Hi Gang,
New here, but recently had a checkup that revealed an M-spike and IgG kappa elevated levels. I'm awaiting my marrow results and I am told this could be the key factor, but of course am worried and freaking out. Doc says most likely some type of myeloma, although no bone lesions revealed on standard X-rays, very slight anemia (RBC and WBC normal, HGB slightly low?), normal calcium, Renal good, no sign of kidney issues.
I feel pretty good other than being a bit out of shape (not weight, just inactive). He seems to have already rule out MGUS, but I would love any feedback if you have the same situation. Also wondering about second opinions and when to get one. Sounds like my doc wants to administer treatment ASAP depending on the marrow. Here's what I've got so far:
Kappa FLC is high (also shown in urine): 19.30 mg/dL (ref 0.33-1.94)
Normal Lambda 1.51 mg/dL
High kappa-lambda ratio of 12.78
Urine:
Monoclonal kappa light chain (Bence Jones Proteins)
Trace of monoclonal IgG kappa in urine
Monoclonal band in the gamma region
Trace of albumin detected in electrophoresis pattern
Urine protein normal 50 to 80 mg/24hr at rest. <250 mg/24h following intense exercise (not sure what this is)
IgG is high: 2640 mg/dL (ref 758-1612)
IgM is low: 26 mg/dL (ref 40-233)(doc said he was not concerned about this)
IgA 103 mg/dL
Monoclonal protein 2.2 mg/dL
Monoclonal Protein % 26.2 % (not sure what this means)
Hgb 13.1 gm/dL (up from 12.8 2 months ago, ref 13.7-16.7) was 14.0 in 2006 (I know!)
No immediate signs of kidney failure.
Thanks and chime in if you can. Guess for now I am just reaching out like the rest of you and hope to make sense of all this sooner than later. I've read all I can, but it seems I could be MGUS or smoldering multiple myeloma. It's clear that something is going on and am hoping to get any feedback on treatments, lifestyle and diet habits that may increase my chances of living a long life.
Thanks for your kindness.
Forums
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mid40sIgGKappa - Name: mid40sigGKappa
- Who do you know with myeloma?: being diagnosed
- When were you/they diagnosed?: April 2015
- Age at diagnosis: 45
Re: High IgG & kappa-lambda ratio, awaiting marrow results
HI mid40sIgGKappa,
Welcome to the forum!
It does look like it could be MGUS or SMM - your plasma percentage from your bone marrow biopsy would help confirm that.
Nothing you have said here suggests that you are "symptomatic" yet. Note that in order to be considered anemic by multiple myeloma standards, you need to be at least 2 g/dL lower than the low end of normal (i.e. < 11.4 g/dL if the normal Hgb range is 13.4-18 g/dL).
Unless your plasma percentage is quite high (>60%) from your bone marrow biopsy, the standard IMWG treatment guidelines for multiple myeloma would not suggest you start treatment until you are considered "symptomatic".
The most recent criteria for symptomatic multiple myeloma can be found here:
SV Rajkumar, "New Criteria For The Diagnosis Of Multiple Myeloma And Related Disorders", The Myeloma Beacon, Oct 26, 2014
You may want to also consider getting a PET/CT scan since an MRI or PET/CT is the new standard for imaging for initial multiple myeloma diagnosis (see above article). Xrays can sometimes miss developing lytic lesions and finding a facility that can do a whole-body MRI can be quite challenging, so that is why I might suggest a PET/CT. There is a really good article on multiple myeloma imaging here:
P Kapoor, "To PET or not to PET" (Beacon forum posting,Jul 24, 2014)
A low IgM level coupled with a high IgG level can potentially signal a condition called "immunoparesis", and may lower your overall immunity a bit. But by itself, it is not something that would call for starting multiple myeloma treatment.
A second opinion from a really good multiple myeloma specialist is always a good idea. If you let us know what city you are in, folks on this site can make some recommendations on where to find a multiple myeloma specialist. But I might wait to do this until you have your bone marrow biopsy results back...but certainly before starting any treatment.
Hope this helps and good luck on your bone marrow biopsy results!
