[mujtaba]

Likely myeloma diagnosis; any additional testing needed?

by mujtaba on Mon Jun 25, 2018 4:53 am

Dear all,

In July 2017, my father, aged 64, was diagnosed with solitary plasmacytoma. The treatment suggested was surgery plus radiotherapy. After completing radiotherapy, we were advised to do regular tests every three months as there was a risk of the disease progressing to multiple myeloma. For the entire duration of the last one year, we have been doing tests and no M-spike was seen. So we were under the impression that all is well.

About 3 months back, my dad started complaining about pain in ribs and back. At first we thought it is osteoporosis. The doctor recommended that if the pain persists we need to go for a PET scan. Since the pain continued, we finally did a PET scan, which revealed multiple metabolically active bone lesions in vertebrae and femur. The doctor said it looks like the disease has pro­gressed to multiple myeloma and asked us to do a myeloma profile blood test, 24-hour urine, and PSA (since my father's prostate was enlarged and the doctor wanted to eliminate the possibility of it being a prostate malignancy).

The results just came back and the PSA is normal, which rules out the possibility of prostate being the origin of the disease. The myeloma profile showed no M-spike. But the test revealed that the lambda free chain value was up at 416. This was alarming. After this, the doctor suggested a bone marrow biopsy, which we did late last week.

At the moment we are awaiting the bone marrow biopsy test results, which could take up to a week. The doctor says that this result will be confirmatory of the multiple myeloma (though he says it is 99.9% likely to be multiple myeloma, but just to be sure). After the confirmation and evaluation of the disease, the treatment will commence.

At this stage, is there any additional testing we should be doing to ensure my father is correctly diagnosed?

Wishing each one of you or your loved one a healthy, happy and long life.

Warm regards
Mujtaba

[Multibilly]

Re: Likely myeloma diagnosis; any additional testing needed?

by Multibilly on Mon Jun 25, 2018 9:19 am

Hi Mujtaba,

Welcome to the forum.

Besides getting the tests to measure serum free light chains, M-spikes (serum electrophoresis), 24-hour urine test, bone marrow biopsy (which should include iFISH testing, flow cytometry and Congo red staining) and PET/CT, he should also be getting a quantitative immunoglobulin (IgG, IgA, IgM), serum immuonfixation, beta2 microglobulin (used for initial prognosis purposes), CBC and comprehensive metabolic panel test. Also getting a DEXA scan to measure his baseline bone density wouldn't be a bad idea.

[mujtaba]

Re: Likely myeloma diagnosis; any additional testing needed?

by mujtaba on Thu Jul 12, 2018 2:31 pm

Dear Multibilly,

Many thanks for your reply. My apologies for not being able to acknowledge and respond to your email earlier.

The doctor did prescribe most of the tests that you mentioned. Those and the tissue biopsy confirmed that my father in fact does have multiple myeloma. While this has been a very worrisome development, we are determined to do our best in terms of the treatment. Hoping for the best

Once again, thank you very much.

Warm regards,
Mujtaba