Hello,
I now have a monoclonal gammopathy stage 1. MGUS discovered in 2010, which has evolved, I have the t(4; 14), abnormal free light chain ratio, and other pretty things.
I am a little surprised, but my hematologist does not take care of the M-spike anymore. He thinks it's too random, and he relies solely on the gamma globulin level.
For him, I'm stable (20.3 g / L currently, and 14.8 g / L in May 2011).
Does it make sense not to look at the M-spike? I am at 14.5 g /L (1.45 g/dL). This peak has been declining for 6 months, but gamma globulins vary up and down.
Thank you,
Jacqueline
Forums
10 posts
• Page 1 of 1
Re: Monitoring gamma globulin level instead of M-spike?
Hello Jacqueline,
It seems a bit curious to me that your hematologist would not monitor your monoclonal proteins, as well as the gamma globulin units. On my routine blood testing, the following proteins are measured: total protein, alpha-1 globulin, alpha-2 globulin, beta1 globulin, beta2 globulin, gamma globulin, monoclonal , and also the IgA, IgG, IgM; as well as free kappa light chains, free lambda light chains and the free kappa/lambda ratio! With all of this information, my doctor has a lot to look at and can tell if anything is out of normal ranges. Of course, there is no normal range for the monoclonal proteins.
I did not know I had myeloma until being diagnosed with it, so I did not have measuring done during the MGUS or smoldering myeloma phases, and am not sure whether such a comprehensive testing would have been done then. Probably other MGUS patients would be able to tell you what is measured on their routine blood tests.
Hope that is helpful!
It seems a bit curious to me that your hematologist would not monitor your monoclonal proteins, as well as the gamma globulin units. On my routine blood testing, the following proteins are measured: total protein, alpha-1 globulin, alpha-2 globulin, beta1 globulin, beta2 globulin, gamma globulin, monoclonal , and also the IgA, IgG, IgM; as well as free kappa light chains, free lambda light chains and the free kappa/lambda ratio! With all of this information, my doctor has a lot to look at and can tell if anything is out of normal ranges. Of course, there is no normal range for the monoclonal proteins.
I did not know I had myeloma until being diagnosed with it, so I did not have measuring done during the MGUS or smoldering myeloma phases, and am not sure whether such a comprehensive testing would have been done then. Probably other MGUS patients would be able to tell you what is measured on their routine blood tests.
Hope that is helpful!
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: Monitoring gamma globulin level instead of M-spike?
I agree with Nancy. This seems a bit curious of a way to monitor myeloma. Assuming your M-spike is in the gamma region, I don't get the logic of using your total gamma globulin level as a proxy for keeping on top of your monoclonal protein level, especially since M-spike measurements and serum free light chain testing are fairly accurate (except at very low levels), and variations in the "healthy" polyclonal component of your gamma globulin level can and will vary over time. Maybe there's something else that your doctor is considering that is causing him to use this approach?
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Monitoring gamma globulin level instead of M-spike?
Thank you for your answers.
Yes, my tests include total protein, alpha-1 globulin, alpha-2 globulin, beta1 globulin, beta2 globulin, which are standard, and gamma globulin, which my hematologist (professor at the hospital) looks at.
I have also had hemoglobin, platelets, creatinine, creatinuria, etc., which are correct. These last analyzes are from September 2017.
I do not have an IgA IgG IgM dosage in particular.
In December 2016, for B2 microglobulin and the ratio K / L, I had to ask them myself in the laboratory, without prescription.
I did not think gamma globulin included healthy components (I'm not a doctor!),
I have an appointment on November 16th. May I be able to ask the question?
Best regards,
Jacqueline
IgG Kappa
Stage 1 - No treatment
Yes, my tests include total protein, alpha-1 globulin, alpha-2 globulin, beta1 globulin, beta2 globulin, which are standard, and gamma globulin, which my hematologist (professor at the hospital) looks at.
I have also had hemoglobin, platelets, creatinine, creatinuria, etc., which are correct. These last analyzes are from September 2017.
I do not have an IgA IgG IgM dosage in particular.
In December 2016, for B2 microglobulin and the ratio K / L, I had to ask them myself in the laboratory, without prescription.
