I have been on Velcade / Revlimid / dexamethasone this past month. Have just received some new test results and hope someone on the forum can assist.
My involved IgA kappa is now down to 69, which is below normal. IgG and IgM values are also below normal. My absolute neutrophil count is down to 1100.
I do understand that I am now more susceptible to serious infection, but in terms of the myeloma, what could the below normal IgA signify?
Moderator's Note
This thread initially was part of another thread ("What's your intermediate & high-risk myeloma experience?", started Feb 10, 2015). We felt, however, that the subject of the discussion here is distinct enough from the subject of the other thread that the postings deserve a thread of their own.
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Re: Low involved immunoglobulin during initial treatment
Hi Mrozdav,
When you say your "involved IgA kappa" level is down to 69, what exactly do you mean? Do you mean your total IgA level is 69, or something else?
Also, what does your lab list as the reference (normal) range for IgA? I've seen a normal range of 61-356 mg/dL, which is why I ask.
When you say your "involved IgA kappa" level is down to 69, what exactly do you mean? Do you mean your total IgA level is 69, or something else?
Also, what does your lab list as the reference (normal) range for IgA? I've seen a normal range of 61-356 mg/dL, which is why I ask.
Re: Low involved immunoglobulin during initial treatment
Hi mrozdav,
In general, if your involved immunoglobin gets down to a below-normal value, that means you are responding well to the treatment. I'm curious what your m-spike is.
BTW the normal range for my lab's IgA value is 40-350 mg/dl.
Mike
In general, if your involved immunoglobin gets down to a below-normal value, that means you are responding well to the treatment. I'm curious what your m-spike is.
BTW the normal range for my lab's IgA value is 40-350 mg/dl.
Mike
-
mikeb - Name: mikeb
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2009 (MGUS at that time)
- Age at diagnosis: 55
Re: Low involved immunoglobulin during initial treatment
Thanks for responding, Mikeb. Johns Hopkins' lower limit for IgA is 85 or 89. I have not had an M-spike for quite a while, kappa/ lambda has always been fine, but the IFE has usually indicated a persisting very faint band for the IgA. I am now waiting for the latest IFE result and am hoping that no band was seen this time.
I am somewhat concerned about the IgA going down below normal because I do not want to develop any respiratory problems. Once I get them, they do not go away.
I have not been able to find any literature that discusses an INVOLVED immunoglobulin dipping below normal as a result of chemotherapy. Interestingly, this morning, after I posted, I found an entry from a year or so ago by one of our contributing doctors in which he stated that he himself had done some research but could not find anything in the literature that discussed this precise issue. While uninvolved immunoglobulins dipping below normal is often encountered, it appears that my situation, where the involved immunoglobulin dips, seems unusual. I don't think that it is the same thing as what happens after an SCT, i.e., where everything goes down and one waits for renewal. But maybe it is.
If anyone has any information regarding this issue, I would be glad to receive a response.
I am somewhat concerned about the IgA going down below normal because I do not want to develop any respiratory problems. Once I get them, they do not go away.
I have not been able to find any literature that discusses an INVOLVED immunoglobulin dipping below normal as a result of chemotherapy. Interestingly, this morning, after I posted, I found an entry from a year or so ago by one of our contributing doctors in which he stated that he himself had done some research but could not find anything in the literature that discussed this precise issue. While uninvolved immunoglobulins dipping below normal is often encountered, it appears that my situation, where the involved immunoglobulin dips, seems unusual. I don't think that it is the same thing as what happens after an SCT, i.e., where everything goes down and one waits for renewal. But maybe it is.
If anyone has any information regarding this issue, I would be glad to receive a response.
Re: Low involved immunoglobulin during initial treatment
OK, guess my trying to clarify the question, and sharing a common reference range for IgA, doesn't merit a response. Will keep that in mind for the future when figuring out who to help here in the forum.
