Does anyone know how high IgA levels usually are in symptomatic IgA multiple myeloma?
With IgA multiple myeloma, the M-spike is not very accurate in accessing disease burden, but IgA and serum free light chain levels can be followed. Normal IgA is 45-300 mg/dL.
My IgA is currently 1000 mg/dL, up from about 720 mg/dL 15 months ago. I am IgA lambda and also have an elevated lambda FLC of about 100 mg/L (up from about 80 mg/DL). To complicate matters further, I have a biclonal gammopathy, and also have an IgG kappa paraprotein, though this seems to be a more minor issue (m-spike has been stable at about .3 - .4 g/dL).
I am trying to understand when I might become symptomatic from the disease and need active treatment. Obviously many factors are involved, but I wonder if there is a level of IgA at which one would most likely be symptomatic, or at which treatment would be recommended.
I also have results of a Hevylite assay from a few months ago, which showed IgA kappa of .72 g/L (nl .48-2.82), IgA lambda of 7.14 g/L (nl .36-1.98), k/l ratio .10 (nl .80-2.04).
Can anyone who has IgA multiple myeloma, or who is familiar with watching these values help me get a better understanding of what they mean?
Thanks, Ciro
Forums
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ciro - Who do you know with myeloma?: me
- When were you/they diagnosed?: MGUS 2013, SMM Feb 2016
- Age at diagnosis: 62
Re: What IgA levels are common in IgA multiple myeloma?
Ciro,
One doesn't determine if one is symptomatic by one's M-spike (or IgA λ HLC pair, IgA κ/IgA λ ratio). You instead look for signs of end-organ damage developing (as defined by the CRAB criteria), or by an increasing FLC ratio, increasing bone marrow plasma cell percentage or the presence of one of more focal lesions.
https://myelomabeacon.org/news/2014/10/26/new-multiple-myeloma-diagnostic-criteria/
I'm not a doctor, but I think the best way to help predict if one is moving to symptomatic multiple myeloma with lab tests is to graph one's key markers for the CRAB criteria (calcium, creatinine, hemoglobin). To track monoclonal expansion in the case of IgA-type SMM (expansion may very well indicate that you might be headed to experiencing symptomatic multiple myeloma), I would be graphing my M-spike, IgA λ HLC pair, IgA κ/IgA λ ratio, λ FLC and my FLC ratio. Looking at all of these graphs together should give you a pretty clear picture and indicate whether you are headed to becoming symptomatic. And, of course, you would also be getting imaged from time to time if any lab findings and/or pain warranted getting re-imaged. This is basically what I do as a smoldering patient, although I don't currently have a need for Hevylite testing.
In the case of the Hevylite tests, I don't think that the Hevylite chain test has enough history behind it such that the IMWG can say that any particular set of Hevylite test thresholds would be indicative of a high likelihood that one would progress from SMM to symptomatic multiple myeloma in a set amount of time (unlike the FLC ratio of 60% standard that currently exists in the latest IMWG criteria for symptomatic multiple myeloma that I listed above). But Hevylite certainly seems to be a better way to track IgA clonal expansion in general.
One doesn't determine if one is symptomatic by one's M-spike (or IgA λ HLC pair, IgA κ/IgA λ ratio). You instead look for signs of end-organ damage developing (as defined by the CRAB criteria), or by an increasing FLC ratio, increasing bone marrow plasma cell percentage or the presence of one of more focal lesions.
https://myelomabeacon.org/news/2014/10/26/new-multiple-myeloma-diagnostic-criteria/
I'm not a doctor, but I think the best way to help predict if one is moving to symptomatic multiple myeloma with lab tests is to graph one's key markers for the CRAB criteria (calcium, creatinine, hemoglobin). To track monoclonal expansion in the case of IgA-type SMM (expansion may very well indicate that you might be headed to experiencing symptomatic multiple myeloma), I would be graphing my M-spike, IgA λ HLC pair, IgA κ/IgA λ ratio, λ FLC and my FLC ratio. Looking at all of these graphs together should give you a pretty clear picture and indicate whether you are headed to becoming symptomatic. And, of course, you would also be getting imaged from time to time if any lab findings and/or pain warranted getting re-imaged. This is basically what I do as a smoldering patient, although I don't currently have a need for Hevylite testing.
In the case of the Hevylite tests, I don't think that the Hevylite chain test has enough history behind it such that the IMWG can say that any particular set of Hevylite test thresholds would be indicative of a high likelihood that one would progress from SMM to symptomatic multiple myeloma in a set amount of time (unlike the FLC ratio of 60% standard that currently exists in the latest IMWG criteria for symptomatic multiple myeloma that I listed above). But Hevylite certainly seems to be a better way to track IgA clonal expansion in general.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: What IgA levels are common in IgA multiple myeloma?
Hi Multibilly,
Thanks for your response.
I think I am relatively early in the disease process. All of my labs are normal except for the elevated IgA and free lambda measurements. The imaging studies do not show any focal lesions.
The diagnosis of smoldering multiple myeloma was made on the basis of a bone marrow biopsy showing 5-10% plasma cells, done initially in 2013. A repeat biopsy in 2014 again showed 5-10% PC, but also revealed a high risk genetic profile.
