Last week following a routine blood test that showed "mild anemia," a second test showed an M-spike (band 1) of 0.4 g/dL. A follow-up kappa-lambda test showed what the doctor called a "high ratio."
I am waiting for a hematologist to contact me about the results.
Is this likely multiple myeloma, or could it still be something else? I'm learning a new vocabulary.
Thanks for any counsel / information that you can offer.
Dennis (DCJ)
Forums
Re: M-spike with high ratio: is it likely to be myeloma?
Hi Dennis,
The persistent presence of a monoclonal protein (paraprotein, M-spike) is an abnormal health condition. It is a sign of either "monoclonal gammopathy of undetermined significance" (MGUS), a usually benign condition that is more prevalent than often realized in people over the age of 70 or 75. An M-spike also can be a sign of smoldering myeloma, a type of multiple myeloma where the disease has not caused any symptoms or organ damage. The current standard of care is not to treat smoldering multiple myeloma.
Of course, an M-spike also can be a sign of (symptomatic, or active) multiple myeloma, which is a blood cancer that does require treatment.
Finally, some people with an M-spike involving a particular immunoglobulin (IgM) have a condition known as Waldenstrom's macroglobulinemia (WM). This disease is often treated similarly to the way multiple myeloma is treated.
Your M-spike of 0.4 g/dL is rather low, and it suggests you may have either MGUS or smoldering myeloma, assuming you do not have an IgM M-spike. However, if your free light chain ratio is, in fact, "very high" – either over 100 or less than 0.01 – then this would suggest a diagnosis that is more likely to be multiple myeloma.
To understand more what the criteria are for a diagnosis of MGUS, smoldering myeloma, or (symptomatic) multiple myeloma, see the three "Criteria" forum posts pinned to the top of the "Do I have multiple myeloma?" section of the forum:
Going forward, you should look more closely at your existing lab results, such as your hemoglobin, creatinine, and calcium levels, to see if they suggest you are experiencing signs of multiple myeloma as listed in the forum posts I just mentioned. You also will want to arrange for imaging (xrays, MRIs, etc.) to check for bone damage, and most likely a bone marrow biopsy. The results of all these tests will help to pin down exactly what your diagnosis is.
I hope this helps. Good luck, and keep us posted on how things go.
P.S. - Although multiple myeloma is a form of a cancer, it is an increasingly treatable form of cancer. Although not curable in most cases, it can be successfully treated such that more and more people with the disease are living many years after diagnosis.
The persistent presence of a monoclonal protein (paraprotein, M-spike) is an abnormal health condition. It is a sign of either "monoclonal gammopathy of undetermined significance" (MGUS), a usually benign condition that is more prevalent than often realized in people over the age of 70 or 75. An M-spike also can be a sign of smoldering myeloma, a type of multiple myeloma where the disease has not caused any symptoms or organ damage. The current standard of care is not to treat smoldering multiple myeloma.
Of course, an M-spike also can be a sign of (symptomatic, or active) multiple myeloma, which is a blood cancer that does require treatment.
Finally, some people with an M-spike involving a particular immunoglobulin (IgM) have a condition known as Waldenstrom's macroglobulinemia (WM). This disease is often treated similarly to the way multiple myeloma is treated.
Your M-spike of 0.4 g/dL is rather low, and it suggests you may have either MGUS or smoldering myeloma, assuming you do not have an IgM M-spike. However, if your free light chain ratio is, in fact, "very high" – either over 100 or less than 0.01 – then this would suggest a diagnosis that is more likely to be multiple myeloma.
To understand more what the criteria are for a diagnosis of MGUS, smoldering myeloma, or (symptomatic) multiple myeloma, see the three "Criteria" forum posts pinned to the top of the "Do I have multiple myeloma?" section of the forum:
Going forward, you should look more closely at your existing lab results, such as your hemoglobin, creatinine, and calcium levels, to see if they suggest you are experiencing signs of multiple myeloma as listed in the forum posts I just mentioned. You also will want to arrange for imaging (xrays, MRIs, etc.) to check for bone damage, and most likely a bone marrow biopsy. The results of all these tests will help to pin down exactly what your diagnosis is.
I hope this helps. Good luck, and keep us posted on how things go.
P.S. - Although multiple myeloma is a form of a cancer, it is an increasingly treatable form of cancer. Although not curable in most cases, it can be successfully treated such that more and more people with the disease are living many years after diagnosis.
Re: M-spike with high ratio: is it likely to be myeloma?
