Hello all,
I was diagnosed with IgA myeloma back in 2014. I had a stem cell transplant last June. Labs have been looking great up until last month. Last week's immunofixation electrophoresis (IFE) said "An IgG lambda monoclonal paraprotein is identified".
My IgG has always been low and is still just a little low, being below range. It never showed up on any past IFE. My question is: how come am I now having an IgG lambda monoclonal paraprotein identified and not the IgA that I was originally diagnosed with?
Thank you,
George
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10 posts
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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: Had IgA myeloma, lab test now says IgG lambda?
Hi George,
It sounds like you experienced either an "isotype switch" or you have developed "secondary MGUS" after your transplant. Both of these phenomena happen from time to time (usually post-transplant) and both are generally considered to be good things. See these articles:
Jo, J-C, et al, "Clinical Significance of Immunoglobulin Isotype Switching in Patients with Multiple Myeloma," Blood, ASH 2012 Annual Meeting Abstract 4980, Dec 2012 (full text of abstract)
Zou, D, et al, "Secondary Monoclonal Gammopathy of Undetermined Significance Is Frequently Associated with High Response Rate and Superior Survival in Patients with Plasma Cell Dyscrasias," Biology of Blood and Marrow Transplantation, March 2014 (full text of article)
Andrew in particular has also posted quite a bit about secondary MGUS:
"Secondary MGUS - articles" (forum thread started April 10, 2016)
You would need to chat with your doctor to understand if this is truly an isotype switch as opposed to secondary MGUS (I've never been clear if you can technically have secondary MGUS when the original isotype is no longer present and presumably wiped out by treatment).
It sounds like you experienced either an "isotype switch" or you have developed "secondary MGUS" after your transplant. Both of these phenomena happen from time to time (usually post-transplant) and both are generally considered to be good things. See these articles:
Jo, J-C, et al, "Clinical Significance of Immunoglobulin Isotype Switching in Patients with Multiple Myeloma," Blood, ASH 2012 Annual Meeting Abstract 4980, Dec 2012 (full text of abstract)
Zou, D, et al, "Secondary Monoclonal Gammopathy of Undetermined Significance Is Frequently Associated with High Response Rate and Superior Survival in Patients with Plasma Cell Dyscrasias," Biology of Blood and Marrow Transplantation, March 2014 (full text of article)
Andrew in particular has also posted quite a bit about secondary MGUS:
"Secondary MGUS - articles" (forum thread started April 10, 2016)
You would need to chat with your doctor to understand if this is truly an isotype switch as opposed to secondary MGUS (I've never been clear if you can technically have secondary MGUS when the original isotype is no longer present and presumably wiped out by treatment).
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Had IgA myeloma, lab test now says IgG lambda?
Multibilly,
Thank you very much for all the information. I will be reading this over. I see my local oncologist next week. I forgot to also mention that my SPEP said that there is a faint area of restriction noted in the gamma region. It may be suggestive of a specific immune response or early monoclonal protein.
Thanks again,
George
Thank you very much for all the information. I will be reading this over. I see my local oncologist next week. I forgot to also mention that my SPEP said that there is a faint area of restriction noted in the gamma region. It may be suggestive of a specific immune response or early monoclonal protein.
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: Had IgA myeloma, lab test now says IgG lambda?
Hello George,
You might also have the lab check to see if it the report has a typo in it. I had that happen to me. It was sort of obvious, but it still didn't get caught until the doctor and I challenged it.
Did they also report an M-spike number associated with it?
You might also have the lab check to see if it the report has a typo in it. I had that happen to me. It was sort of obvious, but it still didn't get caught until the doctor and I challenged it.
Did they also report an M-spike number associated with it?
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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: Had IgA myeloma, lab test now says IgG lambda?
Foundry738,
I thought that it was a typo also. I see my local oncologist on Monday. I will ask about that.
My SPEP says there is a faint area of restriction in the gamma region. And it may be suggestive of a specific immune response or early monoclonal protein. Plus suggested to do an IFE to rule out the presence of paraprotein.
The IFE report only says an IgG lambda monoclonal paraprotein is identified.
But no M-spike is shown on the report.
The strange part is that my IgG a few months ago was under 400 and I needed to have an IVIG to raise it. It came up to around 500. Its still under the reference of 657-1610 at 642.
I thought that it was a typo also. I see my local oncologist on Monday. I will ask about that.
My SPEP says there is a faint area of restriction in the gamma region. And it may be suggestive of a specific immune response or early monoclonal protein. Plus suggested to do an IFE to rule out the presence of paraprotein.