Welcome to the forum!
It does look like it could be MGUS or SMM - your plasma percentage from your bone marrow biopsy would help confirm that.
Nothing you have said here suggests that you are "symptomatic" yet. Note that in order to be considered anemic by multiple myeloma standards, you need to be at least 2 g/dL lower than the low end of normal (i.e. < 11.4 g/dL if the normal Hgb range is 13.4-18 g/dL).
Unless your plasma percentage is quite high (>60%) from your bone marrow biopsy, the standard IMWG treatment guidelines for multiple myeloma would not suggest you start treatment until you are considered "symptomatic".
The most recent criteria for symptomatic multiple myeloma can be found here:
SV Rajkumar, "New Criteria For The Diagnosis Of Multiple Myeloma And Related Disorders", The Myeloma Beacon, Oct 26, 2014
You may want to also consider getting a PET/CT scan since an MRI or PET/CT is the new standard for imaging for initial multiple myeloma diagnosis (see above article). Xrays can sometimes miss developing lytic lesions and finding a facility that can do a whole-body MRI can be quite challenging, so that is why I might suggest a PET/CT. There is a really good article on multiple myeloma imaging here:
P Kapoor, "To PET or not to PET" (Beacon forum posting,Jul 24, 2014)
A low IgM level coupled with a high IgG level can potentially signal a condition called "immunoparesis", and may lower your overall immunity a bit. But by itself, it is not something that would call for starting multiple myeloma treatment.
A second opinion from a really good multiple myeloma specialist is always a good idea. If you let us know what city you are in, folks on this site can make some recommendations on where to find a multiple myeloma specialist. But I might wait to do this until you have your bone marrow biopsy results back...but certainly before starting any treatment.
Hope this helps and good luck on your bone marrow biopsy results!
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: High IgG & kappa-lambda ratio, awaiting marrow results
Hi Multibilly,
Thanks for the quick response, article link and feedback.
Based on what I read in this article, it looks as if the plasma percentage could be up to 60? I understood it to be anything over 10% to indicate SMM or multiple myeloma. But I guess this early on I don't have the info yet, or much of a baseline to compare to, as many of the tests were only done on the second go-around, after the presence of the initial protein.
A CT scan does seem like the next step though get a closer look. It seems like that's something they would "offer" - or should I be demanding it?
I am in Seattle and seeing a physician on the east side. I won't post the name of course, but this is his criteria. So I'm guessing I need to seek out a more specialized myeloma physician? Guess I'm a bit new to the lingo of doctor qualifications. I was referred to him by my GP after my long overdue annual physical.
Thanks again, and I will update once results are in. See below
Information about current physician
Medical Oncologist
Clinical Expertise
Board Certified Medical Oncology
Primarily sees patients with gastrointestinal or lung cancers, as well as genitourinary and head/neck cancers.
He does not see patients with breast or gynecologic malignancies.
Board Certified Hematology
Sees patients with benign and malignant hematologic disorders.
Thanks for the quick response, article link and feedback.
Based on what I read in this article, it looks as if the plasma percentage could be up to 60? I understood it to be anything over 10% to indicate SMM or multiple myeloma. But I guess this early on I don't have the info yet, or much of a baseline to compare to, as many of the tests were only done on the second go-around, after the presence of the initial protein.
A CT scan does seem like the next step though get a closer look. It seems like that's something they would "offer" - or should I be demanding it?
I am in Seattle and seeing a physician on the east side. I won't post the name of course, but this is his criteria. So I'm guessing I need to seek out a more specialized myeloma physician? Guess I'm a bit new to the lingo of doctor qualifications. I was referred to him by my GP after my long overdue annual physical.
Thanks again, and I will update once results are in. See below
Information about current physician
Medical Oncologist
Clinical Expertise
Board Certified Medical Oncology
Primarily sees patients with gastrointestinal or lung cancers, as well as genitourinary and head/neck cancers.
He does not see patients with breast or gynecologic malignancies.
Board Certified Hematology
Sees patients with benign and malignant hematologic disorders.