For the record, the phrase "involved IgA kappa" is non-standard language at best, not to mention confusing, since it suggests that there is also an "uninvolved" IgA kappa. That's why I asked about the intended meaning of the phrase. I couldn't tell, for example, if perhaps "involved" was supposed to mean "healthy" (referring back to the ongoing discussion here in the forum about the "healthy" and "unhealthy" components of someone's involved immunoglobulin).
It also sure would be nice to have a link to that previous posting that's relevant to this topic, rather than just a vague reference to it being made by "one of our contributing doctors" "a year or so ago".
For the record, the phrase "involved IgA kappa" is non-standard language at best, not to mention confusing, since it suggests that there is also an "uninvolved" IgA kappa. That's why I asked about the intended meaning of the phrase. I couldn't tell, for example, if perhaps "involved" was supposed to mean "healthy" (referring back to the ongoing discussion here in the forum about the "healthy" and "unhealthy" components of someone's involved immunoglobulin).
It also sure would be nice to have a link to that previous posting that's relevant to this topic, rather than just a vague reference to it being made by "one of our contributing doctors" "a year or so ago".
Re: Low involved immunoglobulin during initial treatment
TerryH, You completely misjudge the situation. I did not respond to you because I did not see your posting. It is as simple as that. No snub intended. And I do thank you for responding to my posting.
I used the term "involved IgA" as a short-cut. My myeloma is IgA kappa and that is what is deemed "involved," or at least as far as I understand. My IgG and IgM are always tested for along with the IgA, but they are what I call "uninvolved." I started out last August with normal levels of IgG and IgM, but with an IgA level of about 3400. As of this week it is down to 69 which is below normal as far as Johns Hopkins lab is concerned. Hence my question to the forum community. A couple of months ago, the IgG level dipped below normal for the first time since the beginning of August. My IgM stayed normal. This week, however, all three immunoglobulins are below normal.
I agree with you: as I was writing about the doctor's earlier post, I thought to myself that it would be so much better to have been able to give a citation so that others could read for themselves, if interested. A lot of posters here make a point of giving citations and they are usually extremely helpful. I am always glad that they do this. However, it would have taken me a long time to find the doctor's response ( I think it was was Dr. Shain, but am not certain) again and even had I found it, my computer skills are not good enough to reproduce a citation the way others here are able to do.
I used the term "involved IgA" as a short-cut. My myeloma is IgA kappa and that is what is deemed "involved," or at least as far as I understand. My IgG and IgM are always tested for along with the IgA, but they are what I call "uninvolved." I started out last August with normal levels of IgG and IgM, but with an IgA level of about 3400. As of this week it is down to 69 which is below normal as far as Johns Hopkins lab is concerned. Hence my question to the forum community. A couple of months ago, the IgG level dipped below normal for the first time since the beginning of August. My IgM stayed normal. This week, however, all three immunoglobulins are below normal.
I agree with you: as I was writing about the doctor's earlier post, I thought to myself that it would be so much better to have been able to give a citation so that others could read for themselves, if interested. A lot of posters here make a point of giving citations and they are usually extremely helpful. I am always glad that they do this. However, it would have taken me a long time to find the doctor's response ( I think it was was Dr. Shain, but am not certain) again and even had I found it, my computer skills are not good enough to reproduce a citation the way others here are able to do.
Re: Low involved immunoglobulin during initial treatment
Hi Mrozdav,
Glad this has been just a misunderstanding.
You are absolutely correct that your "involved" immunoglobulin is IgA, given that you have IgA kappa myeloma. Your other immunoglobulins, such as IgG and IgM, are your "uninvolved" immunoglobulins.
But to say that your "involved IgA kappa is now down to 69" is confusing because it suggests that you're talking about just part of your IgA, not your total IgA. As I said, it makes it seem that there is some "uninvolved" IgA kappa that you're leaving out of the result that you're reporting. I also couldn't be sure that you were using "involved" as shorthand for something else, like "unhealthy" / "monoclonal".
I know I could have assumed that IgA is your involved immunoglobulin, and that's what you meant by your statement. However, I wanted the issue clarified before I, or someone else, went off looking for postings or articles that might be helpful to you.
