Hi All.
This is a great source of information on multiple myeloma! Brilliant resource.
I have just seen my results online after a bone marrow biopsy. As my only symptoms to date have been slight fatigue, to say I am surprised is an understatement!
I guess I am looking for comments as to what these results mean exactly. I am scheduled for a full body MRI next week, so I guess that will tell me if I have full blown or smoldering multiple myeloma. All comments welcome!
Cheers, Craig.
INDICATION / BACKGROUND:
58 year old man who presented to GP with fatigue. Found to have IgG lambda monoclonal protein of 36 g/L with lambda light chains of 98 mg/L. Also had immunoparesis and positive Bence Jones protein on urinalysis. MRI STIR awaited. Bone marrow biopsy for staging.
PERIPHERAL BLOOD:
Haemoglobin 131 g/L
MCV 92 fL
Platelets 219 x 10e9/L
White blood cells 4.8 x 10e9/L
Neutrophils 2.3 x 10e9/L
Monocytes 0.3 x 10e9/L
Eosinophils 0.1 x 10e9/L,
Basophils 0.05 x 10e9/L
Lymphocytes 2.0 x 10e9/L.
Occasional large mononuclear cells ?subtype.
Blood film: a small number of large mononuclear cells with high N:C ratio are seen which are indeterminate in morphology. Reactive lymphocytes are also seen. The large mononuclear cells are likely part of the population of reactive lymphocytes, although several resemble blasts.
BONE MARROW ASPIRATE:
The bone marrow aspirate yielded adequate number of fragments with mild to moderate hypercellularity. M:E RATIO: 1.1:1
Megakaryocytes: adequate numbers of megakaryocytes seen with normal morphology.
Erythropoiesis: erythropoietic hyperplasia with sequential and normoblastic maturation.
Granulopoiesis: sequential maturation observed in granulocytic lineage.
Mildly reduced granulopoiesis.
Other: increased number of plasma cells including immature forms.
Differential Cell Count:
Nucleated red cells 30%
Blasts 3%
Promyelocytes 4%
Myelocytes 8%
Metamyelocytes 4%
Bands 3%
Segmented neutrophils 5%
Monocytes 5%
Eosinophils 2%
Lymphocytes 15%
Plasma cells 21%
SPECIAL STAINS:
Perls Stain: 3+/6. No ring sideroblasts.
COMMENT:
This moderately hypercellular aspirate sample demonstrates increased plasma cell population of approximately 21% consistent with plasma cell myeloma. Correlation required with STIR MRI and the bone marrow trephine report for
further clarification and to guide management.
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Re: I guess this doesn't look good!
Welcome to the forum, Craig. Sorry you have to be here, but glad you found us.
Based on your plasma cell percentage and the fact that you have an M-spike of 36 g/L (3.6 g/dL), it would appear that you have smoldering multiple myeloma, which is not normally treated.
The key to figuring out whether you have symptomatic multiple myeloma is to check whether you have any of the "CRAB" symptoms – high Calcium, Renal (kidney) damage, Anemia, or Bone damage – or one of three signs that you are close to having symptomatic disease (a free light chain ratio over 100, a bone marrow plasma cell percentage more than 60 percent, or more than 1 focal lesion found by MRI)
The labs you shared don't address all these issues, nor do you discuss whether you've had any x-rays that may have detected bone lesions. Of course, the MRI next week will provide more information about your bone health.
Do you know what your
- Serum calcium level is?
- Serum creatinine level is?
- Kappa-lambda or lambda-kappa serum free light chain ratio is?
(Have you had a serum free light chain test? Sometimes, light chain levels are measured based on a urine test. Those are not as helpful as serum free light chain results.)
Your hemoglobin level is above the cutoff for a myeloma diagnosis (115 g/L for males).
My guess is that smoldering myeloma will be your eventual diagnosis, based on your low M-spike and relatively low bone marrow plasma cell percentage. But, as I said, the final diagnosis will depend on answers to some of the questions I've listed above.
Good luck, and please let us know what you find out.
Based on your plasma cell percentage and the fact that you have an M-spike of 36 g/L (3.6 g/dL), it would appear that you have smoldering multiple myeloma, which is not normally treated.
The key to figuring out whether you have symptomatic multiple myeloma is to check whether you have any of the "CRAB" symptoms – high Calcium, Renal (kidney) damage, Anemia, or Bone damage – or one of three signs that you are close to having symptomatic disease (a free light chain ratio over 100, a bone marrow plasma cell percentage more than 60 percent, or more than 1 focal lesion found by MRI)
The labs you shared don't address all these issues, nor do you discuss whether you've had any x-rays that may have detected bone lesions. Of course, the MRI next week will provide more information about your bone health.
Do you know what your
- Serum calcium level is?
- Serum creatinine level is?
- Kappa-lambda or lambda-kappa serum free light chain ratio is?
(Have you had a serum free light chain test? Sometimes, light chain levels are measured based on a urine test. Those are not as helpful as serum free light chain results.)
Your hemoglobin level is above the cutoff for a myeloma diagnosis (115 g/L for males).
My guess is that smoldering myeloma will be your eventual diagnosis, based on your low M-spike and relatively low bone marrow plasma cell percentage. But, as I said, the final diagnosis will depend on answers to some of the questions I've listed above.
Good luck, and please let us know what you find out.
-
JimNY
Re: I guess this doesn't look good!
Hi Jim NY.
Thanks for the reply. Appreciated. I really do hope that it is smoldering multiple myeloma. So far I don't appear to have any CRAB symptoms, but the full body MRI will answer that for sure I guess. I haven't had any x-rays looking for lesions yet either.
