She had some pain in her bones for a few years now. Had a rheumatologist look at her and she had arthritis in her finger. Thought that these pains could be related. She had some abdominal discomfort and she was tested for celiac disease by gastro. which showed an elevated IgA level. It was 507 (normal 81-463). This was the end of February. Still had abdominal pain, so went to primary doctor and she was given omeprazole (Prilosec, Losec). He did a work up on her blood. He told her that one of the proteins were elevated and he wanted a hematologist to see her.
It appears that all of her numbers were good. Hematologist stated that she would probably not do anything by looking at the numbers but, since she had bone pain, she wanted a full check up. She had an endoscopic exam for the gastric issue but it came back normal. She had a ton of blood work done. (Results can be seen below!!) Bone marrow biopsy showed 15%. MRI and PET scan to be set up. Second opinion at Yale also to be set up by MD. Skeletal xray and bone density tests were done.
Any help in explaining these tests would be of great help. What do you guys think about all of this??
Thanks ahead of time for any help. 24-hour urine is pending.
July 22, 2015 Results
WBC 4.0 - 10.0 x 1000/uL 8.2
RBC 3.8 - 5.2 M/uL 4.8
Hemoglobin 12.0 - 16.0 g/dL 13.4
Hematocrit 37.0 - 47.0 % 38.4
MCV 78 - 94 fL 80
MCH 27.0 - 33.0 pg 27.9
MCHC 33.0 - 37.0 g/dL 34.9
RDW 10.8 - 14.5 % 12.7
Platelets 150 - 350 x 1000/uL 340
MPV 6.0 - 10.0 fL 7.7
Neutrophils 38 - 71 % 72
Lymphocytes 14 - 46 % 20
Mid Cells 2.0 - 15.0 % 8.4
ANC (Abs Neutrophil Count) 1.0-9.0 x 1000/uL 5.9
Absolute Lymphocyte Count 0.6-4.6 x 1000/uL 1.6
July 28, 2015 Results
WBC 4.0 - 10.0 x 1000/uL 8.2
RBC 3.8 - 5.2 M/uL 4.8
Hemoglobin 12.0 - 16.0 g/dL 12.8
Hematocrit 37.0 - 47.0 % 39.3
MCV 78 - 94 fL 82
MCH 27.0 - 33.0 pg 26.8
MCHC 33.0 - 37.0 g/dL 32.5
RDW 10.8 - 14.5 % 12.7
Platelets 150 - 350 x 1000/uL 310
MPV 6.0 - 10.0 fL 6.4
Neutrophils 38 - 71 % 70
Lymphocytes 14 - 46 % 21
Monocytes 2 - 15 % 6
Eosinophils 0 - 5 % 3
Basophils 0 - 2 % 1
ANC (Abs Neutrophil Count) 1.0-9.0 x 1000/uL 5.7
Absolute Lymphocyte Count 0.6-4.6 x 1000/uL 1.7
July 22, 2015 Results
Glucose 70 - 100 mg/dL 132
Albumin (PEP) 3.5-4.7 g/dL 4.3 g/dL
BUN 7 - 20 mg/dL 6
Creatinine 0.5 - 1.2 mg/dL 0.8
BUN/Creatinine Ratio 10.0 - 20.0 7.5
Anion Gap 7 - 16 13
CO2 22.0 - 30.0 mmol/L 25.5
Chloride 96 - 106 mmol/L 103
Sodium 135 - 145 mmol/L 141
Potassium 3.3 - 5.0 mmol/L 3.6
Calcium 8.8 - 10.2 mg/dL 9.1
Aspartate Aminotransferase (AST) 0 - 34 U/L 14
Alanine Aminotransferase (ALT) 0 - 34 U/L 20
Alkaline Phosphatase 30 - 130 U/L 58
Total Bilirubin <1.20 mg/dL 0.40
Globulin 2.3 - 3.5 g/dL 4.4
A/G Ratio 1.0 - 2.2 0.9
IgG 700 - 1600 mg/dL 1,373
IgA 70 - 400 mg/dL 500
IgM 40 - 230 mg/dL 198
Ig Kappa Free Light Chain 0.33 - 1.94 mg/dL 1.93
Ig Lambda Free Light Chain 0.57 - 2.63 mg/dL 1.40
Kappa/Lambda FLC Ratio 0.26 - 1.65 1.38
Beta-2 Microglobulin (YH) 0.00 - 2.64 mg/L 1.34
Immunofixation Electrophoresis Gel
Interpretation: Monoclonal component detected in the beta region
in serum and characterized as IgA, likely IgA kappa. This component
was not detected by concomitant serum protein electrophoresis (SPEP),
precluding quantification. Suggest twenty-four hour urine collection
to complete evaluation.
