[seann04]

M-protein detectable but unable to quantitate

by seann04 on Wed May 06, 2015 4:23 pm

Hello,

My name is Sean. I just turned 28 years old. I live in Canada. Today I followed up with my gastroenterologist regarding celiac testing. He informed me the test indicated an M-protein spike of less than 1 g/l (0.1 g/dL).

Specifically, the report reads:

An IgG M-protein with kappa light chain specificity detectable. Unable to quantitate band estimate. Less than 1 g/l. Suggest repeat in 4-6 months."

Today roughly marked 5 months. I gave blood again. He told me my GP should have the results in 2-4 weeks. If it shows the M-protein spike again, I will be referred to a hematologist. Apparently a wait of 6-18 months.

Is it possible that this M-spike was caused by something harmless? Does this mean I have MGUS? What if it shows again? What should I do / not do while I wait for my appointments?

As you can imagine, I am a bit shaken up over this and would appreciate any and all information you are willing to share.

Thank you so much.

[bond007]

Re: M-protein detectable but unable to quantitate

by bond007 on Wed May 06, 2015 4:57 pm

You don't mention where you live in Canada, but if there is a question of a multiple myeloma diagnosis, then you should be referred to an hematologist at one of the regional cancer centres and, given the lack of urgency, the wait would be 2 - 4 weeks, not 6 - 18 months.

[Toni]

Re: M-protein detectable but unable to quantitate

by Toni on Wed May 06, 2015 4:57 pm

Sean,

I am sorry for what you are going through. It's very stressful waiting for the results, isn't it?

Did I read that correctly that you have to wait 6-18 months before you first see a hema­tol­o­gist / oncologist? Is this because of the health care system in Canada, or is that what your physician recommended?

Additionally, did they have you do a 24 hour urine specimen? Sometimes people have this in the urine and the only way to accurately test is through the 24 hour test.

Has your physician run all other tests? A CBC? Is anything in the high or low range? Creatinine, calcium, protein? Do you have any anemia?

I hope that others will pipe up here as your M-spike indeed seems to be almost undetectable, but any presence of a monoclonal gammopathy is not "normal".

Mostly I just wanted to assure you that you are in the right place and likely you will receive some other comments from those more knowledgeable than I.

Do try to practice some relaxation that works best for you. Unfortunately, these tests do take some time, and as someone who has MGUS, I can empathize with how you are feeling right now waiting for that test result! yikes

All the best - Toni

[seann04]

Re: M-protein detectable but unable to quantitate

by seann04 on Wed May 06, 2015 5:08 pm

Thank you for your quick replies. I live in Hamilton, Ontario.

I was told today by a gastroenterologist about the M-spike of less than 1 g/l. He is the one who said 6-18 months potential wait for a hematologist. He had me do blood work again, which he said will be at my GP's office in 2-4 weeks. From there, he said that, if the M-protein spike shows again, she will refer me to the hematologist.

I have not had any testing aside from the blood work. So, as of now, all I know is that my blood showed an M-protein spike of less than 1 g/l and that that may be evidence of multiple myeloma or MGUS.

I was wondering if it is possible the M-protein spike was caused by something benign?

Also, if I should take some comfort in the fact that it was less than 1 g/l?

[Nancy Shamanna]

Re: M-protein detectable but unable to quantitate

by Nancy Shamanna on Wed May 06, 2015 5:27 pm

Hi Seann,

That is stressful for you to be waiting on results for blood work which may indicate myeloma. I agree with Bond007 that you should be seeing an hematologist sooner than 6-8 months. Actually, you should be seeing an hematological oncologist, preferably with many myeloma patients!

I see that there is a cancer centre in Hamilton linked with McMaster University, the Juravinski. Hopefully you could do some research on your own and find such a specialist to be referred to!

I live in Calgary and have received timely care at the cancer centre here. Myeloma, smoldering multiple myeloma, and MGUS would all be seen by such a specialist, I think!

[seann04]

Re: M-protein detectable but unable to quantitate

by seann04 on Wed May 06, 2015 5:40 pm

Thank you so much.

Has anyone heard of an M-protein spike being caused by something benign / harmless?

[Multibilly]

Re: M-protein detectable but unable to quantitate

by Multibilly on Wed May 06, 2015 5:42 pm

Hi Sean,

I agree with the others about seeing a hematologist sooner rather than later. But, let me try and offer you a bit of hope in the interim.

The tests are sometimes subject to giving false positives because other proteins present in your blood can sometimes be misinterpreted as being monoclonal proteins ... especially given that the serum protein electrophoresis test is unable to quantitate the protein.

