I have now been tracking my results since 2013. My IgM Kappa abnormality has increased almost steadily by 1 g/L (0.1 g/dL) every two and a half years. Never downwards. Just wondering if anybody knows of any research on how quickly IgM MGUS escalates.
I understand that the IgM protein is the larger of the proteins and takes longer to develop. So I'm just wondering if it escalates exponentially, or follows a straight line, or if it's scattered.
Forums
9 posts
• Page 1 of 1
-
Aussie - Name: Assue
- Who do you know with myeloma?: Nil
- When were you/they diagnosed?: 2015
- Age at diagnosis: 37
Re: How do IgM MGUS lab results change during progression?
Hi Aussie,
You wrote "My IgM kappa abnormality has increased almost steadily by 1 g/L (0.1 g/dL) every two and a half years".
Do you mean that your M-spike (paraprotein) is increasing by 1 g/L (0.1 g/dL) every two years?
I'm guessing that's what you mean, but I just want to make sure.
I have to think a bit, and maybe do some reading, before answering your broader question. Others may have relevant studies or first-hand experience they can turn to more immediately to address the question you've asked, and I don't want to discourage them from sharing their perspectives by saying something that isn't fully thought out.
You wrote "My IgM kappa abnormality has increased almost steadily by 1 g/L (0.1 g/dL) every two and a half years".
Do you mean that your M-spike (paraprotein) is increasing by 1 g/L (0.1 g/dL) every two years?
I'm guessing that's what you mean, but I just want to make sure.
I have to think a bit, and maybe do some reading, before answering your broader question. Others may have relevant studies or first-hand experience they can turn to more immediately to address the question you've asked, and I don't want to discourage them from sharing their perspectives by saying something that isn't fully thought out.
Re: How do IgM MGUS lab results change during progression?
Hi TerryH,
You are 100% correct. My M-spike increases 1 g/l (0.1 g/dL) every 2.5 years.
You are 100% correct. My M-spike increases 1 g/l (0.1 g/dL) every 2.5 years.
-
Aussie - Name: Assue
- Who do you know with myeloma?: Nil
- When were you/they diagnosed?: 2015
- Age at diagnosis: 37
Re: How do IgM MGUS lab results change during progression?
Hi Aussie,
Just what level is the value of your current M-spike? A rise of 0.2 g/dL over 5 years is nearly negligible.
Also, it is important not to just focus on one's M-spike, but to also look at other key markers over time, including your involved free light chain value (in your case, your kappa free light chain value) and your free light chain ratio.
Just what level is the value of your current M-spike? A rise of 0.2 g/dL over 5 years is nearly negligible.
Also, it is important not to just focus on one's M-spike, but to also look at other key markers over time, including your involved free light chain value (in your case, your kappa free light chain value) and your free light chain ratio.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: How do IgM MGUS lab results change during progression?
Thanks.
My ratio has remain consistent at 1.06.
Notice in a few post that it's been recommended to monitor the ratio. Why? Isn’t the M-spike one of the main elements in determining your risk profile?
My ratio has remain consistent at 1.06.
Notice in a few post that it's been recommended to monitor the ratio. Why? Isn’t the M-spike one of the main elements in determining your risk profile?
-
Aussie - Name: Assue
- Who do you know with myeloma?: Nil
- When were you/they diagnosed?: 2015
- Age at diagnosis: 37
Re: How do IgM MGUS lab results change during progression?
Yes, an M-spike is important to monitor. But it is also important to monitor your serum free light chains, as well as your hemoglobin, creatinine, and calcium levels, along with your total IgM, IgG and IgA values. This is so you can be on the lookout for any developing organ damage as defined by the myeloma "CRAB" criteria (hyperCalcemia, Renal impairment signaled by high creatinine level, Anemia signaled by low hemoglobin and / or Bone damage detected through imaging) and / or disease progression that is being signaled by an increasing free light chain ratio and / or "immunoparesis" (in your case, that would be low total IgG or low total IgA).
