Update:
The doctor said my husband has smoldering multiple myeloma. The PET scan can back with no bone lesions.
The bone marrow test says:
Final Diagnosis: Monoclonal gammopathy of undetermined significance (MGUS)
Extent of BM involvement: 15% of BM elements.
Phenotype: kappa+, CD38+, CD20-, CD19-, CD58-, and CD117-
Normal: FISH study
His most resent blood work results are:
Free Kappa S - 601.6 mg/l, was 712 (went down)
Free Lambda S - 8.3
Kappa/Lambda Ratio - 72.48, was 90 (went down)
Immunofixation Serum *L*M*O (No Monoclonal Protein Detected)
All there blood work is good except:
RBC 4.56 L
MCH 33.5 H
EO% 8.3 H
EO# 0.30 H
Immunoglobulin A 87
Immunoglobulin G 684 L
Immunoglobulin M 20 L
His Gamma Globulins are still low at 0.6
A/G ratio is 3 H
We have an MRI scheduled next week to look at his spine. His back hurting is the only symptoms he is having.
We are somewhat confused because the doctor said the diagnosis is smoldering multiple myeloma, but the report says MGUS.
I have started him on several vitamins and as much organic food and gluten free food as possible. He is feeling a lot better as far as energy.
Forums
Re: High kappa-lambda ratio, no M-spike: is it myeloma?
My husband's last blood test has his kappa free light chain level at 601, down from 713, and his kappa-lambda ratio has dropped to 63 from its earlier 90.
All other levels are in range but on the low side. He is anemic, but not by much. He has a low level of gamma. His BUN and creatinine levels are in range. His uric acid is 7.0. He is on allopurinol and it is still a little elevated. He does not eat a lot of meat. He is eating very healthy and having fruit and vegetable smoothies daily. I have him on some vitamins.
I'm still confused by the fact that, when his bone marrow biopsy report came back reporting a 15 percent bone marrow plasma cell percentage, it said the diagnosis was MGUS, but the doctor said the diagnosis is smoldering multiple myeloma. Which one is it?
His PET scan came back good along with the full body scan. He had an MRI of the lower back yesterday, waiting for the results. His lower back has been hurting for over a year, with numbness in the left leg and foot occasionally.
I would love to keep him smoldering for as long as I can.
Thank you for any information you can share.
JK
All other levels are in range but on the low side. He is anemic, but not by much. He has a low level of gamma. His BUN and creatinine levels are in range. His uric acid is 7.0. He is on allopurinol and it is still a little elevated. He does not eat a lot of meat. He is eating very healthy and having fruit and vegetable smoothies daily. I have him on some vitamins.
I'm still confused by the fact that, when his bone marrow biopsy report came back reporting a 15 percent bone marrow plasma cell percentage, it said the diagnosis was MGUS, but the doctor said the diagnosis is smoldering multiple myeloma. Which one is it?
His PET scan came back good along with the full body scan. He had an MRI of the lower back yesterday, waiting for the results. His lower back has been hurting for over a year, with numbness in the left leg and foot occasionally.
I would love to keep him smoldering for as long as I can.
Thank you for any information you can share.
JK
Re: High kappa-lambda ratio, no M-spike: is it myeloma?
Glad to hear that your husband's kappa free light chain level and kappa-lambda ratio are heading in the right direction. Let's hope those trends continue!
Did your doctor ever explain to you why your husband's initial serum immunofixation test said there were no monoclonal proteins present, but your husband still had an elevated kappa free light chain level and high kappa-lambda ratio? It would be useful to know what caused the apparent contradiction in results.
The bone marrow plasma cell percentage cutoff between MGUS and smoldering myeloma is 10 percent. Everything else being equal, if the percentage is below 10 percent, the diagnosis is MGUS, and if it's above 10 percent, it's smoldering myeloma. The diagnostic criteria for the three different types of MGUS are summarized here:
https://myelomabeacon.org/forum/criteria-for-mgus-diagnosis-t8507.html
The criteria for a smoldering myeloma diagnosis are summarized here:
https://myelomabeacon.org/forum/criteria-for-smoldering-multiple-myeloma-diagnosis-t8506.html
To understand the possible reason for the difference in the pathology MGUS diagnosis and the doctor's smoldering myeloma diagnosis, it's useful to dive a bit deeper into the meaning of the bone marrow plasma cell percentage from the bone marrow biopsy.
The bone marrow plasma cell percentage that matters for a diagnosis is the CLONAL plasma cell percentage. This is the percent of cells in the bone marrow that are monoclonal, or diseased (not healthy), plasma cells. Normal plasma cells are polyclonal.
The clonal plasma cell percentage will always be less than the total plasma cell percentage, because the total percentage includes both clonal and polyclonal cells. People without myeloma or MGUS usually have a total plasma cell percentage of a few percent (maybe 2-4 percent), and the total is all polyclonal cells.
So, it's possible, but not likely, that your husband's TOTAL (clonal plus polyclonal) bone marrow plasma cell percentage was 15 percent, and his clonal percentage was less than 10 percent, which would have justified a diagnosis of MGUS.
This would be the case, however, only if your husband's polyclonal plasma cell percentage were more than 5 percent. That's not very likely, so the pathology diagnosis of MGUS was probably incorrect, and your doctor's diagnosis of smoldering myeloma was correct.
Good luck!
Did your doctor ever explain to you why your husband's initial serum immunofixation test said there were no monoclonal proteins present, but your husband still had an elevated kappa free light chain level and high kappa-lambda ratio? It would be useful to know what caused the apparent contradiction in results.
The bone marrow plasma cell percentage cutoff between MGUS and smoldering myeloma is 10 percent. Everything else being equal, if the percentage is below 10 percent, the diagnosis is MGUS, and if it's above 10 percent, it's smoldering myeloma. The diagnostic criteria for the three different types of MGUS are summarized here:
https://myelomabeacon.org/forum/criteria-for-mgus-diagnosis-t8507.html
The criteria for a smoldering myeloma diagnosis are summarized here:
https://myelomabeacon.org/forum/criteria-for-smoldering-multiple-myeloma-diagnosis-t8506.html
To understand the possible reason for the difference in the pathology MGUS diagnosis and the doctor's smoldering myeloma diagnosis, it's useful to dive a bit deeper into the meaning of the bone marrow plasma cell percentage from the bone marrow biopsy.
The bone marrow plasma cell percentage that matters for a diagnosis is the CLONAL plasma cell percentage. This is the percent of cells in the bone marrow that are monoclonal, or diseased (not healthy), plasma cells. Normal plasma cells are polyclonal.
The clonal plasma cell percentage will always be less than the total plasma cell percentage, because the total percentage includes both clonal and polyclonal cells. People without myeloma or MGUS usually have a total plasma cell percentage of a few percent (maybe 2-4 percent), and the total is all polyclonal cells.
So, it's possible, but not likely, that your husband's TOTAL (clonal plus polyclonal) bone marrow plasma cell percentage was 15 percent, and his clonal percentage was less than 10 percent, which would have justified a diagnosis of MGUS.
This would be the case, however, only if your husband's polyclonal plasma cell percentage were more than 5 percent. That's not very likely, so the pathology diagnosis of MGUS was probably incorrect, and your doctor's diagnosis of smoldering myeloma was correct.
Good luck!
-
Jonah
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