You can read about this phenomenon in the "False Positive Results" section of this document. It states:

Serum protein elements other than immunoglobulins may falsely suggest the presence of an M-protein. As examples:

• Fibrinogen (in plasma) is seen as a discrete band between the beta and gamma mobility regions. This is indistinguishable from an M-protein; addition of thrombin to the specimen will produce a clot if fibrinogen is present. The presence of fibrinogen is established if the discrete band is no longer detected when electrophoresis is repeated after the addition of thrombin.
• Hemoglobin-haptoglobin complexes secondary to hemolysis may appear as a large band in the alpha-2-globulin region.
• High concentrations of transferrin in patients with iron-deficiency anemia may produce a localized band in the beta region.
• Nephrotic syndrome is often associated with increased alpha-2 and beta bands which can be mistaken for an M-protein. Serum albumin and gamma globulin concentrations are usually reduced in this setting.
• Nonspecific increases in acute phase reactants or certain hyperlipoproteinemias may result in increases in alpha-1 bands.
• A common artifact is the presence of a protein band at the point of application of the sample. A clue to the presence of this artifact is the presence of this band on simultaneously performed samples from multiple patients.

Also, if it does turn out to be MGUS, please understand that many, many people go through life with MGUS without ever knowing they have it. And the risk of it progressing to active multiple myeloma is only about 1% per year. So, try not to worry too much in the meantime.

[seann04]

Re: M-protein detectable but unable to quantitate

by seann04 on Wed May 06, 2015 9:53 pm

Thank you all so much for taking the time to share information with me. I'll be sure to update. If anyone else reads the thread and wishes to share anything, please do.

[Dr. Ken Shain]

Re: M-protein detectable but unable to quantitate

by Dr. Ken Shain on Thu May 07, 2015 7:14 pm

Sean,

Having ab­normal results is never fun. When­ever, we (MDs) see an M-spike (potential mono­clonal protein on serum protein electrophoresis), we need to investigate – even in cases such as this one, where the M-spike is 0.1 ... and barely detectable at that (IgG kappa antibodies are quite small) .

The concerns revolve around a pre-malignant condition called MGUS (monoclonal gam­mop­athy of undetermined significance) or other plasma cell disorders / dyscrasias (PCD) and, more rarely, indolent lymphomas.

MGUS and PCDs are generally seen in individuals much older than you (69-70 on average). But this needs to be examined so that appropriate management can take place.

False positive results are high on my list of possible explanations for a 28-year-old man. As you can see from what already has been posted above, there are a number of potential causes for false positive results. Further, other reactive issues, like autoimmmune disorders, can cause what is called an oligoclonal band – a small number of antibodies that look like an "M-spike."

I would try to sit tight and see what repeat results demonstrate. At 28, this is more likely a re­active process, possibly associated with celiac or other GI issue, than MGUS or another PCD. If positive. I would follow-up with a heme / onc for more complete testing. 6-8 months is actually reasonable – you are not in any danger at this point – but I would still want to know sooner (with the caveat that I do not know how the Canadian health care system works).

Be safe, keep your head up and keep us updated (hopefully much a do about nothing).

[Kas]

Re: M-protein detectable but unable to quantitate

by Kas on Sat May 09, 2015 9:29 am

Sean,

I am in the Toronto area and have MGUS, probably reactive from my sarcoidosis, an auto­im­mune disease. I am monitored every 6 months by my family doctor.

Having said that, I was first sent to a hematologist (appointment within a week or two, so do shop around), and then, based on a recommendation, I saw a multiple myeloma specialist at Sunnybrook, a major cancer centre. That ap­pointment took 6-8 weeks to get.

The specialist ran more bloods and did a bone marrow biopsy, which confirmed my MGUS, also with a very low M protein, but a raised kappa / lambda ratio. I once showed barely de­tectable Bence Jones protein in my urine (I have renal dysfunction - long before MGUS), and was sent back to the multiple myeloma specialist. She was still sure I am MGUS and sent me back to my family doctor with guidelines of what to test for and the numbers to watch should I need to see her again (hopefully, not!). I eat gluten-free and have for 7 years now.

I agree that the wait is not harmful, and your MGUS, if it is that, will just have to be monitored, should it show again. I do highly recommend seeing an myeloma specialist, even just once, and doing a BMB, if required.

And in-between those 6 monthly tests, if that is what is needed, just live life to the fullest and do not make MGUS your focus. It may never change or may take decades. Just be informed and life will carry on.

Best,
Kas