Keeping an eye on both of your free light chain numbers (kappa and lambda), along with their ratio, is important. This is because not everyone's disease presents in the same way, and you can have situations where the free light chains can be going out of kilter while your M-spike can remain fairly stable, or where the M-spike is not ramping up us as dramatically as your involved free light chain or free light chain ratio.
Also, your free light chains don't live as long as the monoclonal heavy chain immunoglobulin that is measured by your M-spike. Therefore, since your free light chains are turning over more quickly than your heavy chains, your involved free light chain number and free light chain ratio can potentially signal disease progression sooner than your M-spike would.
Lastly, high free light chain levels can cause kidney damage, so it behooves your to keep an eye on them.
The reason it is important to also look at the free light chain ratio in addition to the absolute values of the kappa and lambda free light chains is because it is normal to have some amount of free light chains in your blood, and the ratio helps determine the degree of free light chain "clonality" in your blood. Things such as inflammation and infection can affect your free light chain numbers. But if you have a high involved-to-uninvolved free light chain ratio (in your case, kappa/lambda ratio), that high ratio almost always signals that the free light chain imbalance is due to free light chain clonality and not some other "polyclonal" phenomenon such as an infection.
So, it would be helpful if you actually posted what your m-spike, kappa and lambda free light chain, free light chain ratio, creatinine, calcium, hemoglobin, IgG, IgA and IgM values have done over time when wondering if you may be progressing or not. I might also encourage you to chart all these values over time so that you can easily spot any trends that may be developing and to understand just how much your numbers will normally vary over time. This post will give you an idea of how I chart my markers as a smoldering patient:
https://myelomabeacon.org/forum/fenofibrate-tricor-and-multiple-myeloma-t2690-80.html#p52895
Keeping an eye on both of your free light chain numbers (kappa and lambda), along with their ratio, is important. This is because not everyone's disease presents in the same way, and you can have situations where the free light chains can be going out of kilter while your M-spike can remain fairly stable, or where the M-spike is not ramping up us as dramatically as your involved free light chain or free light chain ratio.
Also, your free light chains don't live as long as the monoclonal heavy chain immunoglobulin that is measured by your M-spike. Therefore, since your free light chains are turning over more quickly than your heavy chains, your involved free light chain number and free light chain ratio can potentially signal disease progression sooner than your M-spike would.
Lastly, high free light chain levels can cause kidney damage, so it behooves your to keep an eye on them.
The reason it is important to also look at the free light chain ratio in addition to the absolute values of the kappa and lambda free light chains is because it is normal to have some amount of free light chains in your blood, and the ratio helps determine the degree of free light chain "clonality" in your blood. Things such as inflammation and infection can affect your free light chain numbers. But if you have a high involved-to-uninvolved free light chain ratio (in your case, kappa/lambda ratio), that high ratio almost always signals that the free light chain imbalance is due to free light chain clonality and not some other "polyclonal" phenomenon such as an infection.
So, it would be helpful if you actually posted what your m-spike, kappa and lambda free light chain, free light chain ratio, creatinine, calcium, hemoglobin, IgG, IgA and IgM values have done over time when wondering if you may be progressing or not. I might also encourage you to chart all these values over time so that you can easily spot any trends that may be developing and to understand just how much your numbers will normally vary over time. This post will give you an idea of how I chart my markers as a smoldering patient:
https://myelomabeacon.org/forum/fenofibrate-tricor-and-multiple-myeloma-t2690-80.html#p52895
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: How do IgM MGUS lab results change during progression?
Hi
Just as an example in my case, here are the results of my last four sets of blood work.
Moderator's Note - We generally prefer that people enter their lab results as text in postings, not least because it makes it easier for people to search for results of specific tests. Entering the results into a post also requires an effort to better understand the results, which we want to encourage.
Just as an example in my case, here are the results of my last four sets of blood work.
- AussieLast4Labs.png (153.35 KiB) Viewed 1447 times
Moderator's Note - We generally prefer that people enter their lab results as text in postings, not least because it makes it easier for people to search for results of specific tests. Entering the results into a post also requires an effort to better understand the results, which we want to encourage.