I did not think gamma globulin included healthy components (I'm not a doctor!),
I have an appointment on November 16th. May I be able to ask the question?
Best regards,
Jacqueline
IgG Kappa
Stage 1 - No treatment
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Jacqueline - Name: Jacqueline
- When were you/they diagnosed?: november 2010
- Age at diagnosis: 53
Re: Monitoring gamma globulin level instead of M-spike?
Jacqueline,
The protein levels reported in a serum electrophoresis test (alpha-1 globulin, alpha-2 globulin, beta1 globulin, beta2 globulin and gamma globulin) don't differentiate between monoclonal (cancerous) and non-monoclonal (healthy) levels.
Assuming your M-spike is in the gamma region, your gamma globulin level will in most cases be roughly the sum of both your healthy gamma globulin level (which is usually largely made up of most of your healthy IgA, IgG, IgM, IgD and IgE immunoglobulins) and your M-spike. That's why it strikes me as odd that your doctor would want to use your total gamma globulin level instead of your M-spike to track your disease.
To better understand all this, look at this electophoresis graph where you can clearly see that the total gamma (γ) value = the normal healthy gamma globulin level + the M-spike .
I will be curious to find out what you hear from your doctor on this matter.
The protein levels reported in a serum electrophoresis test (alpha-1 globulin, alpha-2 globulin, beta1 globulin, beta2 globulin and gamma globulin) don't differentiate between monoclonal (cancerous) and non-monoclonal (healthy) levels.
Assuming your M-spike is in the gamma region, your gamma globulin level will in most cases be roughly the sum of both your healthy gamma globulin level (which is usually largely made up of most of your healthy IgA, IgG, IgM, IgD and IgE immunoglobulins) and your M-spike. That's why it strikes me as odd that your doctor would want to use your total gamma globulin level instead of your M-spike to track your disease.
To better understand all this, look at this electophoresis graph where you can clearly see that the total gamma (γ) value = the normal healthy gamma globulin level + the M-spike .
- M-spike.png (14.7 KiB) Viewed 3087 times
I will be curious to find out what you hear from your doctor on this matter.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Monitoring gamma globulin level instead of M-spike?
Hello Jacqueline,
Thanks for telling us more about how you are tested.
I can see that Multibilly has specifically answered as to how measuring the monoclonal protein is helpful for tracking any level of multiple myeloma. Of course, in my opinion, you should be able to ask your physician any pertinent question to your diagnosis. Even to gain better understanding of the physician's thought processes, it would give you peace of mind!
Thanks for telling us more about how you are tested.
I can see that Multibilly has specifically answered as to how measuring the monoclonal protein is helpful for tracking any level of multiple myeloma. Of course, in my opinion, you should be able to ask your physician any pertinent question to your diagnosis. Even to gain better understanding of the physician's thought processes, it would give you peace of mind!
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: Monitoring gamma globulin level instead of M-spike?
Hello,
I saw my hematologist yesterday. The consultation lasted exactly 15 minutes.
I asked the question, the doctor made a small sketch, and I admit that I had to write the explanation in speed (one sentence). I could ask another question just as he pushed me to the exit. It's frustrating.
For him, the sliders (cursors) measure the area under the curve, and it is not extremely precise. We narrow the sliders to have the 2 digits, but, as I understand it, the result for the M-spike would not be accurate. After consultation I did not really remember anymore.
The doctor considers me stable, because he has compared the number of gammaglobulins + spike of September 2016, which was 20.8 g / l (2.08 g/dL) to that of September 2017. which is 20.3 g / l (2.03 g/dL) (the M Spike of September 2016 was 18.1 g / L).
Regards,
Jacqueline
I saw my hematologist yesterday. The consultation lasted exactly 15 minutes.
I asked the question, the doctor made a small sketch, and I admit that I had to write the explanation in speed (one sentence). I could ask another question just as he pushed me to the exit. It's frustrating.
For him, the sliders (cursors) measure the area under the curve, and it is not extremely precise. We narrow the sliders to have the 2 digits, but, as I understand it, the result for the M-spike would not be accurate. After consultation I did not really remember anymore.
