I noticed something odd on my immunoglobins lab testing. My IgM level is <16 md/dL, the normal range is 40-230 mg/dL. IgA is 248 mg/dL where the normal range is listed as 70-400 mg/dL and IgG is 940 mg/dL where the normal range is listed as 700-1600 mg/dL.
Why would IgM be so low while IgA and IgM are at levels they should be? Looking at past results the IgM level has been in the 20-30 mg/dL range for some time, but has slowly been getting lower over the last year.
I have IgG kappa myeloma. I have a positive immunofixation and 5% clonal plasma cells from my last bone marrow aspiration three months ago. Initial therapy was Velcade and dexamethasone, followed by an auto stem cell transplant in October 2011. I have been on 10 mg Revlimid maintenance therapy for a little over two years.
My other labs results look good except for CBC numbers, which are usually just below the normal ranges, and occasionally my WBC takes a large dip below the normal range requiring me to stop the Revlimid for a few weeks.
There is not much information on the internet about low IgM. Anybody else have this? Is this any reason for concern?
Forums
Re: Low IgM antibody levels - any cause for concern?
I would suspect that Revlimid is the culprit behind the IgM drop.
Ron
Ron
-
Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
Re: Low IgM antibody levels - any cause for concern?
Ron Harvot wrote: "I would suspect that Revlimid is the culprit behind the IgM drop."
I believe that could well be the case, but if it is, it does not seem to be a very common side effect from Revlimid.
I have been researching this on the internet and, apparently, having low IgM with normal IgA and IgG levels is a condition called “isolated IgM deficiency”, or SIgM, and is pretty uncommon, if not rare. There is not much information on it, but I saw one reference that said immunosuppressive therapy can be linked to it, which is what I believe Revlimid does.
As far back as I can see in my labs available to me, my IgM levels have always been low, even as my WBC has gone up and down with Revlimid use. I have been tracking my WBC differential to assess my risk of infection and deciding if I should travel or swim in the ocean and such, but now I am not so sure that WBC alone is a good indicator of my immune system’s ability to fight infection.
Also my last lab test that had a level IgM level of < 16 mg/dL was taken just as I ended a three week break from taking Revlimid because of low WBC. My WBC came back up, but IgM went down a little further during that three week break.
A lot of the people that have the condition seem to have been born with it and have had it their whole lives. Maybe that is my case too, but I have not seen any of my immunoglobulin tests going back before 2012. I am asking my physicians about it but I am curious if anyone else here has heard or see SIgM as a side effect of myeloma or myeloma treatments such as Revlimid or SCT.
In reading up on this, it appears that clinical immunologists are the specialists who usually deal with SIgM. It also appears there is nothing that is done to treat it, but having it can influence what is done to treat infections, of which it seems I have been getting more lately.
I believe that could well be the case, but if it is, it does not seem to be a very common side effect from Revlimid.
I have been researching this on the internet and, apparently, having low IgM with normal IgA and IgG levels is a condition called “isolated IgM deficiency”, or SIgM, and is pretty uncommon, if not rare. There is not much information on it, but I saw one reference that said immunosuppressive therapy can be linked to it, which is what I believe Revlimid does.
As far back as I can see in my labs available to me, my IgM levels have always been low, even as my WBC has gone up and down with Revlimid use. I have been tracking my WBC differential to assess my risk of infection and deciding if I should travel or swim in the ocean and such, but now I am not so sure that WBC alone is a good indicator of my immune system’s ability to fight infection.
Also my last lab test that had a level IgM level of < 16 mg/dL was taken just as I ended a three week break from taking Revlimid because of low WBC. My WBC came back up, but IgM went down a little further during that three week break.
A lot of the people that have the condition seem to have been born with it and have had it their whole lives. Maybe that is my case too, but I have not seen any of my immunoglobulin tests going back before 2012. I am asking my physicians about it but I am curious if anyone else here has heard or see SIgM as a side effect of myeloma or myeloma treatments such as Revlimid or SCT.
In reading up on this, it appears that clinical immunologists are the specialists who usually deal with SIgM. It also appears there is nothing that is done to treat it, but having it can influence what is done to treat infections, of which it seems I have been getting more lately.
-
Eric Hofacket - Name: Eric H
- When were you/they diagnosed?: 01 April 2011
- Age at diagnosis: 44
Re: Low IgM antibody levels - any cause for concern?
Hey Eric,
Was your IgM below normal levels before you started any treatment of any kind?
Was your IgM below normal levels before you started any treatment of any kind?
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Low IgM antibody levels - any cause for concern?
Multibilly asked: "Was your IgM below normal levels before you started any treatment of any kind?"
That I do not know, but it would be really good to find out. I have not been able to see all my lab results going back to my first immunoglobulin test in 2011 when I was diagnosed (and before my stem cell transplant and Revlimid use). I should be able to get these though.
That I do not know, but it would be really good to find out. I have not been able to see all my lab results going back to my first immunoglobulin test in 2011 when I was diagnosed (and before my stem cell transplant and Revlimid use). I should be able to get these though.
-
Eric Hofacket - Name: Eric H
- When were you/they diagnosed?: 01 April 2011
- Age at diagnosis: 44
Re: Low IgM antibody levels - any cause for concern?
Eric,
We always concern ourselves with high Ig (immunoglobulins) associated with the monoclonal paraproteins with a new diagnosis or with progressive disease -- specifically the involved paraprotein. In some patients, when there is a large burden of disease, the dominant plasma cell clone suppresses one or both of the other immunoglobulins - a condition called immunoparesis. For instance, if a patient has IgG kappa multiple myeloma, their IgG may be 7000 mg/dl, and IgA 56 and IgM undetectable.