Albumin Electrophoresis 3.50 - 4.70 g/dL 4.52
Alpha-1-Globulin 0.10 - 0.30 g/dL 0.23
Alpha-2-Globulin 0.60 - 1.00 g/dL 0.95
Beta Globulin 0.70 - 1.20 g/dL 1.19
Gamma Globulin 0.70 - 1.50 g/dL 1.61
SPEP Interpretation: No discrete abnormal bands. Mild increase in
polyclonal gamma globulins. Recommend correlation with concomitant
serum immunofixation electrophoresis (IFE).
Albumin (EP), Urine, Random 0.04
Alpha-1 Globulins, Urine, Random 0.01
Alpha-2 Globulins, Urine, Random 0.02
Beta Globulins, Urine, Random 0.02
Gamma Globulins, Urine, Random 0.02
UPEP Interpretation, Urine, Random
Interpretation: No abnormal proteins detected in this spot urine
specimen. Recommend correlation with concomitant urine immunofixation
electrophoresis (IFE).
Immunofixation Electrophoresis Urine Random
Interpretation: Faint monoclonal IgA heavy chain detected in this
spot urine specimen. This component was not detected by urine protein
electrophoresis (UPEP), precluding quantification.
eGFR (NON African-American) >60 mL/min/1.73m2 >60
Values under 60mL/min/1.73m2 may indicate CKD if noted for more than
3 months. eGFR is only valid if creatinine is at steady state.
Protein Urine Random <0.16 g/L 0.10
Creatinine, Urine, Random Not Establishd mg/dL cancelled
Creatinine, Urine, Random Not Establishd mg/dL 175
Protein/Creatinine Ratio, Urine, Random <=0.1 mg/mg Cr 0.1
SKELETAL SURVEY July 30, 2015
Comparison: None.
Indication: Monoclonal gammopathy
Technique: AP chest, bilateral AP humerus, lateral skull, lateral
cervical, thoracic and lumbar spine, AP pelvis and bilateral AP femurs.
Findings:
The lungs are clear. The cartilage silhouette is normal. Clips from
prior cholecystectomy are noted. There are clips in the left axilla.
There are no lytic, sclerotic or destructive osseous lesions in the
visualized bones. Phleboliths are noted in the pelvis.
Impression: Unremarkable skeletal survey.
Is there any thing else we should be doing or any other labs need to be done?
Forums
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Re: Wife just diagnosed with smoldering myeloma (age 44)
Welcome to the forum, Cons2000, I'm sorry to hear of your wife's diagnosis. Please keep in mind, though, that her diagnosis is smoldering multiple myeloma, which generally does not require treatment. Only if her disease progresses to what is sometimes called "symptomatic" multiple myeloma, will it be necessary for her to start treatment.
I'm not a doctor, but after looking over your wife's lab results, it seems to me that she barely "qualifies" as having smoldering myeloma. If her bone marrow plasma cell percentage were lower (less than 10 percent, I believe), she would be classified as having an even earlier stage of multiple myeloma known as "monoclonal gammopathy of undetermined significance." This myeloma precursor disease is known for having a very low lifetime probability of progressing to symptomatic multiple myeloma or other related diseases requiring treatment.
Here are some of the key results you want to focus on.
First, you want to look at the lab results that determine whether your wife has any of the so-called "CRAB" symptoms that define, in part, multiple myeloma. These are
C = elevated Calcium in the bone (from the disease damaging the bones)
R = Renal (kidney) damage; the blood creatinine level is good for tracking this
A = Anemia (tracked by the hemoglobin level)
B = Bone lesions (determined by x-rays, MRIs, or other imaging techniques
Your wife does not have results that indicate that she has any of these symptoms. That's great news. You will want to track these lab results going forward. See, for example, how forum member Multibilly, who also has smoldering myeloma, has tracked his results in this forum thread:
https://myelomabeacon.org/forum/fenofibrate-tricor-and-multiple-myeloma-t2690-40.html
The bone marrow plasma cell percentage is also important, as I mentioned earlier. But that is not measured regularly (thankfully!!!).
