Although on prior immunofixation electrophoresis (IFE) tests two bands of IgA with corresponding kappa light chains were indicated, I am now down to one band, but it is heavy chain only with no corresponding light chain. I gather that having one band is better than having two and that my cancer cells are now producing heavy chain only.
Can anyone tell me what the significance of this is and how it impacts, if at all, the kind of treatment I should be receiving?
I do not see my specialist until the end of February and have not had much luck researching this topic.
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Re: IFE change - now shows IgA heavy chain band only
What is your M-spike value from your SPEP (serum protein electrophoresis)? What are the values of your free light chains from your serum free light chain assay?
Tracking IgA multiple myeloma can be a bit of a challenge because other blood components can be present in the same area on the lab graphs as the IgA immunoglobulin itself.
Tracking IgA multiple myeloma can be a bit of a challenge because other blood components can be present in the same area on the lab graphs as the IgA immunoglobulin itself.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: IFE change - now shows IgA heavy chain band only
There is no M-spike and my kappa/lambda ratio as well as each light chain is normal. I am in near complete remission except, of course, for the IFE result. Even that shows low grade cancer.
I am just wondering about this heavy chain component without corresponding light chain. As far as I can tell, it is not a common occurrence. Thank you for responding.
I am just wondering about this heavy chain component without corresponding light chain. As far as I can tell, it is not a common occurrence. Thank you for responding.
Re: IFE change - now shows IgA heavy chain band only
Well, I'm not a pathologist, but here is my guess as a dangerous layman.
You may have had what is known as oligoclonal banding after treatment, where you had two IgA bands. This is generally a positive sign after treatment of multiple myeloma. Oligoclonal banding can be temporary and can disappear over time, which is why you now only show one IgA band in your IFE.
Now, the fact that the IFE shows the presence of monoclonal IgA may in fact be the result of the issue I alluded to before with detecting and measuring IgA. Namely, that other proteins like transferrin can occupy the same location where one expects to find IgA on an IFE report. So, your IFE could be erroneous in reporting the presence of any monoclonal IgA?
Anyway, this is just a wild ass guess on my part. It sounds like you are in good shape given your SPEP and sFLC results and that you shouldn't worry about this and simply follow up with your doc.
Note that there is a new test called the HevyLite assay that can overcome the challenges of tracking IgA-type multiple myeloma. But I don't think it is widely available to doctors yet. You might want to discuss that test with your doc.
You may have had what is known as oligoclonal banding after treatment, where you had two IgA bands. This is generally a positive sign after treatment of multiple myeloma. Oligoclonal banding can be temporary and can disappear over time, which is why you now only show one IgA band in your IFE.
Now, the fact that the IFE shows the presence of monoclonal IgA may in fact be the result of the issue I alluded to before with detecting and measuring IgA. Namely, that other proteins like transferrin can occupy the same location where one expects to find IgA on an IFE report. So, your IFE could be erroneous in reporting the presence of any monoclonal IgA?
Anyway, this is just a wild ass guess on my part. It sounds like you are in good shape given your SPEP and sFLC results and that you shouldn't worry about this and simply follow up with your doc.
Note that there is a new test called the HevyLite assay that can overcome the challenges of tracking IgA-type multiple myeloma. But I don't think it is widely available to doctors yet. You might want to discuss that test with your doc.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: IFE change - now shows IgA heavy chain band only
Hi mrozdav,
As usual, Multibilly has given you a lot of useful feedback.
The one thing that I would add that might help in sorting things out a bit is a quick question. You wrote in your first posting that, until recently, you've had two IgA heavy light chain bands with kappa light chains on your previous IFE tests. My question is: Was this the case all the way back to the time you were diagnosed? Or did those two bands develop after you had been undergoing treatment for a while.
As usual, Multibilly has given you a lot of useful feedback.
The one thing that I would add that might help in sorting things out a bit is a quick question. You wrote in your first posting that, until recently, you've had two IgA heavy light chain bands with kappa light chains on your previous IFE tests. My question is: Was this the case all the way back to the time you were diagnosed? Or did those two bands develop after you had been undergoing treatment for a while.
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JimNY
Re: IFE change - now shows IgA heavy chain band only
JimNY,
That is a perceptive question. I had two M-spikes even before I started treatment, i.e., while I was smoldering and earlier than that.
That is a perceptive question. I had two M-spikes even before I started treatment, i.e., while I was smoldering and earlier than that.
Re: IFE change - now shows IgA heavy chain band only
Jim did ask a good question. Note that you can also have a biclonal gammopathy (or even a triclonal gammopathy) prior to treatment, or even prior to being symptomatic.
http://allaboutblood.com/2013/09/13/biclonal-gammopathy/
Also, the nature of one's involved gammopathy (i.e., which immunoglobulins are involved) can also evolve over time. There are instances where patients have had an immunoglobulin class switch, where the disease transformed from being something like IgG-type multiple myeloma to being IgA-type multiple myeloma.
As my youngest kid likes to say, "this is all just really messed up"
http://allaboutblood.com/2013/09/13/biclonal-gammopathy/
Also, the nature of one's involved gammopathy (i.e., which immunoglobulins are involved) can also evolve over time. There are instances where patients have had an immunoglobulin class switch, where the disease transformed from being something like IgG-type multiple myeloma to being IgA-type multiple myeloma.
As my youngest kid likes to say, "this is all just really messed up"
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: IFE change - now shows IgA heavy chain band only
If the total IgA level is trending down or now staying stable, this is a good finding. As was very nicely stated by Multibilly, analysis of IgA by M-protein can be complicated on protein electrophoresis as IgA does not "migrate" on the protein electrophoresis as distinctly as do IgG proteins. The amount of IgA kappa may be at such a low level that the immunofixation is not picking up a kappa light chain at this time.
Hopefully this will be confirmed in discussion with your doctor.
Hopefully this will be confirmed in discussion with your doctor.
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Dr. Jason Valent - Name: Jason Valent, M.D.
Beacon Medical Advisor
Re: IFE change - now shows IgA heavy chain band only
Thank you, Dr. Valent.
I am not getting any clear answer to my question, possibly because I have failed to articulate the question properly. I can understand that testing technology limitations may be such that light chain kappa cannot be picked up on the IFE. I accept that as the likelihood in my case.
However, is there a possibility that the predominate cancer clone that now exits after six and a half rounds of Rd is producing only heavy chain IgA? And if so, what does that mean, if anything? My IgA reading is currently 119 . Kappa and lambda readings are normal, as is the kappa/lambda ratio. No M- spike detected.
If anyone else can make a contribution here, I would welcome it.
I am not getting any clear answer to my question, possibly because I have failed to articulate the question properly. I can understand that testing technology limitations may be such that light chain kappa cannot be picked up on the IFE. I accept that as the likelihood in my case.
However, is there a possibility that the predominate cancer clone that now exits after six and a half rounds of Rd is producing only heavy chain IgA? And if so, what does that mean, if anything? My IgA reading is currently 119 . Kappa and lambda readings are normal, as is the kappa/lambda ratio. No M- spike detected.
If anyone else can make a contribution here, I would welcome it.
9 posts
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