Just a quick question-
When you go in for your 2, 3, or 6 month testing, does your test include all 3 of your immunoglobulins? IgA, IgG, IgM?
The reason why I ask is because mine does not and it is bothering me. I am IgA and when I brought it up to my doctor that I want my immunoglobulins tested along with all the other tests (she does test everything else), she stated she will update it and include testing my IgA in my labs.
When I went and did my last test in December, I noticed she actually did only add IgA BUT not IgG or IgM. She says she knows they are already low.
Shouldn't we be watching IgG and IgM as well since they are suppressed and low? What if they go really low and we don't know. Is there a such thing? Maybe not, and it wouldn't affect me if they did?
Any input on this would be great. I am getting ready to go in again next week for my 2-3 month draws and really need to know if I should be pushing for it or not.
Thank you for your time!
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Re: Immunoglobulin (IgA, IgG, IgM) testing
What tests do you have done regularly, who has recommended that you get those tests done when you do – a PCP, a general oncologist, or a myeloma specialist – and what has the rationale been for the tests and their frequency?
Also, are you currently considered MGUS or smoldering?
Also, are you currently considered MGUS or smoldering?
Re: Immunoglobulin (IgA, IgG, IgM) testing
I am MGUS/borderline smoldering myeloma. I see an oncologist with Kaiser. I have asked for a myeloma specialist but will have to fight that with Kaiser when and if the time comes. For now, I do like my hematologist/oncologists.
I have all the regular testing - blood testing (can't recall what everyone calls them) but I do get CBC, free light testing, M-spike, and IgA (about 4-5 vials of blood draw every 2-3 months), SPEP.
My IgA is usually anywhere between 1650 low to high of 2500. M-spike is 1.3 to 1.5 g/dL (13 to 15 g/L) and I have free light ratios involved.
My concern is since she has NOT been watching my other immunoglobulins; can this cause a problem?
Thanks, Cheryl, for your time!
I have all the regular testing - blood testing (can't recall what everyone calls them) but I do get CBC, free light testing, M-spike, and IgA (about 4-5 vials of blood draw every 2-3 months), SPEP.
My IgA is usually anywhere between 1650 low to high of 2500. M-spike is 1.3 to 1.5 g/dL (13 to 15 g/L) and I have free light ratios involved.
My concern is since she has NOT been watching my other immunoglobulins; can this cause a problem?
Thanks, Cheryl, for your time!
Re: Immunoglobulin (IgA, IgG, IgM) testing
I really can't speak to quantitative immunoglobulin testing as it relates to MGUS or smoldering patients. But since I was diagnosed and proceeded into upfront autologous stem cell transplants, I can say I have been tested for all three immunoglobulins at least monthly, or whenever I send it in.
While it may not be medically necessary, it sure gives me peace of mind. If I'm going to have 13 bone marrow biopsies over 2 years, I'm going to prefer testing on my blood draws.
Mine are still suppressed, but right or wrong, now that they are near normal, I feel my immune system is fairly robust.
While it may not be medically necessary, it sure gives me peace of mind. If I'm going to have 13 bone marrow biopsies over 2 years, I'm going to prefer testing on my blood draws.
Mine are still suppressed, but right or wrong, now that they are near normal, I feel my immune system is fairly robust.
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blueblood - Name: Craig
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: March 2014
- Age at diagnosis: 54
Re: Immunoglobulin (IgA, IgG, IgM) testing
Cslatosch,
Suppressed uninvolved immunoglobulins (immunoparesis) can be a marker for increased risk of progression. So, I therefore like being on top of all my immunoglobulins as a smoldering patient. However, as I understand it, immunoparesis is not used to determine if one is symptomatic or may require treatment unless one is experiencing a lot of infections due to the immunoparesis compromising one's immune system (the "I" in the "CRABI" criteria). So, technically, I guess a doctor could get away without following your uninvolved immunoglobulins until you started developing some infections.
But having said that, the difference in cost of a full quantified IgG / IgA / IgM test versus an IgA test is extremely small. The negotiated amount that an insurance company pays for an IgG / IgA / IgM panel is less than $10, so we aren't talking about an expensive test to begin with. I'm therefore surprised that your doc is pushing back on this. As a smoldering patient, I routinely get my IgG / IgA / IgM tested every 8-10 weeks.
Suppressed uninvolved immunoglobulins (immunoparesis) can be a marker for increased risk of progression. So, I therefore like being on top of all my immunoglobulins as a smoldering patient. However, as I understand it, immunoparesis is not used to determine if one is symptomatic or may require treatment unless one is experiencing a lot of infections due to the immunoparesis compromising one's immune system (the "I" in the "CRABI" criteria). So, technically, I guess a doctor could get away without following your uninvolved immunoglobulins until you started developing some infections.
