Hello everyone.
I just looked on my portal to see what my latest lab results were. I am still waiting for my serum protein electrophoresis (SPEP) and immunofixation electrophoresis (IFE) as they are send outs. My immunoglobulins have really increased and both of my serum kappa and lambda free light chain levels have risen above acceptable range.
The only thing different between this lab test and the previous test is that my oncologist had me try 5 mg finasteride (Proscar) for an increase in my PSA. After taking this drug for about two weeks, I had tremendous muscle and joint pain and felt really tired. Three days after stopping finasteride, all the muscle and joint pain went away. I currently feel fine.
Here are my test results. Even though my immunoglobulins are within range, it is a huge increase from what they were 24 days prior. Also, why would both kappa and lambda increase?
I did have my IgA switch after transplant to IgG.
Thank You George
Immunoglobulin Results:
IgA was 178 now 208 (73-347)
IgG was 630 now 885 (657-1610)
IgM was 23 now 104 (46-304)
Serum Free Light Chain Results:
Free Kappa/Lambda ratio 1.04 (0.26-1.65)
Free Kappa Serum 27.8 mg/L was 10.5 (3.3-19.4)
Free Lambda Serum 26.8 mg/L was 7.1 (5.7-26.3)
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Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
Re: Finasteride & immunoglobulin and free light chain levels
Hi Castaway,
Your lambda and kappa free light chains rose in tandem while your ratio remained normal. Also, all of your heavy chain immunoglobulin levels rose together. I would therefore suspect that you are having a polyclonal immunoglobulin reaction to your muscle irritation instead of a monoclonal increase in your immunoglobulins due to your myeloma. Your SPEP and IFE results will tell you if this is the case or not.
Also, if you now have an IgA isotype, you might want to consider asking your oncologist about also using the HevyLite chain assay. The HevyLite assay is intended to be better at tracking IgA monoclonal protein levels than the SPEP test.
Your lambda and kappa free light chains rose in tandem while your ratio remained normal. Also, all of your heavy chain immunoglobulin levels rose together. I would therefore suspect that you are having a polyclonal immunoglobulin reaction to your muscle irritation instead of a monoclonal increase in your immunoglobulins due to your myeloma. Your SPEP and IFE results will tell you if this is the case or not.
Also, if you now have an IgA isotype, you might want to consider asking your oncologist about also using the HevyLite chain assay. The HevyLite assay is intended to be better at tracking IgA monoclonal protein levels than the SPEP test.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Finasteride & immunoglobulin and free light chain levels
Multibilly, Thank You.
I didn't think of that bone and muscle pain possibly causing the rise in my labs. I was diagnosed 4 1/2 years ago with IgA. After the transplant it's showing IgG. But I will bring up the HevyLite assay to my oncologist.
Thanks again, George
I didn't think of that bone and muscle pain possibly causing the rise in my labs. I was diagnosed 4 1/2 years ago with IgA. After the transplant it's showing IgG. But I will bring up the HevyLite assay to my oncologist.
Thanks again, George
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Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
Re: Finasteride & immunoglobulin and free light chain levels
Update:
I received my send out lab results, and I'm more confused now more than ever. My lab before this one was done on September 4, 2018. This latest lab was taken on September 26, 2018. Here is what the IFE and SPEP coments / interpretation read.
Gamma globulin protein spike is still present and now comprises 3.5% of total protein compared to a faint area of restriction which was too small to quantitate in the study on 9/4/2018.
IFE Serum Path Interpetation,
A large IgG protein and two faint IgM / kappa monoclonal paraproteins and two lambda proteins without heavy chain correlates are identified,
I feel fine as I did before taking finasteride for about a month then having extreme bone pain and muscle pain. The pain stopped about 3 or 4 days after stopping finasteride. My concern here is that before transplant i was IgA and a several months back it changed to IgG. Also, now there's an increase spike to 3.5%. This whole switching and with the IFE interpetation of a large IgG protein has me worried.
Thank You, George
I received my send out lab results, and I'm more confused now more than ever. My lab before this one was done on September 4, 2018. This latest lab was taken on September 26, 2018. Here is what the IFE and SPEP coments / interpretation read.
Gamma globulin protein spike is still present and now comprises 3.5% of total protein compared to a faint area of restriction which was too small to quantitate in the study on 9/4/2018.
IFE Serum Path Interpetation,
A large IgG protein and two faint IgM / kappa monoclonal paraproteins and two lambda proteins without heavy chain correlates are identified,
I feel fine as I did before taking finasteride for about a month then having extreme bone pain and muscle pain. The pain stopped about 3 or 4 days after stopping finasteride. My concern here is that before transplant i was IgA and a several months back it changed to IgG. Also, now there's an increase spike to 3.5%. This whole switching and with the IFE interpetation of a large IgG protein has me worried.