As far as putting links in postings here in the forum, it's pretty easy. Just enter a link like this:
https://myelomabeacon.org/forum/hypogammaglobulinemia-t595.html#p2381
This is a link to a posting Dr. Shain made about four years ago that touches on issues similar to those that you have raised. I found it using the forum "Advanced Search" function. (I don't think it's exactly the posting you mentioned.) To get the link for an individual posting, all you have to do is click on the title of the posting (in this case, "Re: Hypogammaglobulinemia"), and the link will be in your browser address bar.
I know that links often end up being made "prettier", with text and all that, but I believe the moderators do that.
Glad this has been just a misunderstanding.
You are absolutely correct that your "involved" immunoglobulin is IgA, given that you have IgA kappa myeloma. Your other immunoglobulins, such as IgG and IgM, are your "uninvolved" immunoglobulins.
But to say that your "involved IgA kappa is now down to 69" is confusing because it suggests that you're talking about just part of your IgA, not your total IgA. As I said, it makes it seem that there is some "uninvolved" IgA kappa that you're leaving out of the result that you're reporting. I also couldn't be sure that you were using "involved" as shorthand for something else, like "unhealthy" / "monoclonal".
I know I could have assumed that IgA is your involved immunoglobulin, and that's what you meant by your statement. However, I wanted the issue clarified before I, or someone else, went off looking for postings or articles that might be helpful to you.
As far as putting links in postings here in the forum, it's pretty easy. Just enter a link like this:
https://myelomabeacon.org/forum/hypogammaglobulinemia-t595.html#p2381
This is a link to a posting Dr. Shain made about four years ago that touches on issues similar to those that you have raised. I found it using the forum "Advanced Search" function. (I don't think it's exactly the posting you mentioned.) To get the link for an individual posting, all you have to do is click on the title of the posting (in this case, "Re: Hypogammaglobulinemia"), and the link will be in your browser address bar.
I know that links often end up being made "prettier", with text and all that, but I believe the moderators do that.
Re: Low involved immunoglobulin during initial treatment
Thank you, TerryH. I will try to follow your directions for next time.
Re: Low involved immunoglobulin during initial treatment
Hi again mrozdav,
I'm sorry to be slow in returning to this thread. I'm behind on reading the Beacon Forum postings.
You asked if anyone else has had their involved immunoglobulin go to a below normal level after or during treatment and, if so, what does that mean? Or something to that effect.
It turns out that my involved heavy chain immunoglobulin, IgA, has been slightly lower than the listed reference range for my lab in about half of the monthly tests that I've received in the past year. I understand your concern about possibly being more susceptible to infections with low immunoglobulins. In my case, though, I have not had an unusually large number of infections over the last year -- just two sinus infections during the past winter. That's been about average for me for decades, way before I got multiple myeloma.
While I am no expert on the immune system, I think your absolute neutrophil count (ANC) and white blood cell count (WBC) are more important as indicators of the strength of your immune system. At least those are the numbers my doctor seems most interested in regarding my immune system.
Once again, it sounds like you've had an excellent response to your treatment, so congratulations!
Mike
I'm sorry to be slow in returning to this thread. I'm behind on reading the Beacon Forum postings.
You asked if anyone else has had their involved immunoglobulin go to a below normal level after or during treatment and, if so, what does that mean? Or something to that effect.
It turns out that my involved heavy chain immunoglobulin, IgA, has been slightly lower than the listed reference range for my lab in about half of the monthly tests that I've received in the past year. I understand your concern about possibly being more susceptible to infections with low immunoglobulins. In my case, though, I have not had an unusually large number of infections over the last year -- just two sinus infections during the past winter. That's been about average for me for decades, way before I got multiple myeloma.
While I am no expert on the immune system, I think your absolute neutrophil count (ANC) and white blood cell count (WBC) are more important as indicators of the strength of your immune system. At least those are the numbers my doctor seems most interested in regarding my immune system.
Once again, it sounds like you've had an excellent response to your treatment, so congratulations!
Mike
-
mikeb - Name: mikeb
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2009 (MGUS at that time)
- Age at diagnosis: 55
9 posts
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