[Daninewry]

Can an M-spike increase for benign reasons?

by Daninewry on Sun Dec 16, 2018 8:10 am

Hi,

My dad was diag­nosed with IgG mgus in 2011 with an M-spike of 24 (UK) (24 g/l, or 2.4 g/dL). He did not have a bone marrow biopsy. His M-spike went as low as 17 g/l and then stayed at 21 g/l for a few years, then in September it was 23 g/l and now it is 27 g/l (2.7 g/dL). He does not meet any of the "CRAB" criteria, and there has not been any increase in his serum free light chain levels.. I haven’t stopped crying. They may do a bone marrow biopsy in February depending on the results produced the next time.

My question is can there be a benign explanation for such a jump? He had his flu jab in November and also recently was put on Eliquis (apixaban) and came off aspirin.

I feel sick with worry. I feel like I’ve already lost him.

[Multibilly]

Re: Can an M-spike increase for benign reasons?

by Multibilly on Sun Dec 16, 2018 9:56 am

Hi Daninewry,

M-spike values can and do normally fluctuate over time, especially in MGUS and smoldering patients. I've been smoldering for 6+ years and you can see how my m-spike has varied over the years if you look at these graphs.

It's also a good thing that there has not been any increase in his serum free light chain values. Things like flu shots tend to muck with free light chain levels more so than M-spike levels.

In any case, I wouldn't necessarily jump to the conclusion that he is progressing towards the smoldering stage (which is still not a symptomatic stage that requires treatment) and I would instead wait till you have one or two more test results in hand to see if any sort a significant and steady trend is developing.

Lastly, if you haven't reviewed this article yet on diagnosing IgM monoclonal gammopathies, I would strongly suggest that you do:

J Mikhael, "Ask the Hematologist: A Diagnostic Approach to Patients with an IgM monoclonal protein", The Hematologist, Sep 15, 2014 (full text of article)

Good luck and let us know how things turn out over the coming months.

[Daninewry]

Re: Can an M-spike increase for benign reasons?

by Daninewry on Sun Dec 16, 2018 7:27 pm

Thank you so much.

That’s very refreshing to hear. Hopefully it’s my anxiety that’s playing a big part. Like honestly I felt like I’d just been told he had a terminal illness. Keep bursting into tears and finding it hard to func­tion.

I’m so glad to hear that the levels can fluctuate as at least I have hope x

[Mike F]

Re: Can an M-spike increase for benign reasons?

by Mike F on Mon Dec 17, 2018 2:31 pm

I completely understand your anxiety and your concern for your father and I don't want to seem like I'm trying to minimize something that's very important to him and to you. But the fact is that even if your dad progresses into myeloma, there are still many reasons to believe he'll continue to do well. Multiple myeloma is an extremely serious disease and it can hit some people very hard. But for many if not most now, the range of available therapies work pretty well without the kinds of horrible side effect you get from traditional chemotherapy. And every passing year seems to bring in new possibilities for therapies that offer even longer-ranging control of the disease. Indeed, one of the biggest problems for oncologists now is figuring out which of the many available combinations of therapy is best for a particular patient. No one can say for sure how it will work out when one is diagnosed with this disease, but things look much better for myeloma patients now then they did ten years ago and they should look even better in the relatively near future. Have you read up on the therapies that are currently available? If not, I think you might want to. This could help ease your mind a bit when you think of the possibility of your dad getting diagnosed with myeloma.

That said, I very much hope that this never becomes an issue for you, your dad, and the rest of your family.

[Daninewry]

Re: Can an M-spike increase for benign reasons?

by Daninewry on Wed Dec 19, 2018 2:10 pm

Thank you so much, Mike, I really appreciate it. I always have seen myeloma as a death sentence. Ever since I found out his paraprotein was raised I found myself almost unable to speak to daddy for fear I would break down. I definitely think my anxiety has a lot to answer for.

I hope that your experience with myeloma has been much less negative than what’s in my head. I must catch up on your story.

Thank you once again x