Yes, I have had a serum free light chain test. My kappa / lambda ratio is 0.08, which is outside (low) the 0.26 low level:
Serum free kappa light chains:7 mg/L ( 3-19 )
Serum free lambda light chains:98 mg/L ( 6-26 ) H
Serum kappa/lambda ratio:0.08 ( 0.26-1.65 ) L
When you say a ratio of more than 100, I guess that is just the highest number divided by the smallest number, so in my case above, 14? (Or the inverse of 0.08 near enough.)
Creatinine level was OK I think.
Microalbumin urine: 3 mg/L ( < 30 )
Creatinine urine:13.3 mmol/L
Alb/Creat ratio:< 1.0 mg/mmol ( < 2.5 )
Calcium also:
Calcium: 2.32 mmol/L ( 2.10 - 2.55 )
Adjusted Calcium: 2.40 mmol/L ( 2.10 - 2.55 )
Albumin: 33 g/L ( 32 - 48 )
As you can probably tell, I don't really know what I am talking about, and I'm finding this all a steep learning curve!! I am just trying to interpret tests as best I can, but the final meeting with the hematologist will be interesting!!
As I mentioned before, it is great having others in a similar position who are prepared to share their experiences. Thank you all. I will keep this forum informed as I travel the road!
Cheers, Craig.
Thanks for the reply. Appreciated. I really do hope that it is smoldering multiple myeloma. So far I don't appear to have any CRAB symptoms, but the full body MRI will answer that for sure I guess. I haven't had any x-rays looking for lesions yet either.
Yes, I have had a serum free light chain test. My kappa / lambda ratio is 0.08, which is outside (low) the 0.26 low level:
Serum free kappa light chains:7 mg/L ( 3-19 )
Serum free lambda light chains:98 mg/L ( 6-26 ) H
Serum kappa/lambda ratio:0.08 ( 0.26-1.65 ) L
When you say a ratio of more than 100, I guess that is just the highest number divided by the smallest number, so in my case above, 14? (Or the inverse of 0.08 near enough.)
Creatinine level was OK I think.
Microalbumin urine: 3 mg/L ( < 30 )
Creatinine urine:13.3 mmol/L
Alb/Creat ratio:< 1.0 mg/mmol ( < 2.5 )
Calcium also:
Calcium: 2.32 mmol/L ( 2.10 - 2.55 )
Adjusted Calcium: 2.40 mmol/L ( 2.10 - 2.55 )
Albumin: 33 g/L ( 32 - 48 )
As you can probably tell, I don't really know what I am talking about, and I'm finding this all a steep learning curve!! I am just trying to interpret tests as best I can, but the final meeting with the hematologist will be interesting!!
As I mentioned before, it is great having others in a similar position who are prepared to share their experiences. Thank you all. I will keep this forum informed as I travel the road!
Cheers, Craig.
-
smithy09 - Name: Smithy
- When were you/they diagnosed?: Jan 2017
- Age at diagnosis: 58
Re: I guess this doesn't look good!
Just a quick update to my test results, I had a full body MRI scan and they found no bone lesions or any evidence of myeloma symptoms, so I guess I am in the clear for now. I work overseas, so I will have an appointment with the hematologist later this month. Report below:
Date of exam: 17 Jan 2017
Examination(s) included in this report:
MR Whole Body Turbo STIR - DWIBS
INDICATION
58 year old man with 36 g/L of paraprotein and mild anaemia. Possible myeloma. MRI STIR to help determine disease burden and go on treatment.
TECHNIQUE
Coronal STIR, T1 whole body and coronal whole body DWI.
FINDINGS
No suspicious focal STIR hyper-intense/T1 hypo-intense lesion is detected throughout the imaged skeleton. Within the left humeral head a linear focus of STIR hyperintensity is consistent with a prominent vessel. Within the right posterior iliac blade there are two linear foci of STIR hyperintensity which are most consistent with previous bone marrow biopsy. No vertebral compression/pathological fracture or osseous destruction. Modic type 1 reactive marrow signal change about the degenerative L5/S1 intervertebral disc. No periosseous soft tissue mass. Incidental note is made of cholelithiasis. There are several small scattered simple cysts throughout the liver. A simple cortical cyst projected in the upper pole of the right kidney. No other visceral pathology is detected.
INTERPRETATION
No MRI evidence of myeloma.
Date of exam: 17 Jan 2017
Examination(s) included in this report:
MR Whole Body Turbo STIR - DWIBS
INDICATION
58 year old man with 36 g/L of paraprotein and mild anaemia. Possible myeloma. MRI STIR to help determine disease burden and go on treatment.
TECHNIQUE
Coronal STIR, T1 whole body and coronal whole body DWI.
FINDINGS
No suspicious focal STIR hyper-intense/T1 hypo-intense lesion is detected throughout the imaged skeleton. Within the left humeral head a linear focus of STIR hyperintensity is consistent with a prominent vessel. Within the right posterior iliac blade there are two linear foci of STIR hyperintensity which are most consistent with previous bone marrow biopsy. No vertebral compression/pathological fracture or osseous destruction. Modic type 1 reactive marrow signal change about the degenerative L5/S1 intervertebral disc. No periosseous soft tissue mass. Incidental note is made of cholelithiasis. There are several small scattered simple cysts throughout the liver. A simple cortical cyst projected in the upper pole of the right kidney. No other visceral pathology is detected.
INTERPRETATION
No MRI evidence of myeloma.
-
smithy09 - Name: Smithy
- When were you/they diagnosed?: Jan 2017
- Age at diagnosis: 58
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