The doctor considers me stable, because he has compared the number of gammaglobulins + spike of September 2016, which was 20.8 g / l (2.08 g/dL) to that of September 2017. which is 20.3 g / l (2.03 g/dL) (the M Spike of September 2016 was 18.1 g / L).
Regards,
Jacqueline
- gamma-v2.jpg (84.35 KiB) Viewed 2856 times
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Jacqueline - Name: Jacqueline
- When were you/they diagnosed?: november 2010
- Age at diagnosis: 53
Re: Monitoring gamma globulin level instead of M-spike?
Hello Jacqueline,
The article listed below may help explain things but I hope won't confuse you further. Although the topic of the article is to propose a new method for estimating M-spike, it provides a good explanation of how M-spike is determined. The PDF version of the article (available at the link below) shows the illustrations clearly.
Zhang, S, et al., "Improved Method for Estimating M-Spike Proteins in Serum Protein Electrophoresis," Journal of Clinical & Experimental Pathology, June 26, 2014 (full text of article)
As Multibilly explained, all of the normal, "good", polyclonal immunoglobulins will be spread out in the area marked on your graph with the monoclonal immunoglobulins clustering to make the dark line at the far right of the multiple lines. The intensity of the lines is measured and displayed graphically. As you can imagine, there can be some interpretation issues by the lab regarding the M-spike, but a significant infection that raises your good, polyclonal IgA, IgG and/or IgM will make the total number go up independently from your monoclonal IgG that is producing the spike.
Hope this helps.
Steve
The article listed below may help explain things but I hope won't confuse you further. Although the topic of the article is to propose a new method for estimating M-spike, it provides a good explanation of how M-spike is determined. The PDF version of the article (available at the link below) shows the illustrations clearly.
Zhang, S, et al., "Improved Method for Estimating M-Spike Proteins in Serum Protein Electrophoresis," Journal of Clinical & Experimental Pathology, June 26, 2014 (full text of article)
As Multibilly explained, all of the normal, "good", polyclonal immunoglobulins will be spread out in the area marked on your graph with the monoclonal immunoglobulins clustering to make the dark line at the far right of the multiple lines. The intensity of the lines is measured and displayed graphically. As you can imagine, there can be some interpretation issues by the lab regarding the M-spike, but a significant infection that raises your good, polyclonal IgA, IgG and/or IgM will make the total number go up independently from your monoclonal IgG that is producing the spike.
Hope this helps.
Steve
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Foundry738 - Name: Biclonal
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 2016
- Age at diagnosis: 67
Re: Monitoring gamma globulin level instead of M-spike?
Thank you very much, Foundry738, for this article, that in fact is very interesting but should be "digested".
So there are two possible approaches, and my hematologist is not wrong in one way, when he told me it was imprecise ?
Measurement of M-spike is clinically important, and all this worries me a little.
Thanks to Multibilly and Nancy for their answers.
Jacqueline
So there are two possible approaches, and my hematologist is not wrong in one way, when he told me it was imprecise ?
Measurement of M-spike is clinically important, and all this worries me a little.
Thanks to Multibilly and Nancy for their answers.
Jacqueline
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Jacqueline - Name: Jacqueline
- When were you/they diagnosed?: november 2010
- Age at diagnosis: 53
Re: Monitoring gamma globulin level instead of M-spike?
Glad to help, Jacqueline.
To clarify, the Zhang article looks at two ways of estimating, or defining, the area to be measured for the M-spike, which is the narrow, obvious area of the curve. Your doctor is looking at the entire amount in the gamma area: the amount between the colored bars in your posting, including the relatively low, wide area to the left of the spike as well as the spike itself. That numerical value is not dependent on how the M-spike is measured. In any case, consistency of measurement is important because trends are as, or more, important than actual values.
Steve
To clarify, the Zhang article looks at two ways of estimating, or defining, the area to be measured for the M-spike, which is the narrow, obvious area of the curve. Your doctor is looking at the entire amount in the gamma area: the amount between the colored bars in your posting, including the relatively low, wide area to the left of the spike as well as the spike itself. That numerical value is not dependent on how the M-spike is measured. In any case, consistency of measurement is important because trends are as, or more, important than actual values.
Steve
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Foundry738 - Name: Biclonal
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 2016
- Age at diagnosis: 67
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