My lambda/kappa ratio is around 10 (though one might question the validity of this because I have an abnormal kappa clone as well as an abnormal lambda clone).
I have been graphing most of the parameters that you mentioned. These graphs reveal that there has been a gradual increase in IgA and free lambda over the past 2 years. This indicates to me that the IgA lambda clone is expanding, but I have no way to judge when this clonal expansion will become significant enough to cause symptoms.
Perhaps the results of the next bone marrow biopsy will be helpful in figuring this out.
I believe that FLC values can be very high in active myeloma (greater than 1000mg/L). I am not sure how high IgA values get, and wondered if anyone might have this information.
Ciro
Thanks for your response.
I think I am relatively early in the disease process. All of my labs are normal except for the elevated IgA and free lambda measurements. The imaging studies do not show any focal lesions.
The diagnosis of smoldering multiple myeloma was made on the basis of a bone marrow biopsy showing 5-10% plasma cells, done initially in 2013. A repeat biopsy in 2014 again showed 5-10% PC, but also revealed a high risk genetic profile.
My lambda/kappa ratio is around 10 (though one might question the validity of this because I have an abnormal kappa clone as well as an abnormal lambda clone).
I have been graphing most of the parameters that you mentioned. These graphs reveal that there has been a gradual increase in IgA and free lambda over the past 2 years. This indicates to me that the IgA lambda clone is expanding, but I have no way to judge when this clonal expansion will become significant enough to cause symptoms.
Perhaps the results of the next bone marrow biopsy will be helpful in figuring this out.
I believe that FLC values can be very high in active myeloma (greater than 1000mg/L). I am not sure how high IgA values get, and wondered if anyone might have this information.
Ciro
Last edited by ciro on Thu Dec 10, 2015 8:33 am, edited 1 time in total.
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ciro - Who do you know with myeloma?: me
- When were you/they diagnosed?: MGUS 2013, SMM Feb 2016
- Age at diagnosis: 62
Re: What IgA levels are common in IgA multiple myeloma?
If you have an M-spike of 0.3-0.4g/dL and a bone marrow plasma percentage (BMPC) of 5-10% and an FLC ratio of 10, then it sounds like you have MGUS, not smoldering multiple myeloma. Your BMPC has to be > 10% to technically be diagnosed with SMM.
A "high" IgA M-spike is considered to be ~ 5 g/dL using the Durie Salmon staging criteria. Doing the math and taking an average "healthy" IgA level of about 200 mg/dL, and adding an IgA M-spike of 5 g/dL (5000 mg/dL), that would give you a total possible IgA of 5200 mg/dL (or more). A "low" IgA M-spike is considered to be < 3 g/dL.
I seem to recall reading about involved FLCs on this forum reaching more than 3000 mg/L.
Again, I don't think there are any specific M-spike levels that will suggest when CRAB might kick in.
A "high" IgA M-spike is considered to be ~ 5 g/dL using the Durie Salmon staging criteria. Doing the math and taking an average "healthy" IgA level of about 200 mg/dL, and adding an IgA M-spike of 5 g/dL (5000 mg/dL), that would give you a total possible IgA of 5200 mg/dL (or more). A "low" IgA M-spike is considered to be < 3 g/dL.
I seem to recall reading about involved FLCs on this forum reaching more than 3000 mg/L.
Again, I don't think there are any specific M-spike levels that will suggest when CRAB might kick in.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: What IgA levels are common in IgA multiple myeloma?
Multibilly,
Thanks so much for your helpful reply.
I think the diagnosis of probable smoldering multiple myeloma was made in my case because of the high risk genetics, and the rising IgA and lambda levels, though I realize that I do not strictly meet the criteria for this diagnosis yet.
I am always hopeful that my levels will stabilize and I will remain in the MGUS category. I am trying to eat well, exercise, and keep the stresses in my life at a reasonable level. Perhaps I will get lucky, and be able to enjoy many years yet of good health.
I did not know about the Durie Salmon staging criteria and this does help with putting the IgA level into perspective.
I greatly admire your ability to grasp the information about this complicated disease, and provide so much help to everyone on this forum.
Thanks again,
Ciro
Thanks so much for your helpful reply.
I think the diagnosis of probable smoldering multiple myeloma was made in my case because of the high risk genetics, and the rising IgA and lambda levels, though I realize that I do not strictly meet the criteria for this diagnosis yet.
I am always hopeful that my levels will stabilize and I will remain in the MGUS category. I am trying to eat well, exercise, and keep the stresses in my life at a reasonable level. Perhaps I will get lucky, and be able to enjoy many years yet of good health.
I did not know about the Durie Salmon staging criteria and this does help with putting the IgA level into perspective.
I greatly admire your ability to grasp the information about this complicated disease, and provide so much help to everyone on this forum.
Thanks again,
Ciro
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ciro - Who do you know with myeloma?: me
- When were you/they diagnosed?: MGUS 2013, SMM Feb 2016
- Age at diagnosis: 62
Re: What IgA levels are common in IgA multiple myeloma?