Thanks Terry. Very helpful.
My GP today gave me the results from the kappa lambda test. Kappa is high, 27.20, and the lambda is normal, 12.56. The kappa-lambda ratio is 2.17. This is coupled with a 0.4 M-spike. I have no other indications except a mild anemia.
He walked me through a diagnostic tree that was inconclusive. It looks like it could be MGUS or multiple myeloma or ?? Not too helpful.
I'm seeing a hematologist tomorrow. My GP didn't "think" that she would do a bone marrow biopsy, but was equally unsure.
Thanks for sharing some questions for me to ask. But with anxiety running high, are these ratios definitive? Any insights would be appreciated.
Dennis
My GP today gave me the results from the kappa lambda test. Kappa is high, 27.20, and the lambda is normal, 12.56. The kappa-lambda ratio is 2.17. This is coupled with a 0.4 M-spike. I have no other indications except a mild anemia.
He walked me through a diagnostic tree that was inconclusive. It looks like it could be MGUS or multiple myeloma or ?? Not too helpful.
I'm seeing a hematologist tomorrow. My GP didn't "think" that she would do a bone marrow biopsy, but was equally unsure.
Thanks for sharing some questions for me to ask. But with anxiety running high, are these ratios definitive? Any insights would be appreciated.
Dennis
Re: M-spike with high ratio: is it likely to be myeloma?
Hi Dennis,
Have you had blood tests before that tested your hemoglobin level? It would be worth going through old lab reports, if you have them, to see if there have been signs of your "mild anemia" for a long time.
If the mild anemia is something new, then the hematologist may take it as a sign to do some further investigations, including imaging (x-rays, MRIs, etc.) and perhaps even a bone marrow biopsy. What exactly is your hemoglobin level?
Your free light chain ratio is not very far out of the normal range, which is 0.26 to 1.65 in people with normal kidney function. So that's a good sign.
Good luck, and keep us posted on what the additional testing finds.
Have you had blood tests before that tested your hemoglobin level? It would be worth going through old lab reports, if you have them, to see if there have been signs of your "mild anemia" for a long time.
If the mild anemia is something new, then the hematologist may take it as a sign to do some further investigations, including imaging (x-rays, MRIs, etc.) and perhaps even a bone marrow biopsy. What exactly is your hemoglobin level?
Your free light chain ratio is not very far out of the normal range, which is 0.26 to 1.65 in people with normal kidney function. So that's a good sign.
Good luck, and keep us posted on what the additional testing finds.
Re: M-spike with high ratio: is it likely to be myeloma?
Thanks again. I went to the hematologist-oncologist yesterday, who ordered a range of blood tests and x-rays. My hemoglobin level last week showed 12.5 g/dL. Previously it hovered about 13.5-13.8 g/dL. Today's lab results are 13.4 g/dL. That seems to fall within a normal range.
The rest of the blood work (white cell differential, serum calcium, albumin, beta-2 microglobulin, lactate dehydrognsase) all showed normal ranges.
The full x-ray skeletal survey showed no lytic lesions or other abnormalities.
Terry, as you suggested, the oncologist wasn't overly concerned about the degrees of elevation shown by the M-spike and kappa/lambda tests (0.4 and 2.17 respectively). She mentioned that because of a childhood disease that slightly reduced my kidney function, this could be a contributing factor. My GFR and creatinine rates based on this morning's lab tests are within the normal range.
I believe that I'm still waiting for some additional tests (not sure if she is repeating the M-spike or free light chain ratios, or adding something else). Hoping to hear from the hematologist-oncologist today.
She did order a 24-hour urine collection sample, but this is in process.
Thanks, again, for your comments and counsel.
Dennis
The rest of the blood work (white cell differential, serum calcium, albumin, beta-2 microglobulin, lactate dehydrognsase) all showed normal ranges.
The full x-ray skeletal survey showed no lytic lesions or other abnormalities.
Terry, as you suggested, the oncologist wasn't overly concerned about the degrees of elevation shown by the M-spike and kappa/lambda tests (0.4 and 2.17 respectively). She mentioned that because of a childhood disease that slightly reduced my kidney function, this could be a contributing factor. My GFR and creatinine rates based on this morning's lab tests are within the normal range.
I believe that I'm still waiting for some additional tests (not sure if she is repeating the M-spike or free light chain ratios, or adding something else). Hoping to hear from the hematologist-oncologist today.
She did order a 24-hour urine collection sample, but this is in process.
Thanks, again, for your comments and counsel.
