[CMolinaro]

Lab Results help

by CMolinaro on Sat May 11, 2013 6:41 pm

Hello, so Im 35 with iga kappa multiple myeloma and have been is remission for 3 years following two auto scts. Ive received my lab results and my doctor is saying that my multiple myeloma is becoming active again even though Im still in remission. Can you guys let me know what you gather from my results?

 
Free K+L Lt Chains,Qn,S
 

Test Low Normal High Reference Range Units
Free Lambda Lt Chains,S 5.87 5.71-26.30 mg/L
Free Kappa Lt Chains,S 39.36 3.30-19.40 mg/L
Kappa/Lambda Ratio,S 6.71 0.26-1.65 1
 
Comp. Metabolic Panel (14)
 

Test Low Normal High Reference Range Units
Glucose, Serum 112 65-99 mg/dL
Potassium, Serum 4.5 3.5-5.2 mmol/L
Sodium, Serum 139 134-144 mmol/L
Globulin, Total 2.4 1.5-4.5 g/dL
Bun/Creatinine Ratio 11 8-19 1
Alkaline Phosphatase, S 79 25-150 IU/L
A/G Ratio 1.8 1.1-2.5 1
Egfr If Africn Am 125 >59 mL/min/1.73
Ast (Sgot) 31 0-40 IU/L
Albumin, Serum 4.4 3.5-5.5 g/dL
Creatinine, Serum 0.92 0.76-1.27 mg/dL
Calcium, Serum 9.6 8.7-10.2 mg/dL
Protein, Total, Serum 6.8 6.0-8.5 g/dL
Bilirubin, Total 0.4 0.0-1.2 mg/dL
Alt (Sgpt) 35 0-44 IU/L
Egfr If Nonafricn Am 108 >59 mL/min/1.73
Carbon Dioxide, Total 25 20-32 mmol/L
Bun 10 6-20 mg/dL
Chloride, Serum 99 97-108 mmol/L
 
Ldh
 

Test Low Normal High Reference Range Units
Ldh 147 0-225 IU/L
 
Immunofixation, Serum
 

Test Low Normal High Reference Range Units
Immunoglobulin G, Qn, Serum 720 700-1600 mg/dL
Immunoglobulin M, Qn, Serum 41 40-230 mg/dL
Immunoglobulin A, Qn, Serum 104 91-414 mg/dL
Immunofixation Result, Serum Comment:
 
Protein Elec + Interp, Serum
 

Test Low Normal High Reference Range Units
Albumin 4.4 3.2-5.6 g/dL
Gamma Globulin 0.6 0.5-1.6 g/dL
Globulin, Total 2.4 2.0-4.5 g/dL
M-Spike Not Observed Not Observed
Beta Globulin 0.9 0.6-1.3 g/dL
P E Interpretation, S The SPE pattern appears essentially unremarkable. Evidence of monoclonal protein is not apparent.
A/G Ratio 1.8 0.7-2.0 1
Alpha-2-Globulin 0.7 0.4-1.2 g/dL
Alpha-1-Globulin 0.2 0.1-0.4 g/dL
 
Ife+Protein Electro, 24-Hr Ur
 

Test Low Normal High Reference Range Units
M-Spike, Mg/24 Hr 11 Not Observed mg/24 hr
M-Spike, % 56.8 Not Observed %
Protein,Total,Urine 4.7 0.0-15.0 mg/dL
Alpha-2-Globulin, U 6.8 %
Albumin, U 21.1 %
Alpha-1-Globulin, U 1.0 %
Immunofixation Result, Urine Bence Jones Protein positive; kappa type.
Beta Globulin, U 61.7 %
Gamma Globulin, U 9.5 %
Prot,24hr Calculated 18.8 30.0-150.0 mg/24 hr
 
Venipuncture
 

Test Low Normal High Reference Range Units
 
Creatinine Clearance
 

Test Low Normal High Reference Range Units
Creatinine Clearance 19 97-137 mL/min
Creatinine, Ur 24hr 245.2 1000.0-2000.0 mg/24 hr
Creatinine, Urine 61.3 24.0-392.0 mg/dL
 

[CMolinaro]

Re: Lab Results help

by CMolinaro on Mon May 13, 2013 9:06 am

My kappa numbers are still rising. Now they are up to 39.36 mg/ and my ratio is 6.71. The lfe+protein electro, 24 hr test shows m spike mg/24 hr of 11, but no m spike in the protein elect+interp serum. Two months ago, my kappa numbers were around 29 mg. Any interpretations on what this means?

[Perseverance]

Re: Lab Results help

by Perseverance on Mon May 13, 2013 2:24 pm

I'm hoping someone will respond to your posting because I have a similar thing going on.

[DM Wallking]

Re: Lab Results help

by DM Wallking on Mon May 13, 2013 4:22 pm

Looks light you have a classic example of light chain escape......your remission is now being supplanted by a different clone producing aberrant light chains only. Such a wonderful disease.

[CMolinaro]

Re: Lab Results help

by CMolinaro on Mon May 13, 2013 4:36 pm

So is this essentially the beginnings of a relapse? I'm assuming this would be treatment with meds or like I mentioned in my other thread, an Allo transplant?

[rockdoc2005]

Re: Lab Results help

by rockdoc2005 on Mon May 13, 2013 5:39 pm

Your numbers are not that different than mine. Mine bounce around but overall they haven't changed much in the past 3 years. Suggest that you go on a monthly testing program and monitor changes over a 3-4 month period.

If your numbers don't change too much just continue as you are. You may go years with no significant changes.

I only take dex 10 mg/2 times a week (20 mg per week in two 10 mg doses).

Good Luck

[DM Walking]

Re: Lab Results help

by DM Walking on Mon May 13, 2013 5:40 pm

Disclaimer; I am no doctor, but hopefully some here will add their valued opinion. And perhaps they might just advise a watchful waiting approach, especially as all your blood work otherwise looks very good.

In addition, on a positive note - to the extent anything about this f$%^&ng diease is positive - if you do need treatment, because you have been in remission some 3 years or so, you may respond well with the same drugs you took initially - if not a subset of them.

[Dr. Adam Cohen]

Re: Lab Results help

by Dr. Adam Cohen on Sun May 19, 2013 9:59 pm

Dear CMolinaro,
Your labs show that there is some disease present, since there is a small urine M-spike and your free kappa light chains are elevated with an abnormal ratio. However, these are only minimally elevated, and your kidney function and calcium are normal. Assuming you don't have worsening anemia or any new bone lesions, there is certainly no indication to start treatment just based on this. Typically we would just continue with close observation, and as long as the numbers are staying relatively low and there is no end-organ damage, observation is continued. Patients can often go months to even years with low level relapses like this before re-treatment is needed.
Hope this helps,
Adam Cohen.