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mid40sIgGKappa - Name: mid40sigGKappa
- Who do you know with myeloma?: being diagnosed
- When were you/they diagnosed?: April 2015
- Age at diagnosis: 45
Re: High IgG & kappa-lambda ratio, awaiting marrow results
So, a normal blood plasma % is usually under 5%. You are right that if it is over 10%, then that would qualify you as having smoldering multiple myeloma. But if it is >60%, then you would technically be classified as symptomatic, since this level is now considered a "Myeloma Defining Event" (MDE). One's plasma % can actually go quite a bit higher than 60%.
But I bet your percentage is nowhere close to 60% given your other numbers ... and it could be less than 10%.
In Seattle, you have access to some really great multiple myeloma specialists at the Seattle Cancer Care Alliance, including Dr. Edward Libby, who is a regular contributor to this forum.
http://www.seattlecca.org/diseases/multiple-myeloma-doctors.cfm
But I bet your percentage is nowhere close to 60% given your other numbers ... and it could be less than 10%.
In Seattle, you have access to some really great multiple myeloma specialists at the Seattle Cancer Care Alliance, including Dr. Edward Libby, who is a regular contributor to this forum.
http://www.seattlecca.org/diseases/multiple-myeloma-doctors.cfm
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: High IgG & kappa-lambda ratio, awaiting marrow results
Thanks for the info. They are right down the street from me. The doctor I have been seeing is associated with SCC but on the east side. But it looks like the Seattle office has more multiple myeloma specialists, so perhaps a good option for that second opinion.
A bit off topic - I thought I would run this by you and, although it seems unlikely, but I am reading more and more articles that suggest there is a small chance my condition could be allergy related or perhaps IBS. I have a history of gas / bloating and occasional-to-frequent abdominal discomfort when eating just about anything (along with regular airy and / or greasy stool) and, quite frankly, have never had the best eating habits.
Additionally, I have a history of nasal / upper sinus allergies that have been more prevalent since moving into my current location 2 years ago. From what I understand, both of these issues can contribute to high IgG levels, although I have no idea what subclass mine are in, only that IgG is most common with multiple myeloma.
Looking into other reasons of course is probably just my way of coping until full lab results are in, but perhaps there is some significance to this which should be explored with a gas doctor or allergist. Not really sure.
Thanks for any input you are willing to give on this and I greatly appreciate again your replies.
A bit off topic - I thought I would run this by you and, although it seems unlikely, but I am reading more and more articles that suggest there is a small chance my condition could be allergy related or perhaps IBS. I have a history of gas / bloating and occasional-to-frequent abdominal discomfort when eating just about anything (along with regular airy and / or greasy stool) and, quite frankly, have never had the best eating habits.
Additionally, I have a history of nasal / upper sinus allergies that have been more prevalent since moving into my current location 2 years ago. From what I understand, both of these issues can contribute to high IgG levels, although I have no idea what subclass mine are in, only that IgG is most common with multiple myeloma.
Looking into other reasons of course is probably just my way of coping until full lab results are in, but perhaps there is some significance to this which should be explored with a gas doctor or allergist. Not really sure.
Thanks for any input you are willing to give on this and I greatly appreciate again your replies.
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mid40sIgGKappa - Name: mid40sigGKappa
- Who do you know with myeloma?: being diagnosed
- When were you/they diagnosed?: April 2015
- Age at diagnosis: 45
Re: High IgG & kappa-lambda ratio, awaiting marrow results
I'm not a doc, but you've got a serum M-spike of 2.2 g/dL (your monoclonal reading), so I don't think you can attribute this to an allergy or IBS. Sorry ...
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: High IgG & kappa-lambda ratio, awaiting marrow results
Hi there 
I am MGUS with IgG kappa and an elevated kappa / lambda ratio as well.
There are a couple of things I just wanted to add to the excellent information / resources Multibilly provided to you.
First, with the MGUS / smoldering multiple myeloma / multiple myeloma diagnosis, symptoms are not the diagnostic factor; serum and urine labs, bone marrow biopsy, and imaging are what determines your diagnosis. So far, there is no clear cut association as a cause-effect of a monoclonal gammopathy. With lung cancer, if you smoke 2 packs of cigarettes a day, you know you're at a high risk of developing lung cancer. With multiple myeloma, there are weak associations.