-
Aussie - Name: Assue
- Who do you know with myeloma?: Nil
- When were you/they diagnosed?: 2015
- Age at diagnosis: 37
Re: How do IgM MGUS lab results change during progression?
So, you have an extremely small M-spike to begin with (0.2 to 0.3 g/dL, or 2 to 3 g/l). The accuracy of the SPEP test in measuring M-spikes this small isn't that great and you could easily write off a change of 0.1 g/dL to test inaccuracy or just normal day-to-day fluctuations. Also,given that all of your free light chain numbers are normal, I wouldn't be worrying about progressing until you start to see a sustained and major change in your numbers. Your current numbers barely register the fact that you have MGUS.
However, if your M-spike should get to 0.5 g/dL, you may want to consider discussing a bone marrow biopsy with your doctor, if only for baseline disease progression purposes. I say this based on Dr. Mikhael's recommendation in this article (I encourage you to read the entire article since you have IgM MGUS):
J Mikhael, "Ask the Hematologist: A Diagnostic Approach to Patients with an IgM monoclonal protein", The Hematologist, Sep 15, 2014 (full text of article)
From the article:
"Bone marrow evaluation – Although many patients with MGUS do not require this procedure, in higher-risk cases (M-protein concentration >1.5 gm/dL and IgM-MGUS), bone marrow aspirate and biopsy is recommended and may also include cytogenetic, myeloma FISH, and flow cytometric analyses and targeted gene sequencing. I do not, however, recommended bone marrow analysis for all patients with an M protein. Specifically, I may defer bone marrow analysis in the very elderly, in those in whom the M protein concentration is low (less than 0.5 gm/dL), and in patients with an inflammatory condition, as low risk MGUS is relatively common in these settings.
However, if your M-spike should get to 0.5 g/dL, you may want to consider discussing a bone marrow biopsy with your doctor, if only for baseline disease progression purposes. I say this based on Dr. Mikhael's recommendation in this article (I encourage you to read the entire article since you have IgM MGUS):
J Mikhael, "Ask the Hematologist: A Diagnostic Approach to Patients with an IgM monoclonal protein", The Hematologist, Sep 15, 2014 (full text of article)
From the article:
"Bone marrow evaluation – Although many patients with MGUS do not require this procedure, in higher-risk cases (M-protein concentration >1.5 gm/dL and IgM-MGUS), bone marrow aspirate and biopsy is recommended and may also include cytogenetic, myeloma FISH, and flow cytometric analyses and targeted gene sequencing. I do not, however, recommended bone marrow analysis for all patients with an M protein. Specifically, I may defer bone marrow analysis in the very elderly, in those in whom the M protein concentration is low (less than 0.5 gm/dL), and in patients with an inflammatory condition, as low risk MGUS is relatively common in these settings.
- Myeloma FISH and targeted gene sequencing – Recommended if marrow findings are consistent with multiple myeloma or lymphoma. Finding t(11;14) by cytogenetics or FISH suggests IgM multiple myeloma, and mutant MYD88 supports a diagnosis of Waldenstroms macroglobulinemia.
- Flow cytometry – This analysis is informative in patients suspected of having a B cell lymphoproliferative disorder including CLL, non-Hodgkin lymphoma or Waldenstroms macroglobulinemia."
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: How do IgM MGUS lab results change during progression?
Thank you for the references. I started tracking my results in Excel since 2013. Results stayed consistent for most part. It's just the M-spike that appears to increase every few years. Also had a bone marrow test that came back normal.
Reading comments and some of the references material, I guess the level of increase in my M-spike is not something to get too excited about.
I am not a mathematician, but as I started to notice a trend in the increase of the M-spike, I was wondering if you could extrapolate it as to determine when it may progress into something else.
Reading comments and some of the references material, I guess the level of increase in my M-spike is not something to get too excited about.
I am not a mathematician, but as I started to notice a trend in the increase of the M-spike, I was wondering if you could extrapolate it as to determine when it may progress into something else.
-
Aussie - Name: Assue
- Who do you know with myeloma?: Nil
- When were you/they diagnosed?: 2015
- Age at diagnosis: 37
9 posts
• Page 1 of 1