But having said that, the difference in cost of a full quantified IgG / IgA / IgM test versus an IgA test is extremely small. The negotiated amount that an insurance company pays for an IgG / IgA / IgM panel is less than $10, so we aren't talking about an expensive test to begin with. I'm therefore surprised that your doc is pushing back on this. As a smoldering patient, I routinely get my IgG / IgA / IgM tested every 8-10 weeks.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Immunoglobulin (IgA, IgG, IgM) testing
Thank you for everyone's input. Since it does bother me, I will bring it up again and knowing I am not asking too much it shouldn't be an issue.
Thanks again guys and gals!
Thanks again guys and gals!
Re: Immunoglobulin (IgA, IgG, IgM) testing
Hi cslatosch ,
Before I was referred to a major cancer center that specializes in myeloma, my quantitative immunoglobulin levels were never tested. Based on the two hem/onc specialists that I saw prior to moving my case to the specialty center, it seems that if you have a fairly low M spike (of a common type) and no other concerns, quantitative immunoglobulin levels are not routinely tested.
At this time I have smoldering multiple myeloma (IgG kappa) and developed immunoparesis (uninvolved immunoglobulin IgM levels are below normal) and I'll never know my IgM level when my IgG M spike was 1st found in 2010.
My IgM level was on the lower end of normal Spring 2014 when my 1st quantitative immunoglobulin test took place and during each subsequent workup it dropped further and now ranges in lower 20's (mg/dl). The low normal cutoff is usually 35-43 depending on the lab.
My IgA is in the middle norm range and IgG (involved type in my case) is within norm range sitting at the Hi end of Norm though my "bad" IgG (M spike) subtracted from my full IgG level results in a well below normal functional IgG level.
The low IgM stands out because immunoparesis (the suppression of an uninvolved immunoglobulin) is now known as a risk factor tied to smoldering multiple myeloma progression:
So I'd really like to know if my IgM level was very healthy in 2010 when my M spike which was faint (100 g/d) dropping since then to below normal levels or perhaps my IgM level has always been on the low side my entire life, though selective IgM deficiency is very rare, so likely the IgM suppression is due to my evolving plasma cell dyscrasia,
I'd definitely ask for quantitative immunoglobulin testing because, though the odds are your levels will be fine (there are very few here that seem to have immunoparesis such as my case and, if so, it's usually never only IgM that's low and even if so it's due to treatment effects, not a natural slowing down of only IgM), it would be helpful to have the values to compare over time so that you will have a known base level of each immunoglobulin type.
Good Luck
Before I was referred to a major cancer center that specializes in myeloma, my quantitative immunoglobulin levels were never tested. Based on the two hem/onc specialists that I saw prior to moving my case to the specialty center, it seems that if you have a fairly low M spike (of a common type) and no other concerns, quantitative immunoglobulin levels are not routinely tested.
At this time I have smoldering multiple myeloma (IgG kappa) and developed immunoparesis (uninvolved immunoglobulin IgM levels are below normal) and I'll never know my IgM level when my IgG M spike was 1st found in 2010.
My IgM level was on the lower end of normal Spring 2014 when my 1st quantitative immunoglobulin test took place and during each subsequent workup it dropped further and now ranges in lower 20's (mg/dl). The low normal cutoff is usually 35-43 depending on the lab.
My IgA is in the middle norm range and IgG (involved type in my case) is within norm range sitting at the Hi end of Norm though my "bad" IgG (M spike) subtracted from my full IgG level results in a well below normal functional IgG level.
The low IgM stands out because immunoparesis (the suppression of an uninvolved immunoglobulin) is now known as a risk factor tied to smoldering multiple myeloma progression:
So I'd really like to know if my IgM level was very healthy in 2010 when my M spike which was faint (100 g/d) dropping since then to below normal levels or perhaps my IgM level has always been on the low side my entire life, though selective IgM deficiency is very rare, so likely the IgM suppression is due to my evolving plasma cell dyscrasia,
I'd definitely ask for quantitative immunoglobulin testing because, though the odds are your levels will be fine (there are very few here that seem to have immunoparesis such as my case and, if so, it's usually never only IgM that's low and even if so it's due to treatment effects, not a natural slowing down of only IgM), it would be helpful to have the values to compare over time so that you will have a known base level of each immunoglobulin type.
Good Luck
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pinball - Who do you know with myeloma?: Myself
- When were you/they diagnosed?: 2010 MGUS, 2014 Smoldering
- Age at diagnosis: 39
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