But remember that immunoglobulins are part of the normal immune system, as they are produced by normal B cells. As such, they are also sensitive to immunosuppressive therapy. In your case, long-term maintenance lenalidomide (Revlimid) is likely the culprit, as your disease appears to be well controlled.
I would not be overly concerned at this point.
Best of luck and I hope that your myeloma stays under excellent control .
We always concern ourselves with high Ig (immunoglobulins) associated with the monoclonal paraproteins with a new diagnosis or with progressive disease -- specifically the involved paraprotein. In some patients, when there is a large burden of disease, the dominant plasma cell clone suppresses one or both of the other immunoglobulins - a condition called immunoparesis. For instance, if a patient has IgG kappa multiple myeloma, their IgG may be 7000 mg/dl, and IgA 56 and IgM undetectable.
But remember that immunoglobulins are part of the normal immune system, as they are produced by normal B cells. As such, they are also sensitive to immunosuppressive therapy. In your case, long-term maintenance lenalidomide (Revlimid) is likely the culprit, as your disease appears to be well controlled.
I would not be overly concerned at this point.
Best of luck and I hope that your myeloma stays under excellent control .
-
Dr. Ken Shain - Name: Ken Shain, M.D., Ph.D.
Beacon Medical Advisor
Re: Low IgM antibody levels - any cause for concern?
Dr. Shain,
I am confused by your response. In my case, from the time I was diagnosed with IgG lambda multiple myeloma, my IgA and IgM have been below normal. I was treated with 6 rounds of VRD and took a couple of months off and had a stem cell transplant on 1/28. I began Revlimid maintenance earlier this week. IgG levels reached the normal range after 2 months of induction and have remained there. Do you believe there is no particular cause for concern?
I am confused by your response. In my case, from the time I was diagnosed with IgG lambda multiple myeloma, my IgA and IgM have been below normal. I was treated with 6 rounds of VRD and took a couple of months off and had a stem cell transplant on 1/28. I began Revlimid maintenance earlier this week. IgG levels reached the normal range after 2 months of induction and have remained there. Do you believe there is no particular cause for concern?
-
goldmine848 - Name: Andrew
- When were you/they diagnosed?: June 2013
- Age at diagnosis: 60
Re: Low IgM antibody levels - any cause for concern?
I actually just asked about a similar situation recently also. The rest of my immunoglobulins also have recovered to normal levels at 9 months post SCT, but the IgM is still suppressed.
My oncologist said that IgM can take longer to recover than others, and she also agreed it might be the most sensitive to lenalidomide (remember that it is an immunomodulatory agent). Like Dr. Shain, she said as long as you don't get infections and your disease is in control, don't get concerned about one low immunoglobulin.
My oncologist said that IgM can take longer to recover than others, and she also agreed it might be the most sensitive to lenalidomide (remember that it is an immunomodulatory agent). Like Dr. Shain, she said as long as you don't get infections and your disease is in control, don't get concerned about one low immunoglobulin.
-
Tough Mom - Who do you know with myeloma?: myself
- When were you/they diagnosed?: January 2013
- Age at diagnosis: 45
Re: Low IgM antibody levels - any cause for concern?
Thanks, although I have two (A and M) that have been low from diagnosis until now without ever being in the normal range.
-
goldmine848 - Name: Andrew
- When were you/they diagnosed?: June 2013
- Age at diagnosis: 60
Re: Low IgM antibody levels - any cause for concern?
Tough Mom wrote:
I am curious if low IgM is a common side effect of Revlimid. If so, it does not seem to be well documented that Revlimid affects this one immunoglobulin more than the others. While my IgG and IgA numbers have recovered and are back in normal range, indicating that my myeloma appears to be well under control as Dr. Shain said, my IgM has stayed low since my SCT and starting Revlimid maintenance.
I am not overly concerned about this, but I had been under the assumption that, as long as my WBC numbers were at decent levels, my immune system was in good shape to fight off infections. From my reading what information I could find on low IgM, I am not so sure about that. It appears you can have normal WBC levels but, with low IgM, the immune system may still have trouble fighting infections.
I actually just asked about a similar situation recently also. The rest of my immunoglobulins also have recovered to normal levels at 9 months post SCT, but the IgM is still suppressed.
My oncologist said that IgM can take longer to recover than others, and she also agreed it might be the most sensitive to lenalidomide (remember that it is an immunomodulatory agent). Like Dr. Shain, she said as long as you don't get infections and your disease is in control, don't get concerned about one low immunoglobulin."
I am curious if low IgM is a common side effect of Revlimid. If so, it does not seem to be well documented that Revlimid affects this one immunoglobulin more than the others. While my IgG and IgA numbers have recovered and are back in normal range, indicating that my myeloma appears to be well under control as Dr. Shain said, my IgM has stayed low since my SCT and starting Revlimid maintenance.
I am not overly concerned about this, but I had been under the assumption that, as long as my WBC numbers were at decent levels, my immune system was in good shape to fight off infections. From my reading what information I could find on low IgM, I am not so sure about that. It appears you can have normal WBC levels but, with low IgM, the immune system may still have trouble fighting infections.
-
Eric Hofacket - Name: Eric H
- When were you/they diagnosed?: 01 April 2011
- Age at diagnosis: 44
23 posts
• Page 1 of 3 • 1, 2, 3