Dennis
Re: M-spike with high ratio: is it likely to be myeloma?
Hi Dennis,
Glad to hear that your hemoglobin was back up close to where it's usually been. As a male, your hemoglobin would need to be down around 11.5, or lower, before it would be considered a "myeloma defining event", according to the latest criteria for a diagnosis of symptomatic multiple myeloma.
Kidney function affects what the "normal" / "reference" range is for the serum free light chain ratio. The reference range for people with normal kidney function is 0.26-1.65. However, if you have impaired kidney function, then the reference range is considered to be 0.37-3.10. I think this is what the hematologist-oncologist was referring to when she mentioned that your kidney function could be a "contributing factor." Kidney impairment would NOT be the cause of an M-spike. The M-spike is the result of abnormal immunoglobulin being produced by mutated, monoclonal plasma cells in your bone marrow.
With the sort of lab results that you have, it would not be unreasonable to move forward with just regular blood tests to track your myeloma-related blood results. However, you may want to discuss with your hematologist-oncologist the potential value of additional imaging (MRI or PET/CT) and a bone marrow biopsy to better establish where you are at right now. It appears, however, very likely that you have MGUS, or perhaps smoldering multiple myeloma.
Regardless of whether you get more imaging work or a bone marrow biopsy, I'd think about getting blood work done every 3 months or so for the next 12 months, and then perhaps every 6 months if things stay stable during the first year. The 3-month interval for testing is more frequent than some doctors might suggest, but I think it's reasonable immediately after diagnosis, just to get a better sense of whether or not the disease is progressing.
Good luck!
Glad to hear that your hemoglobin was back up close to where it's usually been. As a male, your hemoglobin would need to be down around 11.5, or lower, before it would be considered a "myeloma defining event", according to the latest criteria for a diagnosis of symptomatic multiple myeloma.
Kidney function affects what the "normal" / "reference" range is for the serum free light chain ratio. The reference range for people with normal kidney function is 0.26-1.65. However, if you have impaired kidney function, then the reference range is considered to be 0.37-3.10. I think this is what the hematologist-oncologist was referring to when she mentioned that your kidney function could be a "contributing factor." Kidney impairment would NOT be the cause of an M-spike. The M-spike is the result of abnormal immunoglobulin being produced by mutated, monoclonal plasma cells in your bone marrow.
With the sort of lab results that you have, it would not be unreasonable to move forward with just regular blood tests to track your myeloma-related blood results. However, you may want to discuss with your hematologist-oncologist the potential value of additional imaging (MRI or PET/CT) and a bone marrow biopsy to better establish where you are at right now. It appears, however, very likely that you have MGUS, or perhaps smoldering multiple myeloma.
Regardless of whether you get more imaging work or a bone marrow biopsy, I'd think about getting blood work done every 3 months or so for the next 12 months, and then perhaps every 6 months if things stay stable during the first year. The 3-month interval for testing is more frequent than some doctors might suggest, but I think it's reasonable immediately after diagnosis, just to get a better sense of whether or not the disease is progressing.
Good luck!
Re: M-spike with high ratio: is it likely to be myeloma?
Thank you Terry. Your help in understanding all of this is really appreciated.
The oncologist sent me the last lab results and a diagnosis of MGUS. She's also sent a standing order to my health plan's lab for me to repeat tests every 3 or 4 months. Your suggestion of every 3 months is helpful.
The updated lab results are:
Kappa 24.42 g/dL (previous 27.70)
Lambda 12.04 g/dL (previous 12.56)
Ratio 2.03 (previous 2.17)
Additional results that I hadn't seen before are:
IgG - 1070 (range 600-1600);
IgA - 60 (range 40-375)
IgM - 77 (range 30-190).
A note at the bottom of the results page said, "monoclonal IgG kappa type."
Overall, it seems like positive news. Not sure what the "Ig.." results mean or what the final note on the results page means.
Dennis
The oncologist sent me the last lab results and a diagnosis of MGUS. She's also sent a standing order to my health plan's lab for me to repeat tests every 3 or 4 months. Your suggestion of every 3 months is helpful.
The updated lab results are:
Kappa 24.42 g/dL (previous 27.70)
Lambda 12.04 g/dL (previous 12.56)
Ratio 2.03 (previous 2.17)
Additional results that I hadn't seen before are:
IgG - 1070 (range 600-1600);
IgA - 60 (range 40-375)
IgM - 77 (range 30-190).