Next, you want to look at your wife's "M-spike" (monoclonal protein, or the unhealthy immunoglobulin produced by myeloma cells). This is measured in the serum protein electrophoresis (SPEP) and urine protein electrophoresis (UPEP) tests. The immunofixation electrophoresis (IFE), whether blood or urine, also tests for the presence and "type" of this protein (IgG lambda, IgA kappa, etc.), but it does not measure the level of the protein.
Your wife's SPEP, UPEP, and IFE results all point to her having just a very, very low level of the monoclonal protein in her blood. Were it not for her plasma cell percentage being elevated, these SPEP and IFE results probably would suggest there was no immediate source of concern, and the doctor would simply schedule a follow-up set of tests in, say, 3 or 4 months.
An indirect, but sensitive, way to track changes in the M-spike is through the serum free light chain results, which actually are all in the normal range for your wife, although the kappa level is near the upper limit. You will want to watch her free light chain results going forward (and her SPEP and IFE results) to see if there are signs her disease is progressing in any way.
Finally, it's good to track her immunoglobulin levels -- IgG, IgA, and IgM. Because your wife appears to have IgA kappa smoldering myeloma, her IgA level is slightly elevated. This reflects the fact that she has both polyclonal (normal, healthy) IgA and some monoclonal (myeloma-created) IgA. Pay attention to this level in the coming months and years. In patients with IgA myeloma, the M-spike measured with the SPEP test is not always very accurate, so watching the total IgA level is a double check on what might be happening with the M-spike (level of the unhealthy, monoclonal IgA).
Sorry this has gotten so long, and I know it's a lot to digest all at once. I hope this has been helpful, however, and that you'll feel free to ask follow-up questions, if you have any. There are lots of knowledgeable people here in the forum, including doctors, who will be happy to help and provide support.
Best wishes,
Cheryl.
I'm not a doctor, but after looking over your wife's lab results, it seems to me that she barely "qualifies" as having smoldering myeloma. If her bone marrow plasma cell percentage were lower (less than 10 percent, I believe), she would be classified as having an even earlier stage of multiple myeloma known as "monoclonal gammopathy of undetermined significance." This myeloma precursor disease is known for having a very low lifetime probability of progressing to symptomatic multiple myeloma or other related diseases requiring treatment.
Here are some of the key results you want to focus on.
First, you want to look at the lab results that determine whether your wife has any of the so-called "CRAB" symptoms that define, in part, multiple myeloma. These are
C = elevated Calcium in the bone (from the disease damaging the bones)
R = Renal (kidney) damage; the blood creatinine level is good for tracking this
A = Anemia (tracked by the hemoglobin level)
B = Bone lesions (determined by x-rays, MRIs, or other imaging techniques
Your wife does not have results that indicate that she has any of these symptoms. That's great news. You will want to track these lab results going forward. See, for example, how forum member Multibilly, who also has smoldering myeloma, has tracked his results in this forum thread:
https://myelomabeacon.org/forum/fenofibrate-tricor-and-multiple-myeloma-t2690-40.html
The bone marrow plasma cell percentage is also important, as I mentioned earlier. But that is not measured regularly (thankfully!!!).
Next, you want to look at your wife's "M-spike" (monoclonal protein, or the unhealthy immunoglobulin produced by myeloma cells). This is measured in the serum protein electrophoresis (SPEP) and urine protein electrophoresis (UPEP) tests. The immunofixation electrophoresis (IFE), whether blood or urine, also tests for the presence and "type" of this protein (IgG lambda, IgA kappa, etc.), but it does not measure the level of the protein.
Your wife's SPEP, UPEP, and IFE results all point to her having just a very, very low level of the monoclonal protein in her blood. Were it not for her plasma cell percentage being elevated, these SPEP and IFE results probably would suggest there was no immediate source of concern, and the doctor would simply schedule a follow-up set of tests in, say, 3 or 4 months.
An indirect, but sensitive, way to track changes in the M-spike is through the serum free light chain results, which actually are all in the normal range for your wife, although the kappa level is near the upper limit. You will want to watch her free light chain results going forward (and her SPEP and IFE results) to see if there are signs her disease is progressing in any way.