The IFE report only says an IgG lambda monoclonal paraprotein is identified.
But no M-spike is shown on the report.
The strange part is that my IgG a few months ago was under 400 and I needed to have an IVIG to raise it. It came up to around 500. Its still under the reference of 657-1610 at 642.
-
Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
Re: Had IgA myeloma, lab test now says IgG lambda?
Hi Castaway,
I had a similar thing happen to me. I was diagnosed in April 2014, had a transplant in October, 2014, then had Revlimid, Velcade, and dexamethasone (RVD) maintenance for six months. I'm currently on Velcade and dexamethasone maintenance only bi-weekly. Three years and counting. IgA light chain myeloma, kappa 12,000 at diagnosis.
About two months after my transplant, (which brought me to a stringent complete response, sCR), I developed oligoclonal banding, which was IgG kappa. At one point I had a small M-spike, but mostly it was too small to quantify. Light chains remained in normal range and ratio. It disappeared after about 6 months. I remained in sCR.
About 3 months ago, a similar thing happened; I developed a tiny IgG lambda M-spike. It lasted only about 6 weeks this time. I remained in sCR. I was pretty upset, as you are, that the myeloma had switched isotopes, and that I would be facing a relapse.
My oncologist told me that 8 percent of people my age (63) have an MGUS, and not to worry. It might stay, it might go, but it was super tiny (as yours seems to be), and really nothing to worry about. He also said that although it is possible, he has never actually seen one type of myeloma switch isotopes and become another. Although he is not a myeloma expert, he does treat a lot of it, and I must say he is a really great doctor. Very knowledgeable. And I live in New York City, so these doctors tend to see a lot of everything, due to the diversity and concentration of population here. My oncologist also said that sometimes when you have an autoimmune disease, MGUS is more common.
And then there's also the other point; that these abnormal findings are really the sign of a robust immune system reconstituting itself, as some articles on the subject attest.
So, bottom line, probably not something to worry about. However, I do understand your concern, and I really did not like seeing this errant finding on my labs and was relieved when it disappeared. I bet yours does, too.
Good luck and keep us updated!
I had a similar thing happen to me. I was diagnosed in April 2014, had a transplant in October, 2014, then had Revlimid, Velcade, and dexamethasone (RVD) maintenance for six months. I'm currently on Velcade and dexamethasone maintenance only bi-weekly. Three years and counting. IgA light chain myeloma, kappa 12,000 at diagnosis.
About two months after my transplant, (which brought me to a stringent complete response, sCR), I developed oligoclonal banding, which was IgG kappa. At one point I had a small M-spike, but mostly it was too small to quantify. Light chains remained in normal range and ratio. It disappeared after about 6 months. I remained in sCR.
About 3 months ago, a similar thing happened; I developed a tiny IgG lambda M-spike. It lasted only about 6 weeks this time. I remained in sCR. I was pretty upset, as you are, that the myeloma had switched isotopes, and that I would be facing a relapse.
My oncologist told me that 8 percent of people my age (63) have an MGUS, and not to worry. It might stay, it might go, but it was super tiny (as yours seems to be), and really nothing to worry about. He also said that although it is possible, he has never actually seen one type of myeloma switch isotopes and become another. Although he is not a myeloma expert, he does treat a lot of it, and I must say he is a really great doctor. Very knowledgeable. And I live in New York City, so these doctors tend to see a lot of everything, due to the diversity and concentration of population here. My oncologist also said that sometimes when you have an autoimmune disease, MGUS is more common.
And then there's also the other point; that these abnormal findings are really the sign of a robust immune system reconstituting itself, as some articles on the subject attest.
So, bottom line, probably not something to worry about. However, I do understand your concern, and I really did not like seeing this errant finding on my labs and was relieved when it disappeared. I bet yours does, too.
Good luck and keep us updated!
Re: Had IgA myeloma, lab test now says IgG lambda?
Hello Ellen,
Thank you for the information. I have a local oncologist who is very good. But my transplant doctor is 200 miles from where I live. So luckily they work together as much as possible to suggest my treatments and talk over my concerns.
My transplant doctor called last night and told me it was too early to really define what is going on. But he has set up an appointment to see me in one month and do labs there at the hospital. I did have a low WBC and ABS Neutrophil count due to taking 4 mg Pomalyst as maintenance. I have been off of the Pomalyst for about 3 weeks and my counts are almost normal again.
Not sure if having my immunizations have anything to do with all this, but I just completed the last series of immunizations.
Again, Thank You!
