[Laron1969]

Lytic bone lesions - multiple myeloma or something else?

by Laron1969 on Mon Oct 05, 2015 11:07 am

My wife had shoulder pain last week and on a routine x-ray was noted to have multiple lytic lesions, which on a subsequent bone surgery were noted to be diffusely noted on long bones and skull. Radiologist read as "multiple lytic lesions consistent with multiple myeloma."

Her immunoglobulins, SPEP, M-protein, albumin and other initial labs were all normal. UPEP showed a "trace" increase in kappa light chains. I don't know if Bence Jones was done.

We were able to get in quickly with an oncologist who does not specialize in blood ma­lig­nancies but has been ordering testing. We discussed metastatic disease and she has a chest, abdomen, and pelvis CT tomorrow. I hope this will not show anything, as the lesions are purely lytic.

She had a marrow biopsy on Friday and we are anxiously awaiting results.

My father died this summer after an 18-year battle, so I am unfortunately familiar with the disease.

What my wife and I cannot put together are the following:

• Her age - she is 38 and otherwise very healthy
• She had a routine chest x-ray in August that is completely normal. I had the radiologist re-read the study to look for any lesions and he didn't see anything. She also had an x-ray of her knee last year which was normal. Our oncologist and my father's oncologist were very puzzled by this as well.
• Non definitive lab tests to this point.

I understand the results of the marrow biopsy will give us the information needed, but I am curious to hear from anyone has had a similar experience with diagnosis.

Do lytic lesions appear diffusely in such a short time?

Reading the literature she seems very young for multiple myeloma. Do others know people with multiple myeloma at such a young age?

Could this be light chain myeloma or MGUS, or something entirely different? Do lytic lesions exclude these diagnoses?

Thanks so much in advance, we have been trying not to focus too much until the marrow results are in, but are searching for information.

[Multibilly]

Re: Lytic bone lesions - multiple myeloma or something else?

by Multibilly on Mon Oct 05, 2015 12:35 pm

Dear Laron,

Sorry to hear about this situation.

First off, I'm not a doctor, so verify all this with yours.

Did your doctor order a serum free light chain assay?

Did the surgeon performing the shoulder surgery perform a biopsy of the lesions he found?

If it is multiple myeloma, it could be light chain myeloma as you suggest. The serum free light chain assay is useful for verifying this. Even if one has excess free light chains in their blood, these free light chains don't always spill over into one's urine. So that's why it's good to also get a serum free light chain assay and not just rely on a 24-hour UPEP test.

It could also be non-secretory multiple myeloma (where no markers show up in the blood or urine). Or it may not be multiple myeloma at all. But you are right that the bone marrow biopsy will be the definitive test to determine if a monoclonal gammopathy may be in play.

While not that common, multiple myeloma can and does strike folks in their thirties (there are several young patients on this forum). Multiple myeloma related lesions don't normally show up in the knee, but they do show up in ribs, shoulders, skull, hips, spine and long bones of the body.

Lastly, you might consider discussing getting a PET/CT instead of just a CT. Please see this article as to why I say this:

https://myelomabeacon.org/forum/pet-scans-for-multiple-myeloma-t3687.html

Hope it doesn't turn out to be multiple myeloma. Please let us know how things turn out and wishing you all the best.

Last edited by Multibilly on Mon Oct 05, 2015 3:02 pm, edited 1 time in total.

[Cheryl G]

Re: Lytic bone lesions - multiple myeloma or something else?

by Cheryl G on Mon Oct 05, 2015 12:56 pm

Hello Laron,

I echo Multibilly's comments, and just want to emphasize one particular point that he made, which is that the presence of lytic lesions does not automatically mean that someone has multiple myeloma.

A lytic bone lesion is an area of the bone that has been "eaten away" by something. That "something" can be multiple myeloma, but it also can be other diseases that are not necessarily as serious. There's a useful review of potential causes here:

http://www.livestrong.com/article/189271-what-are-the-causes-of-lytic-bone-lesions/

Until your wife has additional testing to determine if myeloma is the source of the lesions, you can't be sure. Multibilly has given you a good summary of relevant tests to focus on as you, your wife, and your wife's doctors seek to determine more clearly what is causing the lesions that have been observed.

Good luck, and please let us know if you have any further questions, and also how things turn out.

[Multibilly]

Re: Lytic bone lesions - multiple myeloma or something else?

by Multibilly on Mon Oct 05, 2015 1:16 pm

Nice follow up Cheryl. Again, good luck with all this Laron.

[Laron1969]

Re: Lytic bone lesions - multiple myeloma or something else?

by Laron1969 on Wed Oct 07, 2015 9:23 am

Thanks for all of the replies.

Unfortunately we have the preliminary marrow results and she has more than 10% plasma cells in her bone marrow. We are awaiting the genetics report and see a myeloma specialist next week.

Though she has lytic lesions, her beta 2 microglobulin is normal, as is her albumin.

I'm confused as to the classification and staging system since I would guess her beta 2 levels make her technically a stage 1, but with bone disease she has active myeloma. I am wondering how this will effect her treatment plan.

As I might have mentioned, my father passed away from myeloma in July; to have this hit our family again so soon has us all reeling.

Thanks again to all, this looks like a wonderful place for support.

[Multibilly]

Re: Lytic bone lesions - multiple myeloma or something else?

by Multibilly on Wed Oct 07, 2015 10:52 am

Hi Laron,

Sorry to hear that multiple myeloma has struck twice in your family. In your wife's case, it sounds like the docs caught this fairly early.

I'm not a doc. But my understanding is that staging doesn't really influence the drug treatment protocols used by specialists. Treatment regimens are usually more driven by cytogenetics, comorbidities, renal health, age, etc. - and not so much the stage of the disease.

Glad to hear your are working with a multiple myeloma specialist. Let us know how things go.