Hello all! I had my SCT in August of 2013 and have been in a good remission since. However, I have been noticing that my monthly protein studies show my IgG protein is increasing about 100 each month. Everything else is steady, and it's still within the normal range, but could the rate of the IgG protein increase be an indicator or predictor of when relapse could happen?
I am currently on 15 mg Revlimid 2 weeks on 2 weeks off and 40 mg/week of dex for maintenance. Velcade gave me SEVERE gastroparesis, so that is not even an option for treatment anymore, but it worked very well during initial therapy after diagnosis.
I don't want to dwell on something that may or may not happen, but I want to be realistic and prepared. Any input would be greatly appreciated.
Forums
10 posts
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Trhose - Who do you know with myeloma?: Myself
- When were you/they diagnosed?: 2/5/2013
- Age at diagnosis: 39
Re: Do consistent IgG increases predict relapse?
Trhose,
To be clear, your M-spike and free light chain readings have held steady while your IgG level has steadily increased?
To be clear, your M-spike and free light chain readings have held steady while your IgG level has steadily increased?
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Do consistent IgG increases predict relapse?
My free light chain increased slightly from June to September, but no M-spike based on September testing.
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Trhose - Who do you know with myeloma?: Myself
- When were you/they diagnosed?: 2/5/2013
- Age at diagnosis: 39
Re: Do consistent IgG increases predict relapse?
Well, a rising IgG level can be caused by other things such as infection, inflammation, etc ... as well as just changing due to normal fluctuations. I honestly don't know if this can also be an indicator of relapse in the absence of a rising M-protein level (I assume you did have an M-spike prior to treatment?). I also don't know if your immune system could still be reconstituting itself after 15 months and that could explain the rising IgG? Maybe somebody else on this forum would have more insight.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Do consistent IgG increases predict relapse?
I think Multibilly is on the right track. If your M-spike (SPEP) and immunofixation keep coming back with no sign of a monoclonal protein, then the increasing level of your IgG is probably due to something else. Or it just may be a coincidence that you hit a string of measurements that look like an upward trend.
The normal range for IgG is pretty large, from 800 to 1600 mg/dl, so that a few consecutive increases can occur without necessarily meaning anything.
Could you perhaps give us a 5 or 6 months of your IgG lab results, just to see how much of a trend there is? I think it's hard for anyone, including a doctor, to say much without seeing those sorts of results.
Also, were you originally diagnosed with IgG myeloma?
The normal range for IgG is pretty large, from 800 to 1600 mg/dl, so that a few consecutive increases can occur without necessarily meaning anything.
Could you perhaps give us a 5 or 6 months of your IgG lab results, just to see how much of a trend there is? I think it's hard for anyone, including a doctor, to say much without seeing those sorts of results.
Also, were you originally diagnosed with IgG myeloma?
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JimNY
Re: Do consistent IgG increases predict relapse?
JimNY,
Yes, I was diagnosed with IgG myeloma.
June 382
August 458
November 577
December 660
Before June, they were dropping and the 382 was the lowest it has been. Between June and September, I was not taking any maintenance meds due to severe nausea and vomiting. I had one dose of Velcade in September which is how they realized how sick it was making me. So I guess it just concerns me that it looks as though it was when my treatment plan changed is when the numbers started to go up.
This disease still confuses me. I'm trying to enjoy my remission, but even my doctors have expressed fear (for lack of a better term) of relapse.
Thank you Multibilly and JimNY for your responses.
Yes, I was diagnosed with IgG myeloma.
June 382
August 458
November 577
December 660
Before June, they were dropping and the 382 was the lowest it has been. Between June and September, I was not taking any maintenance meds due to severe nausea and vomiting. I had one dose of Velcade in September which is how they realized how sick it was making me. So I guess it just concerns me that it looks as though it was when my treatment plan changed is when the numbers started to go up.
This disease still confuses me. I'm trying to enjoy my remission, but even my doctors have expressed fear (for lack of a better term) of relapse.
Thank you Multibilly and JimNY for your responses.
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Trhose - Who do you know with myeloma?: Myself
- When were you/they diagnosed?: 2/5/2013
- Age at diagnosis: 39
Re: Do consistent IgG increases predict relapse?
Your IgG numbers are low, and that could be a result of treatment. Mine have been below normal since treatment and continue that way as I'm on maintenance.
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Stan W. - Name: Stan
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: SMM-April 2012
- Age at diagnosis: 58
Re: Do consistent IgG increases predict relapse?
Hi Trhose,
When you say your free light chain increased slightly, do you mean your free light chain ratio (involved / uninvolved) increased? Is it still in the normal range?
Back to the heavy proteins with this next question - what have your uninvolved heavy proteins been doing over these past several months? In my case, I have IgA myeloma. Following my SCT, my IgA has stayed at the low end of normal, while IgG (which was way low before my SCT) has come up slightly. It is still abnormally low, but the fact that it has increased some is a good sign. My IgM has not changed much and is still very low.
Mike
When you say your free light chain increased slightly, do you mean your free light chain ratio (involved / uninvolved) increased? Is it still in the normal range?
Back to the heavy proteins with this next question - what have your uninvolved heavy proteins been doing over these past several months? In my case, I have IgA myeloma. Following my SCT, my IgA has stayed at the low end of normal, while IgG (which was way low before my SCT) has come up slightly. It is still abnormally low, but the fact that it has increased some is a good sign. My IgM has not changed much and is still very low.
Mike
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mikeb - Name: mikeb
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2009 (MGUS at that time)
- Age at diagnosis: 55
Re: Do consistent IgG increases predict relapse?
The quantititative IgG levels reflect the total IgG circulating in the serum, which includes normal IgG that we all make, as well as myeloma-related IgG (if the patient has IgG myeloma that is active at that time).
Assuming that your serum M-spike has remained negative, I suspect that this is just a rise in your normal IgG production, which likely reflects normal recovery of your immune system post-stem cell transplant, plus perhaps some immunostimulatory effect from Revlimid. This is not a concerning finding at all.
Hope this helps!
Assuming that your serum M-spike has remained negative, I suspect that this is just a rise in your normal IgG production, which likely reflects normal recovery of your immune system post-stem cell transplant, plus perhaps some immunostimulatory effect from Revlimid. This is not a concerning finding at all.
Hope this helps!
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Dr. Adam Cohen - Name: Adam D. Cohen, M.D.
Beacon Medical Advisor
Re: Do consistent IgG increases predict relapse?
Thank you Dr. Cohen. That does help to relieve my worries.
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Trhose - Who do you know with myeloma?: Myself
- When were you/they diagnosed?: 2/5/2013
- Age at diagnosis: 39
10 posts
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