Thank you for the information. I have a local oncologist who is very good. But my transplant doctor is 200 miles from where I live. So luckily they work together as much as possible to suggest my treatments and talk over my concerns.
My transplant doctor called last night and told me it was too early to really define what is going on. But he has set up an appointment to see me in one month and do labs there at the hospital. I did have a low WBC and ABS Neutrophil count due to taking 4 mg Pomalyst as maintenance. I have been off of the Pomalyst for about 3 weeks and my counts are almost normal again.
Not sure if having my immunizations have anything to do with all this, but I just completed the last series of immunizations.
Again, Thank You!
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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: Had IgA myeloma, lab test now says IgG lambda?
I just thought I would give an update on my IgA, now IgG, multiple myeloma.
I just picked up my lab results and they're pretty much the same again. Kappa and lambda free light chain levels in normal range. SPEP says that there is a faint area of restriction in the gamma region. IFE says gamma globulin protein spike is present indicating an IgG lambda monoclonal paraprotein.
I contacted my local oncologist, and he has no idea why the switch from IgA to IgG has happened. I asked him about doing a bone marrow biopsy, but he said that the report only says a faint area of restriction. And no percentage numbers. So a bone marrow biopsy might not be of help. He basically said we should just continue to wait and watch.
Does anyone have any thoughts about doing a bone marrow biopsy at this point to clarify if I actually do have a switch?
Thank You, George
IgA 153 normal (73-347)
IgG 587 L (657-1610)
IgM 28 L (46-304)
I just picked up my lab results and they're pretty much the same again. Kappa and lambda free light chain levels in normal range. SPEP says that there is a faint area of restriction in the gamma region. IFE says gamma globulin protein spike is present indicating an IgG lambda monoclonal paraprotein.
I contacted my local oncologist, and he has no idea why the switch from IgA to IgG has happened. I asked him about doing a bone marrow biopsy, but he said that the report only says a faint area of restriction. And no percentage numbers. So a bone marrow biopsy might not be of help. He basically said we should just continue to wait and watch.
Does anyone have any thoughts about doing a bone marrow biopsy at this point to clarify if I actually do have a switch?
Thank You, George
IgA 153 normal (73-347)
IgG 587 L (657-1610)
IgM 28 L (46-304)
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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: Had IgA myeloma, lab test now says IgG lambda?
George,
Given that you aren't exhibiting any signs of developing any CRAB symptoms or MDEs and you aren't registering any measurable M-spikes and your free light chain values are normal, what would you or the oncologist do differently at this point if a bone marrow biopsy did confirm an isotype switch? Keep in mind that bone marrow biopsies cost in excess of $10K, have potential medical risks and your doctor has a responsibility to only order those tests that he / she thinks are truly necessary.
Again, remember that isotype switching after a transplant is generally considered to be a good thing prognosis-wise.
Given that you aren't exhibiting any signs of developing any CRAB symptoms or MDEs and you aren't registering any measurable M-spikes and your free light chain values are normal, what would you or the oncologist do differently at this point if a bone marrow biopsy did confirm an isotype switch? Keep in mind that bone marrow biopsies cost in excess of $10K, have potential medical risks and your doctor has a responsibility to only order those tests that he / she thinks are truly necessary.
Again, remember that isotype switching after a transplant is generally considered to be a good thing prognosis-wise.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Had IgA myeloma, lab test now says IgG lambda?
Multibilly,
Thank you for the response.
I guess that I am more curious than anything else. My oncologist has said that he wouldn't worry about it. Just live your life. I also had prostate surgery 1 1/2 years ago to remove the prostate and seminal vesicles. And now my PSA has risen to 0.375. So I'm dealing with two cancers. My oncologist is not wanting me to do prostate radiation due to it being near the pelvic area and the radiation could cause the myeloma to rise or activate.
So I guess it's just wait and continue doing lab work for now. I do have my one-year post-transplant appointment with my transplant doctor in one week. I will bring all this up with him also.
Thanks again,
George
Thank you for the response.
I guess that I am more curious than anything else. My oncologist has said that he wouldn't worry about it. Just live your life. I also had prostate surgery 1 1/2 years ago to remove the prostate and seminal vesicles. And now my PSA has risen to 0.375. So I'm dealing with two cancers. My oncologist is not wanting me to do prostate radiation due to it being near the pelvic area and the radiation could cause the myeloma to rise or activate.
So I guess it's just wait and continue doing lab work for now. I do have my one-year post-transplant appointment with my transplant doctor in one week. I will bring all this up with him also.
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
10 posts
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