My myeloma specialist ordered additional blood tests before my last chemo treatment. The lab results included
Lab Test Standard Range My results
Kappa Free Lt Chains 3.30 - 19.40 mg/L 18.11
Lambda Light Chain 5.71 - 26.30 mg/L 15.25
Kappa/Lambda Ratio. 0.26 - 1.65 1.19
IgE 0 - 100 IU/mL. 2407
Based on these numbers, and the fact that my IgG, IgM, IgD and IgA results were within the standard range, it looks to me like my disease is not nonsecretory, but is type IgE, the rarest form of myeloma, I understand from research. I have my next appointment with the myeloma specialist during the third week of November, when I will confirm my suspicion.
Does anyone else in the forums have this type of immunoglobulin? My concern is that it is so rare that targeting it with treatment could be more of a challenge than we anticipated (because of Revlimid sensitivity, I am being treated with the CyBorD (Velcade, cyclophosphamide, dexamethasone) regimen).
Thoughts?
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JinMingDao - Name: Kim
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 46
Re: IgE type multiple myeloma
Hi Kim,
It's nice to hear from you. I hope your latest treatment regimen has not been too hard on you.
I would be cautious about assuming that, just because your IgE level is elevated, your myeloma is now IgE type. I'm neither a physician nor an expert on things related to IgE immunoglobulin, but my impression from a quick look at the literature is that IgE can bounce around quite a bit depending on infections and allergies. So your elevated IgE may be polyclonal, not monoclonal.
It's also my understanding that monoclonal IgE can be picked up on standard serum protein electrophoresis (SPEP) and serum immunofixation electrophoresis (IFE) tests. Did you recently have an SPEP and serum IFE at the same time that you had your free light chain test? If so, does the SPEP report any M-spike whatsoever, and does the serum immunofixation report the presence and type of any monoclonal proteins?
There is a case report in the literature of someone who had IgE myeloma with an IgE serum concentration that was half your level, but the monoclonal IgE did show up on the serum immunofixation test:
S Altinier et al, "An IgE multiple myeloma: Contradictory findings in clinical laboratory testing," Clinica Chimica Acta, Oct 2013 (abstract)
Also, the IgE immunoglobulin molecule consists of heavy chains and light chains just like other immunoglobulins, so I would think that an elevated level of monoclonal IgE should cause your kappa/lambda ratio to be outside the normal range, just as elevated monoclonal IgG, for example, causes the kappa/lambda ratio to be outside the normal range. Yet that's not the case in your recent free light chain results.
Just in case, here is a review that was published a couple years ago that looks at the IgD and IgE multiple myelomas:
S Pandey & RA Kyle, "Unusual Myelomas: A Review of IgD and IgE Variants," Oncology, Aug 15, 2013 (full text)
There also is an overview of that article here:
PG Richardson et al, "IgD and IgE Variants of Myeloma: Valuable Insights and Therapeutic Opportunities," Oncology, Aug 15, 2013 (full text)
But remember ... as one of the reviews state, there have been only about 50 documented cases of IgE multiple myeloma EVER. It's really, really rare.
Good luck!
It's nice to hear from you. I hope your latest treatment regimen has not been too hard on you.
I would be cautious about assuming that, just because your IgE level is elevated, your myeloma is now IgE type. I'm neither a physician nor an expert on things related to IgE immunoglobulin, but my impression from a quick look at the literature is that IgE can bounce around quite a bit depending on infections and allergies. So your elevated IgE may be polyclonal, not monoclonal.
It's also my understanding that monoclonal IgE can be picked up on standard serum protein electrophoresis (SPEP) and serum immunofixation electrophoresis (IFE) tests. Did you recently have an SPEP and serum IFE at the same time that you had your free light chain test? If so, does the SPEP report any M-spike whatsoever, and does the serum immunofixation report the presence and type of any monoclonal proteins?
There is a case report in the literature of someone who had IgE myeloma with an IgE serum concentration that was half your level, but the monoclonal IgE did show up on the serum immunofixation test:
S Altinier et al, "An IgE multiple myeloma: Contradictory findings in clinical laboratory testing," Clinica Chimica Acta, Oct 2013 (abstract)
Also, the IgE immunoglobulin molecule consists of heavy chains and light chains just like other immunoglobulins, so I would think that an elevated level of monoclonal IgE should cause your kappa/lambda ratio to be outside the normal range, just as elevated monoclonal IgG, for example, causes the kappa/lambda ratio to be outside the normal range. Yet that's not the case in your recent free light chain results.
Just in case, here is a review that was published a couple years ago that looks at the IgD and IgE multiple myelomas:
S Pandey & RA Kyle, "Unusual Myelomas: A Review of IgD and IgE Variants," Oncology, Aug 15, 2013 (full text)
There also is an overview of that article here:
PG Richardson et al, "IgD and IgE Variants of Myeloma: Valuable Insights and Therapeutic Opportunities," Oncology, Aug 15, 2013 (full text)
But remember ... as one of the reviews state, there have been only about 50 documented cases of IgE multiple myeloma EVER. It's really, really rare.
Good luck!
Re: IgE type multiple myeloma
Thanks, Cheryl. 50 cases?! Wow! Please see below:
Monoclonal Spike: Not Observed g/dL
eGFR if African American: >60
The eGFR is an estimated value based on the MDRD equation and is calculated using the serum creatinine and the patient's age, race and sex.
Changes in demographic information outside the laboratory's control automatically initiate recalculation. A corrected report will be sent, but the change will not be called to the requestor.
Agreement with the measured GFR is either not validated or poor for certain groups of individuals including:
- Inpatients and patients with acute illness or serious comorbid conditions
- People over 70 years of age
- Pregnant women
- Extremes of body size, muscle mass, or nutritional status
Individuals with an estimated GFR below 60 mL/min/1.73 m2 are classified as having chronic kidney disease and should be educated about their diagnosis and the implications of decreased kidney function.
Is this the lab work you were referring to?
I'll read what you've linked, and think about it / talk about it with my doc. Thanks!
P.S. - Aside from the insomnia, sigh, and the occasional nausea, and stomach upset, it hasn't been too bad so far. I'm only a couple weeks in, so fingers crossed.
Monoclonal Spike: Not Observed g/dL
eGFR if African American: >60
The eGFR is an estimated value based on the MDRD equation and is calculated using the serum creatinine and the patient's age, race and sex.
Changes in demographic information outside the laboratory's control automatically initiate recalculation. A corrected report will be sent, but the change will not be called to the requestor.
Agreement with the measured GFR is either not validated or poor for certain groups of individuals including:
- Inpatients and patients with acute illness or serious comorbid conditions
- People over 70 years of age
- Pregnant women
- Extremes of body size, muscle mass, or nutritional status
Individuals with an estimated GFR below 60 mL/min/1.73 m2 are classified as having chronic kidney disease and should be educated about their diagnosis and the implications of decreased kidney function.
Is this the lab work you were referring to?
I'll read what you've linked, and think about it / talk about it with my doc. Thanks!
P.S. - Aside from the insomnia, sigh, and the occasional nausea, and stomach upset, it hasn't been too bad so far. I'm only a couple weeks in, so fingers crossed.
-
JinMingDao - Name: Kim
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 46
3 posts
• Page 1 of 1