[kjpoppit]

M spike has gotten higher during treatment - how common?

by kjpoppit on Thu Jan 23, 2014 10:22 pm

My M-spike has risen during treatment, is this common? I started treatment for myeloma on Nov. 20, 2013. I was started on CyBorD. My M-spike had dropped and now it is up again.

Lab Results:

Nov 20, 2013 labs          Dec. 20, 2013 labs      Jan. 17, 2014 labs

M-spike 4.3                M-spike  0.7            M-spike  1.6
IGA 6260 high              IGA 1184  high          IGA 214 normal
IGG 506 low                IGg 637 low             IGg 648 low
Beta Globulin 5.1 high     Beta Globulin 1.6 high  Beta Globulin 2.3
Kappa lt chain 19.68 high  Kappa 3.5 normal        Kappa 1.99 low
lamda lt chain 8.08        Lamda 9.16 normal       Lamda 7.22 normal
ratio 2.44 high            Ratio .38               Ratio .28

I am not sure what to think. I haven't been able to talk to my doctor yet, she is kind of hard to get in touch with.

Does this mean my treatment isn't working? I thought I had been doing well so it surprised me to see the M-spike go up, yet the light chains seem to be doing good.

Any insights or experience any of you have is appreciated.

[Multibilly]

Re: M spike has gotten higher during treatment - how common?

by Multibilly on Fri Jan 24, 2014 9:45 am

I may be wrong, but I think you might want to repeat the test.

You are IgA-Kappa type myeloma, right? The math from your last test doesn't work out between the IgA level and your M-spike. The IgA level in your lab test measures the combination of the IgA produced by your healthy cells and the monoclonal version produced by your myeloma cells. Your M-Spike measures just the monoclonal IgA produced by your myeloma cells.

To see why I think something is off, first normalize the units of the M-Spike from 1.6 g/dL to 1600 mg/dL to match up with your IgA units of mg/dL. If you are IgA-type myeloma, you can't have an M-Spike that is larger than your IgA of 214 mg/dL (i.e. 1600 > 214). The M-Spike should always be smaller than the corresponding total immunoglobulin level in your lab test.

I'm not a doc, but I think something wasn't right with the lab measurement.

[kjpoppit]

Re: M spike has gotten higher during treatment - how common?

by kjpoppit on Fri Jan 24, 2014 12:53 pm

Yes I am IGa kappa. I find your information encouraging. I have treatment today and will ask about retesting. Thanks

[Wayne K]

Re: M spike has gotten higher during treatment - how common?

by Wayne K on Fri Jan 24, 2014 2:15 pm

Your doctor may be aware of what MultiBilly points out. I would bring it up to him, but I wouldn't expect him to retest unless he suspects other conflicts. He can likely clear up your concerns.

[Multibilly]

Re: M spike has gotten higher during treatment - how common?

by Multibilly on Fri Jan 24, 2014 4:13 pm

I found the thread that stuck in my head regarding IgA testing challenges.

https://myelomabeacon.org/forum/iga-protein-vs-m-spike-t292.html

Also, see the discussion from today:

https://myelomabeacon.org/forum/post15135.html#p15135

[Ron Harvot]

Re: M spike has gotten higher during treatment - how common?

by Ron Harvot on Fri Jan 24, 2014 7:15 pm

I guess I would not get all that concerned about it. Your sFLC Assay shows the Kappa FLC have fallen. In fact they have now fallen to below normal so much that your ratio shows a flip. (Lambda is now higher than the Kappa and the ratio is below normal.) Normally those kind of readings would be an indication of a person with IgA Lambda but your multiple myeloma is IgA Kappa.

So this flip is interesting.

Since your overall IgA numbers have also fallen and the treament is showing positive results in the sFLC my overall impression is that you are still responding to treatment. The M spike might jump around a bit and be slower to respond than what the sFLC would indicate. If on your next test you see a continued rise in the M Spike then it might be time to have a discussion with your Dr.

If you see the sFLC where the Kappa levels rise above normal then that would be different but the Kappa level has responded.


Ron

[kjpoppit]

Re: M spike has gotten higher during treatment - how common?

by kjpoppit on Fri Jan 24, 2014 8:38 pm

Didn't get to talk to my doctor today but I have a call into her and hope she will call me back next Monday. I appreciate the feedback. I find the flip interesting too and wonder what that means too. I guess I just need to practice some patience in waiting to talk to my doctor but this does help me be more informed when I do talk to her. Thanks Multibilly for the links, as always you are real helpful and thank you Ron.

[Ron Harvot]

Re: M spike has gotten higher during treatment - how common?

by Ron Harvot on Fri Jan 24, 2014 9:14 pm

Keep us posted, would be interested in hearing what she says.

Ron

[kjpoppit]

Re: M spike has gotten higher during treatment - how common?

by kjpoppit on Wed Jan 29, 2014 11:38 pm

I was able to talk to my doctor. She didn't have an answer for me. She wasn't sure herself and said she thought it might be a lab issue. We will just wait to see what my next tests say.

[JimNY]

Re: M spike has gotten higher during treatment - how common?

by JimNY on Thu Jan 30, 2014 10:32 am

Thanks for the update, Kim. I'll be interested to hear what you and your doctor finally learn about this.