A note at the bottom of the results page said, "monoclonal IgG kappa type."
Overall, it seems like positive news. Not sure what the "Ig.." results mean or what the final note on the results page means.
Dennis
Re: M-spike with high ratio: is it likely to be myeloma?
I continue to get lab results that are confusing. A 24-hour urine lab showed some mixed results. The protein urine (24-hour) was 114 mg/TV (standard range - 0-150).
But my IgG, IgA, and IgM urine values were high:
IgG 0.6
IgA 0.5
IgM 0.7
All are about 0.1 higher than the standard range. This differs from the blood labs that showed these scores in standard ranges. I'm not sure what that means.
The oncologist will get in touch eventually, but the wait is very hard.
But my IgG, IgA, and IgM urine values were high:
IgG 0.6
IgA 0.5
IgM 0.7
All are about 0.1 higher than the standard range. This differs from the blood labs that showed these scores in standard ranges. I'm not sure what that means.
The oncologist will get in touch eventually, but the wait is very hard.
Re: M-spike with high ratio: is it likely to be myeloma?
Hi Dennis,
It's good that the immunoglobulin (IgG, IgA, and IgM) levels in your blood are within normal ranges. This indicates that your bone marrow is not impaired to such an extent that it is producing lower levels of some immunoglobulins.
Given that you may have some reduced kidney function, I would focus more on blood test results rather than your urine results for most things, including your IgG, IgA, and IgM levels.
The result you quoted saying that you have "monoclonal IgG kappa type" is most likely from a serum immunofixation test. It tells you what sort of M-spike you have. The serum protein electrophoresis (SPEP) test tells you how big your M-spike is (0.4 g/dL in your case).
MGUS and multiple myeloma are diseases where there are mutated, "monoclonal" plasma cells in the body (usually in the bone marrow). Plasma cells, whether healthy or mutated, produce immunoglobulins (IgG, IgA, IgM, etc.), and also kappa and lambda free light chains. In your case, you have mutated plasma cells that produce monoclonal IgG and kappa free light chains.
Hope this helps a bit. Keep us posted on how you're doing, and good luck!
It's good that the immunoglobulin (IgG, IgA, and IgM) levels in your blood are within normal ranges. This indicates that your bone marrow is not impaired to such an extent that it is producing lower levels of some immunoglobulins.
Given that you may have some reduced kidney function, I would focus more on blood test results rather than your urine results for most things, including your IgG, IgA, and IgM levels.
The result you quoted saying that you have "monoclonal IgG kappa type" is most likely from a serum immunofixation test. It tells you what sort of M-spike you have. The serum protein electrophoresis (SPEP) test tells you how big your M-spike is (0.4 g/dL in your case).
MGUS and multiple myeloma are diseases where there are mutated, "monoclonal" plasma cells in the body (usually in the bone marrow). Plasma cells, whether healthy or mutated, produce immunoglobulins (IgG, IgA, IgM, etc.), and also kappa and lambda free light chains. In your case, you have mutated plasma cells that produce monoclonal IgG and kappa free light chains.
Hope this helps a bit. Keep us posted on how you're doing, and good luck!
Re: M-spike with high ratio: is it likely to be myeloma?
Hello All,
I've just had my 3-month follow-up labs from an earlier MGUS diagnosis (earlier results are part of this forum thread). All of the "white blood cell differential," and "complete blood count," and calcium serum results were in the normal ranges. My creatinine and calculated glomerular filtration rates reflected my stage 3 kidney disease that I have had since I was a child. For some reason, every January over the past several years they have been outside of the normal range, but by summer or fall they are back to the normal range. Not sure why except a diet / lifestyle issue.
Of concern just now is that my beta-2 microglobulin results came back high. In October, the result was 2,175 (900-2300 ug/L), but today's result was 2,409.
I'm waiting for another result, but my anxiety is through the roof.
I've just had my 3-month follow-up labs from an earlier MGUS diagnosis (earlier results are part of this forum thread). All of the "white blood cell differential," and "complete blood count," and calcium serum results were in the normal ranges. My creatinine and calculated glomerular filtration rates reflected my stage 3 kidney disease that I have had since I was a child. For some reason, every January over the past several years they have been outside of the normal range, but by summer or fall they are back to the normal range. Not sure why except a diet / lifestyle issue.
Of concern just now is that my beta-2 microglobulin results came back high. In October, the result was 2,175 (900-2300 ug/L), but today's result was 2,409.
I'm waiting for another result, but my anxiety is through the roof.
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