Finally, it's good to track her immunoglobulin levels -- IgG, IgA, and IgM. Because your wife appears to have IgA kappa smoldering myeloma, her IgA level is slightly elevated. This reflects the fact that she has both polyclonal (normal, healthy) IgA and some monoclonal (myeloma-created) IgA. Pay attention to this level in the coming months and years. In patients with IgA myeloma, the M-spike measured with the SPEP test is not always very accurate, so watching the total IgA level is a double check on what might be happening with the M-spike (level of the unhealthy, monoclonal IgA).
Sorry this has gotten so long, and I know it's a lot to digest all at once. I hope this has been helpful, however, and that you'll feel free to ask follow-up questions, if you have any. There are lots of knowledgeable people here in the forum, including doctors, who will be happy to help and provide support.
Best wishes,
Cheryl.
Re: Wife just diagnosed with smoldering myeloma (age 44)
More test results:
Surgical Pathology Report
Final Diagnosis
Bone Marrow, Biopsy and Aspirate
- Plasma cell neoplasm (involving 10-15% of total cellularity)
CBC (7/28/2015), BY REPORT: HGB:12.8 MCV:82 WBC:8.2 PLT:310
Bone Marrow Biopsy
Normocellular marrow for age (50% cellular).
Approximately 10-15% of the cellularity is comprised of plasma cells.
Megakaryocytes are normal in number with normal morphology.
The myeloid:erythroid (M:E) ratio is unremarkable.
Erythroid maturation is normal.
Myeloid maturation is normal.
There is slight eosinophilia.
Prominent lymphoid aggregates are not seen.
Granulomas are not seen.
Reticulin stain reveals that reticulin is not significantly increased.
Trabecular bone is unremarkable.
Immunostains
CD138 positive plasma cells account for 10-15% of cellularity and show kappa restriction by kappa and lambda stains.
Immunoperoxidase studies performed on paraffin sections provide additional diagnostic information not provided by flow cytometry. All stains have functional controls.
Bone Marrow Aspirate
The marrow aspirate smears are adequate.
Megakaryocytes are present and show normal morphology. The myeloid:erythroid (M:E) ratio is approximately 3:1. Erythroid maturation is complete. Myeloid maturation is complete. Prussian blue iron stain shows trace storage iron with no increase in ring sideroblasts.
Aspirate Cell Count
A 225-cell differential count reveals 52% myeloid precursors, 18% erythroid precursors, 6% lymphocytes, 1% monocytes, 4% eosinophils, 1% basophils, 4% promyelocytes, 1% blasts and 13% plasma cells
Flow Cytometry
By report, flow cytometric analysis reveals approximately 0.2% of total cells (always an underestimate of the true percentage for plasma cells) are CD38+ CD45- CD28dim+ CD56dim+ CD117dim+ kappa-restricted plasma cells. No evidence of B cell lymphoproliferative disease
24-Hour Urine Results
Free Kappa Lt Chains,Ur 0.14 - 2.42 mg/dL 0.49
Lambda Quantitative FLC, Urine 0.02 - 0.67 mg/dL 0.03
Kappa/Lambda FLC Ratio, Urine 2.04 - 10.37 16.33
Surgical Pathology Report
Final Diagnosis
Bone Marrow, Biopsy and Aspirate
- Plasma cell neoplasm (involving 10-15% of total cellularity)
CBC (7/28/2015), BY REPORT: HGB:12.8 MCV:82 WBC:8.2 PLT:310
Bone Marrow Biopsy
Normocellular marrow for age (50% cellular).
Approximately 10-15% of the cellularity is comprised of plasma cells.
Megakaryocytes are normal in number with normal morphology.
The myeloid:erythroid (M:E) ratio is unremarkable.
Erythroid maturation is normal.
Myeloid maturation is normal.
There is slight eosinophilia.
Prominent lymphoid aggregates are not seen.
Granulomas are not seen.
Reticulin stain reveals that reticulin is not significantly increased.
Trabecular bone is unremarkable.
Immunostains
CD138 positive plasma cells account for 10-15% of cellularity and show kappa restriction by kappa and lambda stains.
Immunoperoxidase studies performed on paraffin sections provide additional diagnostic information not provided by flow cytometry. All stains have functional controls.
Bone Marrow Aspirate
The marrow aspirate smears are adequate.
Megakaryocytes are present and show normal morphology. The myeloid:erythroid (M:E) ratio is approximately 3:1. Erythroid maturation is complete. Myeloid maturation is complete. Prussian blue iron stain shows trace storage iron with no increase in ring sideroblasts.