Ciro,
There was a poll here in the forum a while back that asked about the M-spike people had when they were diagnosed with symptomatic multiple myeloma. You can see the results of the poll here:
https://myelomabeacon.org/forum/weekly-poll-m-spike-at-diagnosis-2014-t3136.html
Obviously, not all of the people who responded had IgA multiple myeloma, but many of them probably did, and I'm not sure why the M-spike at diagnosis would be very different for people with IgA versus IgG myeloma (for example). I know it won't be as accurately measured, but I think it should be distributed about the same as the IgG M-spikes.
To get the total IgA levels corresponding to the M-spikes in the poll results, I would just add about 0.3 g/dL.
Hope this helps a bit.
There was a poll here in the forum a while back that asked about the M-spike people had when they were diagnosed with symptomatic multiple myeloma. You can see the results of the poll here:
https://myelomabeacon.org/forum/weekly-poll-m-spike-at-diagnosis-2014-t3136.html
Obviously, not all of the people who responded had IgA multiple myeloma, but many of them probably did, and I'm not sure why the M-spike at diagnosis would be very different for people with IgA versus IgG myeloma (for example). I know it won't be as accurately measured, but I think it should be distributed about the same as the IgG M-spikes.
To get the total IgA levels corresponding to the M-spikes in the poll results, I would just add about 0.3 g/dL.
Hope this helps a bit.
Re: What IgA levels are common in IgA multiple myeloma?
Thanks, TerryH. This poll is interesting because the m-spikes vary so much in active myeloma; about 40% of folks had an m-spike below 3 g/dl. That was a surprise to me. Ciro
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ciro - Who do you know with myeloma?: me
- When were you/they diagnosed?: MGUS 2013, SMM Feb 2016
- Age at diagnosis: 62
Re: What IgA levels are common in IgA multiple myeloma?
I agree, Ciro. I sometimes see discussions here in the forum where there seems to be an assumption that you have to get to an M-spike of 3.0 g/dL before you're likely to develop CRAB symptoms. That's not the case, as the poll results make clear.
Each patient's disease varies in terms of how much it secretes heavy and light chains, and the disease usually changes over time.
Each patient's disease varies in terms of how much it secretes heavy and light chains, and the disease usually changes over time.
Re: What IgA levels are common in IgA multiple myeloma?
We were told the IgA level wasn't significant however the plasma level (60%) in the bone marrow was the defining factor. No other physical attributes were present. Even though it was technically smoldering, an autologous stem cell transplant (ASCT) was recommended as there'd be a 90% chance of becoming multiple myeloma.
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SK1 - Name: SK
- Who do you know with myeloma?: Spouse
- When were you/they diagnosed?: June 2015
- Age at diagnosis: 62
Re: What IgA levels are common in IgA multiple myeloma?
Hello Ciro
My Mum has IgA lambda light chain myeloma. She was 60 last year. She was diagnosed with MGUS in 2007, although she was not told what this meant or what it could turn in to. Her IgA M-band was 10 g/l (1 g/dL) at the time.
She went back for blood tests every six months for the following 5 years. Her M-band had been slowly rising and in February 2012 it was 41 g/l (4.1 g/dL), and she was diagnosed with symptomatic multiple myeloma. And at this point she was actually told what this meant.
Cut a very long story short, Mum had no conventional treatment for 3 years but was taking various supplements / homeopathy, etc., and then her M-band had risen to about 70 g/l (7 g/dL) and her lambda light chains had taken off and were about 3,000 by March last year and it started to affect her kidneys. Her creatinine was something like 300 / 400.
To save her kidneys, she had 3 months of chemo - Velcade and dex - and this brought her M-band down to less than 3 g/l (0.3 g/dL). Her kappa / lamba ratio returned to normal. Her creatinine dropped to 60, so her kidneys were saved.
It is almost a year since coming off chemo and since then Mum is taking 8 g of curcumin a day.
Hope this helps you. Best of luck.
Mrs C
My Mum has IgA lambda light chain myeloma. She was 60 last year. She was diagnosed with MGUS in 2007, although she was not told what this meant or what it could turn in to. Her IgA M-band was 10 g/l (1 g/dL) at the time.
She went back for blood tests every six months for the following 5 years. Her M-band had been slowly rising and in February 2012 it was 41 g/l (4.1 g/dL), and she was diagnosed with symptomatic multiple myeloma. And at this point she was actually told what this meant.
Cut a very long story short, Mum had no conventional treatment for 3 years but was taking various supplements / homeopathy, etc., and then her M-band had risen to about 70 g/l (7 g/dL) and her lambda light chains had taken off and were about 3,000 by March last year and it started to affect her kidneys. Her creatinine was something like 300 / 400.
To save her kidneys, she had 3 months of chemo - Velcade and dex - and this brought her M-band down to less than 3 g/l (0.3 g/dL). Her kappa / lamba ratio returned to normal. Her creatinine dropped to 60, so her kidneys were saved.
It is almost a year since coming off chemo and since then Mum is taking 8 g of curcumin a day.
Hope this helps you. Best of luck.
Mrs C
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Mrs C
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