Second, I found it really helpful to be constructive when waiting for test results. No matter how calm you ordinarily are, it's really hard to not worry, wonder, or be anxious. But looking at symptoms actually only causes more worry (for me at least). This is not to say you should disregard symptoms, but only to say that they may be indicative of nothing for your monoclonal gammopathy.
Third, I found that it helped me to be better informed so that when I meet with my doctor, I understand what he is telling me and I can be an active part in my health with my doctor.
I would encourage you to stay close to the Myeloma Beacon because there are truly excellent, well-informed articles and studies on this site. Avail yourself of them. Read as much as you can so you can learn better what the mechanisms are when an m-spike is detected. I have found that this is a very complex process and there are a myriad of ways this process manifests itself. It doesn't hurt at this time to start learning about it.
And that brings me to my final point: it seems no two people are exactly the same. I've seen some people with a relatively low m-spike have numerous lytic lesions and be diagnosed with multiple myeloma, and yet I've seen others who have lots of symptoms and a higher m-spike and they're diagnosed MGUS and low risk. You just never know. That's why it's important to learn the most you can for your particular situation.
Personally, I also found crossword puzzles helped a lot when I'm waiting for test results
I am MGUS with IgG kappa and an elevated kappa / lambda ratio as well.
There are a couple of things I just wanted to add to the excellent information / resources Multibilly provided to you.
First, with the MGUS / smoldering multiple myeloma / multiple myeloma diagnosis, symptoms are not the diagnostic factor; serum and urine labs, bone marrow biopsy, and imaging are what determines your diagnosis. So far, there is no clear cut association as a cause-effect of a monoclonal gammopathy. With lung cancer, if you smoke 2 packs of cigarettes a day, you know you're at a high risk of developing lung cancer. With multiple myeloma, there are weak associations.
Second, I found it really helpful to be constructive when waiting for test results. No matter how calm you ordinarily are, it's really hard to not worry, wonder, or be anxious. But looking at symptoms actually only causes more worry (for me at least). This is not to say you should disregard symptoms, but only to say that they may be indicative of nothing for your monoclonal gammopathy.
Third, I found that it helped me to be better informed so that when I meet with my doctor, I understand what he is telling me and I can be an active part in my health with my doctor.
I would encourage you to stay close to the Myeloma Beacon because there are truly excellent, well-informed articles and studies on this site. Avail yourself of them. Read as much as you can so you can learn better what the mechanisms are when an m-spike is detected. I have found that this is a very complex process and there are a myriad of ways this process manifests itself. It doesn't hurt at this time to start learning about it.
And that brings me to my final point: it seems no two people are exactly the same. I've seen some people with a relatively low m-spike have numerous lytic lesions and be diagnosed with multiple myeloma, and yet I've seen others who have lots of symptoms and a higher m-spike and they're diagnosed MGUS and low risk. You just never know. That's why it's important to learn the most you can for your particular situation.
Personally, I also found crossword puzzles helped a lot when I'm waiting for test results
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Toni - Name: Toni
- Who do you know with myeloma?: self - MGUS
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 51
Re: High IgG & kappa-lambda ratio, awaiting marrow results
Fair enough, thanks Multibilly
Hi Toni,
Thanks for the encouragement and chiming in. You're right - it's way to easy to drive myself crazy over the preliminary results. If there has ever been a time I have questioned if I am OCD, it is now. At this point, I have looked up every detail of the bloodwork and probably have seen every article (the ones I can understand anyway).
I am preaching to the choir, I'm sure, but it's hard not to want solid answers this early on. But, like you say, each case is different, and being informed is the first step. I will share my results once they are in and am hoping for the best! Meanwhile, it's a great excuse to eliminate alcohol, sugars, get more exercise, etc.
grrrr! Thank you. Oh, I'm of course curious what your M-spike was / is, if you want to share?
