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Double M-spike
What does it mean if you have a double M-spike, in the gamma region?
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skolman - Name: susan kolman
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: 2012
- Age at diagnosis: 55
Re: Double M-spike
I'm not sure what you're talking about is really a double "M-spike" (presence of two different types of monoclonal protein). Could you share your serum protein electrophoresis (SPEP) and serum immunofixation results that led you to ask your question?
Re: Double M-spike
Hi Susan,
As I recall, I think you have IgA lambda multiple myeloma. It's more common to have more than one M-spike with IgA type multiple myeloma, but it's nothing to worry about regardless of the type of multiple myeloma you have. In fact, some people can have more than two M-spikes.
This phenomenon of having more than one M-spike is called oligoclonal gammopathy. You can see a story of one IgA lambda patient here that actually has four M-spikes.
I Tek et al, "IgA lambda oligoclonal gammopathy in multiple myeloma," Turkish Journal of Hematology, 2010 (link to full text PDF of article)
Note that it's also harder to accurately measure the M-spike(s) in IgA-type multiple myeloma since other blood components tend to occupy the same area of the lab graph where at least one of your IgA M-spikes reside.
But your doctor at Sloan-Kettering will know all this.
Again, there is no significance to multiple M-spikes when it comes to your prognosis.
I agree with Terry that it would be good to have the results of your SPEP and IFE to be sure we are really talking about two M-spikes here.
As I recall, I think you have IgA lambda multiple myeloma. It's more common to have more than one M-spike with IgA type multiple myeloma, but it's nothing to worry about regardless of the type of multiple myeloma you have. In fact, some people can have more than two M-spikes.
This phenomenon of having more than one M-spike is called oligoclonal gammopathy. You can see a story of one IgA lambda patient here that actually has four M-spikes.
I Tek et al, "IgA lambda oligoclonal gammopathy in multiple myeloma," Turkish Journal of Hematology, 2010 (link to full text PDF of article)
Note that it's also harder to accurately measure the M-spike(s) in IgA-type multiple myeloma since other blood components tend to occupy the same area of the lab graph where at least one of your IgA M-spikes reside.
But your doctor at Sloan-Kettering will know all this.
Again, there is no significance to multiple M-spikes when it comes to your prognosis.
I agree with Terry that it would be good to have the results of your SPEP and IFE to be sure we are really talking about two M-spikes here.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Double M-spike
Thank you all for your responses.
Multibilly, the Protein Electrophoresis states:
M-spike 1 as 1.04 (this is in g/dl)
M-spike 2 as 0.07;
PE Gamma 1.56 g/dl;
PE Albumin 3.98 g/dl;
PE Alpha-1 0.30 g/dl;
PE Alpha-2 0.30 g/dl.
PE extended comment says double M-spike in the gamma region;
Beta-1 0.35 g/dl,
Beta-2 0.39 g/dl.
I hope this is what you guys were requesting. All these numbers just throw me for a loop.
Multibilly, I can't believe how you remember everyone and always have the answer.
Thank you, thank you.
Multibilly, the Protein Electrophoresis states:
M-spike 1 as 1.04 (this is in g/dl)
M-spike 2 as 0.07;
PE Gamma 1.56 g/dl;
PE Albumin 3.98 g/dl;
PE Alpha-1 0.30 g/dl;
PE Alpha-2 0.30 g/dl.
PE extended comment says double M-spike in the gamma region;
Beta-1 0.35 g/dl,
Beta-2 0.39 g/dl.
I hope this is what you guys were requesting. All these numbers just throw me for a loop.
Multibilly, I can't believe how you remember everyone and always have the answer.
Thank you, thank you.
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skolman - Name: susan kolman
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: 2012
- Age at diagnosis: 55
Re: Double M-spike
Terry, unless you think otherwise, this does seem like a case of oligoclonal gammopathy to me. Agreed?
Susan:
To figure out your overall M-spike, you simply add your two M-spikes together for an overall reading of 1.11 g/dL (1.04+0.07) ... which is a pretty darn low M-spike.
Again, this has no impact on your prognosis.
As always, you should verify all this with your doc.
Susan:
To figure out your overall M-spike, you simply add your two M-spikes together for an overall reading of 1.11 g/dL (1.04+0.07) ... which is a pretty darn low M-spike.
Again, this has no impact on your prognosis.
As always, you should verify all this with your doc.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Double M-spike
Well, given that the SPEP report states that there are two M-spikes, that much is definitely clear.
I guess what I am not sure about is whether this is definitely a case of "oligoclonal gammopathy" if the immunofixation doesn't state that there are two different types of monoclonal proteins. If both spikes are due to IgA kappa clones, for example, is it still "oligoclonal gammopathy"? It probably is. I just don't know enough about the definitions of these things to say for sure.
I think Multibilly is correct when it comes to how the total M-spike is calculated. It's the total of the two M-spikes. I believe one of the physicians who helps here in the forum confirmed that one time in a posting.
