[Worrisome_son]

Gamma globulin in urine, but normal SPEP?

by Worrisome_son on Mon Jan 09, 2017 1:59 am

I am new here. I think it is wonderful to have such an informative website dedicated to multiple myeloma!

To begin with, my mother had some signs/symptoms of multiple myeloma recently, which became worrisome to me after analyzing some of her initial lab readings and symptoms.

Long story short:

She is currently 54 years old and has been complaining of lower back pain for multiple years now (~6-8 years), with previous x-rays showing no abnormalities according to her PCP (most recent was 5 years ago). I recently saw her PCP because her pain became unbearable and we want to know its underlying etiology. The pain fluctuates, as it has for years now.

Recent (abnormal) basic metabolic panel (BMP) indicated a total protein of 8.3, albumin 4.6, and a calcium 10.3, among other values within normal limits.

Further tests show gamma globulin was "detected" in the urine, while no Bence Jones protein (M-protein) were detected (and all other proteins were not detected). No quantitative values were indicated on this urine protein electrophoresis.

Then, the serum protein electrophoresis (SPEP) indicated everything within normal range, with no spike in gamma globulin ... as one may expect according to the urine analysis mentioned above.

I am going to request a CBC with differential and eventually a bone marrow biopsy. I was just wanting to know what you guys thought about these readings.

I guess I am most confused with the gamma globulin being detected with the urine protein electrophoresis, while the serum protein electrophoresis shows no abnormalities.

Thanks in advance.

[Multibilly]

Re: Gamma globulin in urine, but normal SPEP?

by Multibilly on Mon Jan 09, 2017 10:49 am

Hi Worrisome,

If your mom has pain in her spine, I would first be thinking of getting an MRI of her spine to see what kind of damage is causing her pain. Myeloma-related spinal damage is usually pretty easy to pick up on an MRI and is more sensitive than an x-ray in detecting myeloma-related bone issues.

It's good that her SPEP was clean and that she has no Bence Jones proteins in her urine (assuming it was a 24-hour urine test). However, for completeness in testing for a plasma cell disorder such as myeloma, I would suggest also getting a serum immunofixation, quantitative immunoglobulin, and a serum free light chain assay when you do the CBC. I think any oncologist worth his salt would want to see the results from the previous tests and these additional tests before agreeing to a bone marrow biopsy, given that no test has yet definitively suggested the presence of a plasma cell disorder.

Also, was the urine test a 24-hour test or a spot random sample test? You really want a 24-hour urine test when it comes to screening for things like myeloma. Usually, 24-hour urine tests will quantify the percentages of the various proteins found in one's urine.

[JimNY]

Re: Gamma globulin in urine, but normal SPEP?

by JimNY on Mon Jan 09, 2017 3:52 pm

I agree with all of Multibilly's points. But I'm also confused by your main question, Worrisome. I don't believe it's uncommon for a urine protein electrophoresis to list gamma globulin as present in the urine. See, for example, the UPEP results listed in these threads:

https://myelomabeacon.org/forum/help-understanding-my-upep-t5714.html
https://myelomabeacon.org/forum/urine-protein-electrophoresis-t3665.html

So I guess I'm not seeing any reason why having gamma globulin in the urine would be a contradiction to an SPEP test result showing no monoclonal protein.