon not be reminded of every few months With regards to multiple myeloma, the MRI results sound great, so that is good news.
The problems with MRIs and X-rays is that they always seem to pick up something extraneous that is not associated with multiple myeloma...in my case they always highlight my arthritis, some non-mm-related skeletal issues, and some other non-life threatening issues that I would just as soon not be reminded of every few months
With regards to multiple myeloma, the MRI results sound great, so that is good news.-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
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