I'm curious, Multibilly, why you feel that there is no impact on the chance of progression, or long-term prognosis, of having two M-spikes? Are there data that indicate that? Or is it more that there are no data indicating that there is no negative impact of having two M-spikes?
I ask because, to me, it would seem that having two M-spikes would mean that there are now two different clones that could evolve further into symptomatic disease. That would seem to increase the chances of progression.
Also, if both clones evolved to the point of causing symptomatic disease, it would mean you would have to hit two different clones with whatever treatment you use, not just one. Again, that would seem to make treatment at least a little bit more challenging.
This is probably a way too simplistic way of thinking about all of this, and, Susan, I'm completely not an expert on these things, so don't let anything I've written worry you. I just think it would be worth discussing this some more because it's not the first time that someone with two M-spikes at diagnosis, or not long after diagnosis, has posted in the forum.
I guess what I am not sure about is whether this is definitely a case of "oligoclonal gammopathy" if the immunofixation doesn't state that there are two different types of monoclonal proteins. If both spikes are due to IgA kappa clones, for example, is it still "oligoclonal gammopathy"? It probably is. I just don't know enough about the definitions of these things to say for sure.
I think Multibilly is correct when it comes to how the total M-spike is calculated. It's the total of the two M-spikes. I believe one of the physicians who helps here in the forum confirmed that one time in a posting.
I'm curious, Multibilly, why you feel that there is no impact on the chance of progression, or long-term prognosis, of having two M-spikes? Are there data that indicate that? Or is it more that there are no data indicating that there is no negative impact of having two M-spikes?
I ask because, to me, it would seem that having two M-spikes would mean that there are now two different clones that could evolve further into symptomatic disease. That would seem to increase the chances of progression.
Also, if both clones evolved to the point of causing symptomatic disease, it would mean you would have to hit two different clones with whatever treatment you use, not just one. Again, that would seem to make treatment at least a little bit more challenging.
This is probably a way too simplistic way of thinking about all of this, and, Susan, I'm completely not an expert on these things, so don't let anything I've written worry you. I just think it would be worth discussing this some more because it's not the first time that someone with two M-spikes at diagnosis, or not long after diagnosis, has posted in the forum.
Re: Double M-spike
Terry, I see your points. I made my statement with respect to prognosis based on what Dr. Libby had said on the subject a few months ago:
Multiclonal peaks are not uncommon in multiple myeloma. There are reports of biclonal and even triclonal spikes in patients with newly diagnosed multiple myeloma. There is no definite prognostic significance to this finding."
Source: Forum discussion "Now have two m-spikes - IgA kappa & IgG kappa" (started Jul 24, 2014).
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Double M-spike
Hello Susan,
This is an interesting thread of conversation.
As Multibilly pointed out, based on previous discussions of this topic on the Beacon, there is no scientific evidence that having more than one M-spike worsens a patients prognosis.
Oligoclonal gammopathy generally refers to production of many different proteins by plasma cells due to inflammation or infection. Oligoclonal bands are not due to cancer or myeloma. So this is not oligoclonal in the sense we use this term to diagnose myeloma. At the end of the day, though, determining the exact terminology really isn't that important. For simplicity's sake, I would simply say that you have two monoclonal spikes.
New scientific discoveries have recently demonstrated that, in multiple myeloma, several myeloma clones exist in essentially all patients. Patients generally have one dominant clone at diagnosis and 3-6 subclones. The clones change over time and the dominance of each clone changes over time. How this fact can be manipulated to advantage with different treatment approaches has yet to be shown. The fact that you may have two clones producing M-spikes fits perfectly with the multiclone concept of multiple myeloma.
Great question, thanks for bringing it to the Beacon!
This is an interesting thread of conversation.
As Multibilly pointed out, based on previous discussions of this topic on the Beacon, there is no scientific evidence that having more than one M-spike worsens a patients prognosis.
Oligoclonal gammopathy generally refers to production of many different proteins by plasma cells due to inflammation or infection. Oligoclonal bands are not due to cancer or myeloma. So this is not oligoclonal in the sense we use this term to diagnose myeloma. At the end of the day, though, determining the exact terminology really isn't that important. For simplicity's sake, I would simply say that you have two monoclonal spikes.
New scientific discoveries have recently demonstrated that, in multiple myeloma, several myeloma clones exist in essentially all patients. Patients generally have one dominant clone at diagnosis and 3-6 subclones. The clones change over time and the dominance of each clone changes over time. How this fact can be manipulated to advantage with different treatment approaches has yet to be shown. The fact that you may have two clones producing M-spikes fits perfectly with the multiclone concept of multiple myeloma.
Great question, thanks for bringing it to the Beacon!
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Dr. Edward Libby - Name: Edward Libby, M.D.
Beacon Medical Advisor
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