[Ian]

Re: Elevated IgA level - sign of relapse?

by Ian on Sat Sep 27, 2014 12:42 am

Hi Blair,

What are the last two sets of myeloma labs that you have for your husband. I'm thinking of things like his paraprotein level (M-spike) and light chain levels? Are they showing any sign of relapse?

I know you've suggested that they don't, which is why the IgA result seems strange, but it still would be helpful to have them here, including the dates from when the tests were done.

[blair77]

Re: Elevated IgA level - sign of relapse?

by blair77 on Sat Sep 27, 2014 2:14 am

He is IgA lambda he did have an original M-spike of 1.8 g/dL (18 g/L) when he was diagnosed in April 2013, and his lambda FLC were high (can't remember exact numbers).

Sep 2, 2014 - no m spike
Sep 2, 2014 - kappa FLC - 24 (high, but he's lambda)
Sep 2, 2014 - lambda -23
Sep 2, 2014 - K/L FLC ratio - 1.05 (normal)

Aug 2, 2014 - no m spike
Aug 2, 2014 - kappa and lambda FLCs were both elevated, but with a normal ratio.

He also has type II diabetes and a fatty liver diagnosis.

[Dr. Jason Valent]

Re: Elevated IgA level - sign of relapse?

by Dr. Jason Valent on Tue Sep 30, 2014 10:28 am

Great questions here. I hope this is the answer.

Upon recovery from stem cell transplants, the new immune system grows (term used is "immune reconstitution"). So an increase in the immunoglobulins is not always abnormal, although the IgA of 700 does seem high. If the IgA is increasing due to the myeloma, the immunofixation on the serum should be positive (although, again, this is not a perfect test). With a negative immunofixation and improving numbers otherwise, I think repeating the tests monthly for now will tell you whether or not this is immune reconstitution or the myeloma relapsing.

[blair77]

Re: Elevated IgA level - sign of relapse?

by blair77 on Wed Oct 01, 2014 5:11 pm

Hi again,

Apparently the myeloma tests were actually rerun on September 29th. Still no M spike, negative IFE and kappa free light chains are 34.9 (again, he is lambda ), lambda free light chains are 25.7, kappa/lambda FLC ratio is 1.36 (normal).

Would doing a PET scan reveal whether or not this is relapse? I feel like, with myeloma, if you dig long and hard enough, you will find it. So would it be beneficial from a treatment stand point to keep testing? Would a bone marrow biopsy be more useful then a PET?

[blair77]

Re: Elevated IgA level - sign of relapse?

by blair77 on Sat Jan 10, 2015 12:23 am

So my husbands IgA has climbed to 850 (he is IgA lambda) and for the 3rd time in a row his SPEP and his IFE still say no paraproteins detected.

I knew the SPEP was not that good at detecting IgA, but I thought the IFE wouldn't miss the para­proteins 3 times in a row? Guess it has and I am having a hard time figuring out if the IgA rise qualifies as meeting " relapse" criteria.

His light chains both kappa and lambda are elevated with a normal ratio, so that doesn't help clear up the confusion.

He is on maintenance Revlimid and his doctor says not to up it "yet," but I'm wondering if we should be doing more?

Also, with both a negative SPEP and IFE, how can it be proven that the IgA is elevated due to a monoclonal protein?

I feel like I'm missing a connection because everything I read says the IFE will be positive if a monoclonal protein is present. Should we ask for more blood work to confirm, and what kind should we ask for if so?