Hi Toni,
Thanks for the encouragement and chiming in. You're right - it's way to easy to drive myself crazy over the preliminary results. If there has ever been a time I have questioned if I am OCD, it is now. At this point, I have looked up every detail of the bloodwork and probably have seen every article (the ones I can understand anyway).
I am preaching to the choir, I'm sure, but it's hard not to want solid answers this early on. But, like you say, each case is different, and being informed is the first step. I will share my results once they are in and am hoping for the best! Meanwhile, it's a great excuse to eliminate alcohol, sugars, get more exercise, etc.
grrrr! Thank you. Oh, I'm of course curious what your M-spike was / is, if you want to share?
Last edited by mid40sIgGKappa on Sat Apr 18, 2015 12:57 am, edited 1 time in total.
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mid40sIgGKappa - Name: mid40sigGKappa
- Who do you know with myeloma?: being diagnosed
- When were you/they diagnosed?: April 2015
- Age at diagnosis: 45
Re: High IgG & kappa-lambda ratio, awaiting marrow results
mid40sIgGKappa,
I am smoldering with a bone marrow plasma value of 11%. You can see all my key numbers here:
https://myelomabeacon.org/forum/fenofibrate-tricor-and-multiple-myeloma-t2690-30.html#p27903
I am smoldering with a bone marrow plasma value of 11%. You can see all my key numbers here:
https://myelomabeacon.org/forum/fenofibrate-tricor-and-multiple-myeloma-t2690-30.html#p27903
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: High IgG & kappa-lambda ratio, awaiting marrow results
Sure, I am IgG kappa, M-spike was 1.1 mg/dL (11 mg/L) and now ranges from 0.85 to 1.1; BMB showed 5-10% involvement; bone scan showed osteopenia; no lytic lesions on x-ray; elevated kappa lambda ratio; low IgM indicating possible immunoparesis.
One thing I will strongly encourage you to do is to seek a consult with a myeloma specialist. It sounds like you have some phenomenal resources available to you within close proximity.
MGUS / S multiple myeloma / multiple myeloma, I have read, account for only 1% of all cancers. So if a generalist sees you, they will not have the kind of experience with this condition as a myeloma specialist has. Even with MGUS, it's important to be followed by someone who has a keen eye for signs of progression, or has a sense for when certain tests need to be run where a generalist won't.
It's ok to be anxious about your tests I was a basket case and these kind folks at Myeloma Beacon put up with my incessant questions and gently encouraged me to pursue a specialist and to have a BMB and other things that were good to get a complete picture. I feel more confident in my knowledge now and thus, I feel like I can "go on with my life"
The bigger picture is that on this board you will meet people who do have multiple myeloma and see how they traverse the road through treatment, many with incredible poise and dignity. It is beyond inspiring. These folks are heroes to me. Many years ago I had a friend who had multiple myeloma, but it was diagnosed too late. I want to be better informed and help others to better informed so that someday we really can find a cure for myeloma.
One thing I will strongly encourage you to do is to seek a consult with a myeloma specialist. It sounds like you have some phenomenal resources available to you within close proximity.
MGUS / S multiple myeloma / multiple myeloma, I have read, account for only 1% of all cancers. So if a generalist sees you, they will not have the kind of experience with this condition as a myeloma specialist has. Even with MGUS, it's important to be followed by someone who has a keen eye for signs of progression, or has a sense for when certain tests need to be run where a generalist won't.
It's ok to be anxious about your tests
I was a basket case and these kind folks at Myeloma Beacon put up with my incessant questions and gently encouraged me to pursue a specialist and to have a BMB and other things that were good to get a complete picture. I feel more confident in my knowledge now and thus, I feel like I can "go on with my life"The bigger picture is that on this board you will meet people who do have multiple myeloma and see how they traverse the road through treatment, many with incredible poise and dignity. It is beyond inspiring. These folks are heroes to me. Many years ago I had a friend who had multiple myeloma, but it was diagnosed too late. I want to be better informed and help others to better informed so that someday we really can find a cure for myeloma.
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Toni - Name: Toni
- Who do you know with myeloma?: self - MGUS
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 51
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