Thank You, George
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Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
Re: Finasteride & immunoglobulin and free light chain levels
Hi George,
As mentioned in one of your earlier threads ("Had IgA myeloma, lab test now says IgG lambda?"), istoype switching after a transplant is generally considered to be a good thing:
You may also want to read this post from Dr. Landau.
What were your actual M-spike values (not gamma globulin percentages, but rather the absolute values of the M-spikes themselves) reported on your this latest SPEP and the last few SPEPs? They should be listed somewhere on your SPEP reports. They may also be listed as abnormal protein, abnormal protein band, paraprotein, monoclonal protein entries or something like that on your SPEPs.
As mentioned in one of your earlier threads ("Had IgA myeloma, lab test now says IgG lambda?"), istoype switching after a transplant is generally considered to be a good thing:
You may also want to read this post from Dr. Landau.
What were your actual M-spike values (not gamma globulin percentages, but rather the absolute values of the M-spikes themselves) reported on your this latest SPEP and the last few SPEPs? They should be listed somewhere on your SPEP reports. They may also be listed as abnormal protein, abnormal protein band, paraprotein, monoclonal protein entries or something like that on your SPEPs.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Finasteride & immunoglobulin and free light chain levels
Multibilly,
Thank you for your response. I did read the post from Dr. Landau. Very interesting. Great information. As far as my SPEP and IFE, they didn't show any of the reports you mentioned. The only thing other than I already posted was a Peak1, which shows abnormal at 0.21.
I did see my local oncologist yesterday late. Apparently, I can not view all the reports completely on my portal. He went over several results and at this point he wants a bone marrow biopsy. He believes that with the bone marrow biopsy results, he will have a better idea of what is going on. At that point he will get together with my transplant doctor to go over the results.
Thank You, George
Thank you for your response. I did read the post from Dr. Landau. Very interesting. Great information. As far as my SPEP and IFE, they didn't show any of the reports you mentioned. The only thing other than I already posted was a Peak1, which shows abnormal at 0.21.
I did see my local oncologist yesterday late. Apparently, I can not view all the reports completely on my portal. He went over several results and at this point he wants a bone marrow biopsy. He believes that with the bone marrow biopsy results, he will have a better idea of what is going on. At that point he will get together with my transplant doctor to go over the results.
Thank You, George
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Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
Re: Finasteride & immunoglobulin and free light chain levels
Ah, you are looking at your results online. For some reason, many doctor's office's portals do not include the M-spike values (I used to have this problem with my doctor's portal, but it got remedied after I complained a couple of times).
But you will find the M-spike results on the original lab reports (which likely come from LabCorp or Quest Diagnostics). If your doctor is using LabCorp or Quest, you can also register with their site and get the complete data through their portal. If that doesn't work, then you should ask your doctor's office for copies of the lab reports (which they can also fax to you, or you can go through a bunch of privacy act shenanigans and have them email them to you. See April's column:
"Letters From Cancerland: My HIPAA Release" (June 15, 2018)
Good luck with the biopsy and let us know how things turn out.
But you will find the M-spike results on the original lab reports (which likely come from LabCorp or Quest Diagnostics). If your doctor is using LabCorp or Quest, you can also register with their site and get the complete data through their portal. If that doesn't work, then you should ask your doctor's office for copies of the lab reports (which they can also fax to you, or you can go through a bunch of privacy act shenanigans and have them email them to you. See April's column:
"Letters From Cancerland: My HIPAA Release" (June 15, 2018)
Good luck with the biopsy and let us know how things turn out.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Finasteride & immunoglobulin and free light chain levels
I went to my oncologist today. He had my bone marrow biopsy report. The report comment says that the findings are those of normocellular bone marrow with an erythroid preponderance with a minimal residual population of kappa-restricted, CD38+plasma cells,consistent with minimal involvement by multiple myeloma. Neither morphology nor ICH reveals this population of cells.
It goes on to say that these results are not consistent with the clinical findings of increasing M-protein from the last blood work and likely reflects a sampling issue.
The bone marrow biopsy did not indicate any type, IgG, IgA, etc.
Thank you,
George
It goes on to say that these results are not consistent with the clinical findings of increasing M-protein from the last blood work and likely reflects a sampling issue.
The bone marrow biopsy did not indicate any type, IgG, IgA, etc.
Thank you,
George
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Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
8 posts
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