Aspirate Cell Count
A 225-cell differential count reveals 52% myeloid precursors, 18% erythroid precursors, 6% lymphocytes, 1% monocytes, 4% eosinophils, 1% basophils, 4% promyelocytes, 1% blasts and 13% plasma cells
Flow Cytometry
By report, flow cytometric analysis reveals approximately 0.2% of total cells (always an underestimate of the true percentage for plasma cells) are CD38+ CD45- CD28dim+ CD56dim+ CD117dim+ kappa-restricted plasma cells. No evidence of B cell lymphoproliferative disease
24-Hour Urine Results
Free Kappa Lt Chains,Ur 0.14 - 2.42 mg/dL 0.49
Lambda Quantitative FLC, Urine 0.02 - 0.67 mg/dL 0.03
Kappa/Lambda FLC Ratio, Urine 2.04 - 10.37 16.33
Re: Wife just diagnosed with smoldering myeloma (age 44)
Your wife is so young; this must be quite a blow to you both. I was just diagnosed in April 2015, and part of my routine has been to chart my test results in a simple spreadsheet. I was wondering if this would help you to start to see the ebbs and flows of the tests easier.
In the first column of the worksheet, I have the name of the test. The second column has the data as to what is the normal range. Then in each column after that I have filled in with my lab results.
After filling in the numbers for my latest lab, I go back and highlight the cell in red for what is over the norm, blue for what is under and if the number is still within range, but shows an unusual change, I highlight the cell in yellow.
This has helped me to see what is my "norm" and reassured me as each month goes by (so far, at least) that the labs do not show that I am progressing in the disease.
I also decided to set up this worksheet in Google Drive, so that I can share it with friends who are in the medical field and my spouse. They are worried for me, so this helps to calm their concerns too, but also allows them to make suggestions of changes I might want to make in eating or rest habits. In other words, it keeps us all a bit calmer after the testing days.
The good news is that there are many options open to your wife, and the treatment is only getting better. The stats from 5, 10, 20 years ago will be changing soon.
Stay encouraged!
In the first column of the worksheet, I have the name of the test. The second column has the data as to what is the normal range. Then in each column after that I have filled in with my lab results.
After filling in the numbers for my latest lab, I go back and highlight the cell in red for what is over the norm, blue for what is under and if the number is still within range, but shows an unusual change, I highlight the cell in yellow.
This has helped me to see what is my "norm" and reassured me as each month goes by (so far, at least) that the labs do not show that I am progressing in the disease.
I also decided to set up this worksheet in Google Drive, so that I can share it with friends who are in the medical field and my spouse. They are worried for me, so this helps to calm their concerns too, but also allows them to make suggestions of changes I might want to make in eating or rest habits. In other words, it keeps us all a bit calmer after the testing days.
The good news is that there are many options open to your wife, and the treatment is only getting better. The stats from 5, 10, 20 years ago will be changing soon.
Stay encouraged!
-
mdeering - Name: Who me?
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: May 2015
- Age at diagnosis: 58
Re: Wife just diagnosed with smoldering myeloma (age 44)
Hi Cons2000:
I would second everything that Cheryl has mentioned.
Let me just add the following: There is a good chance that it would need 10 years + (or more) until it might need to be addressed. Multiple myeloma, however, is very very unpredictable. So get a very good doctor who is a myeloma specialist, and get your wife's blood work done 2-4 times per year.
If you are watching it, and it's moving up very slow, you are in very good shape. If it starts to move up more quickly, then that is the reason that you might have to start one of the treatment regimens. You do not want to let it accelerate, you want to catch it before severe effects kick in. But if your doctor is keeping a close eye on it, then let him (or her) worry about it, and live your life.
Good luck
I would second everything that Cheryl has mentioned.
Let me just add the following: There is a good chance that it would need 10 years + (or more) until it might need to be addressed. Multiple myeloma, however, is very very unpredictable. So get a very good doctor who is a myeloma specialist, and get your wife's blood work done 2-4 times per year.
If you are watching it, and it's moving up very slow, you are in very good shape. If it starts to move up more quickly, then that is the reason that you might have to start one of the treatment regimens. You do not want to let it accelerate, you want to catch it before severe effects kick in. But if your doctor is keeping a close eye on it, then let him (or her) worry about it, and live your life.
Good luck
-
JPC - Name: JPC
5 posts
• Page 1 of 1