This is only 2nd round of testing (the results below are 2 months apart and at same lab), so I am still learning.
I was surprised my M-spike increased when my immunoglobulins actually dropped. Am I looking at oranges to compare apples?
I'm also confused by "decrease in gamma globulins" which I thought would be good, but M-spike increased.
Lastly, everything I've read is "bad" that anion gap is low.
Any armchair quarterback insight?
Result JAN'16 MAR'16
Anion Gap 12 Decrease 6
IgA 253 Decrease 229
IgG 2557 Decrease 2471
IgM 35 Decrease 32
M-Spike 2.3 Decrease 2.5
K/L FLC Ratio 7.24 Increase 7.82 (0.26-1.65)
Kappa Free, Serum 6.23 Increase 6.49 (0.33-1.94 mg/dL)
Lambda Free, Serum 0.86 Decrease 0.83 (0.57-2.63 mg/dL)
M-Spike 2.3 Increase 2.5
SPE Interpretation (March 2016)
The SPE pattern demonstrates a decrease in gamma globulins. The SPE pattern demonstrates a single band of restricted mobility in the beta region, which may represent monoclonalprotein.
Immunofixation Electrophoresis, Serum
Monoclonal component typed as IgG kappa. Concentration of monoclonal protein determined by serum protein electrophoresis(g/dL) is 2.5.
SPE Interpretation (January 2016)
The SPE pattern demonstrates a single band of restricted mobility in the beta region, which may represent monoclonal protein.
Immunofixation Electrophoresis, Serum
Monoclonal component typed as IgG kappa. Concentration of monoclonal protein determined by serum protein electrophoresis(g/dL) is 2.3.
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Re: Increase in M-spike with decrease in IgG?
Hi KbinNC,
Are you currently diagnosed with MGUS or smoldering multiple myeloma and currently not undergoing treatment?
If your lab results are correct, your current "healthy" IgG level from your March test is extremely low.
Based on January results, your "healthy" IgG level was only 257 g/dL:
The lower normal range for IgG is usually about 700 mg/dL.
The March results shows your "healthy" IgG level to be non-existent (your IgG-kappa M-spike is actually larger than your total IgG, which is impossible.
Your IgM is also suppressed.
If your IgG and IgM are truly both this low, are you experiencing a lot of infections and/or getting sick quite a bit?
Also, is there any chance that your facility is processing this test through Quest Diagnostics (the SPEP and quantified immuoglobulin report likely states where the test was actually performed)? I've recently had completely bogus immunoglobulin and M-spike results from Quest.
Lastly, I wouldn't necessarily say that having a low anion gap is "bad". It could just be a natural chemical result of having an IgG M-spike. If you have excess IgG protein (which is positively charged) in your blood because of your IgG-type myeloma, this can in turn lower your anion gap reading.
In any case, I would suggest talking over all these numbers with your hematologist ... and maybe discuss getting re-tested somewhere else.
Are you currently diagnosed with MGUS or smoldering multiple myeloma and currently not undergoing treatment?
If your lab results are correct, your current "healthy" IgG level from your March test is extremely low.
Based on January results, your "healthy" IgG level was only 257 g/dL:
Healthy IgG = Total IgG - M-spike = 2557 mg/dL - 2.3 g/dL = 257 mg/dL
The lower normal range for IgG is usually about 700 mg/dL.
The March results shows your "healthy" IgG level to be non-existent (your IgG-kappa M-spike is actually larger than your total IgG, which is impossible.
Your IgM is also suppressed.
If your IgG and IgM are truly both this low, are you experiencing a lot of infections and/or getting sick quite a bit?
Also, is there any chance that your facility is processing this test through Quest Diagnostics (the SPEP and quantified immuoglobulin report likely states where the test was actually performed)? I've recently had completely bogus immunoglobulin and M-spike results from Quest.
Lastly, I wouldn't necessarily say that having a low anion gap is "bad". It could just be a natural chemical result of having an IgG M-spike. If you have excess IgG protein (which is positively charged) in your blood because of your IgG-type myeloma, this can in turn lower your anion gap reading.
In any case, I would suggest talking over all these numbers with your hematologist ... and maybe discuss getting re-tested somewhere else.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Increase in M-spike with decrease in IgG?
Hi MultiBilly,
Thanks for your reply. I just rechecked all of my numbers and they are as posted. I see one of the leading myeloma specialists in the US and I had so many questions the first time I met him (was diagnosed by a hematologist and traveled to the specialist). Labs changed quite a bit from the hematologist so I only included the two rounds from the specialist, as I knew my diagnosis labs were not processed at the same lab as my January and now March labs.
My bone marrow biopsy in December was 10%. I have a lot of bone pain and fall a lot. I also have neuropathy from spinal stenosis surgery, which started this myeloma ball rolling in November 2015.
If my healthy levels are extremely low and/or non-existent, what does that mean to you? I realize you're not a doctor, but you are a rock many of us hold on to, MultiBilly, with your insights. I just had scans done of my bone pain areas and do not have any lesions and was referred from an onc ortho to an ortho who can try and stabilize/reduce the pain with injections.
I see my myeloma specialist in late April and was hoping to increase my comfort level / understanding about my recent round of labs so I don't walk in with concerns that are unfounded which is why I posted to help in increasing my own understanding.
Thanks for your reply. I just rechecked all of my numbers and they are as posted. I see one of the leading myeloma specialists in the US and I had so many questions the first time I met him (was diagnosed by a hematologist and traveled to the specialist). Labs changed quite a bit from the hematologist so I only included the two rounds from the specialist, as I knew my diagnosis labs were not processed at the same lab as my January and now March labs.
My bone marrow biopsy in December was 10%. I have a lot of bone pain and fall a lot. I also have neuropathy from spinal stenosis surgery, which started this myeloma ball rolling in November 2015.
If my healthy levels are extremely low and/or non-existent, what does that mean to you? I realize you're not a doctor, but you are a rock many of us hold on to, MultiBilly, with your insights. I just had scans done of my bone pain areas and do not have any lesions and was referred from an onc ortho to an ortho who can try and stabilize/reduce the pain with injections.
I see my myeloma specialist in late April and was hoping to increase my comfort level / understanding about my recent round of labs so I don't walk in with concerns that are unfounded which is why I posted to help in increasing my own understanding.
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KBinNC - Name: KBinNC
- When were you/they diagnosed?: 2015
- Age at diagnosis: 48
Re: Increase in M-spike with decrease in IgG?
Again, I think you are best advised to chat with your specialist about all this.
Your low IgM can be due to a condition called immunoparesis, where one or more of the uninvolved immunolgobulins (in your case, your IgM) can be suppressed. This can sometimes suggest a stronger likelihood for progression to multiple myeloma. See this article:
"Levels Of Uninvolved Immunoglobulins Linked To Prognosis In Newly Diagnosed Multiple Myeloma," The Myeloma Beacon, March 24, 2014
I'm not sure what the prognostic implications are if one's "healthy" involved immunoglobuin level (in your case, your IgG) is suppressed. But if one were experiencing a lot of infections and had a very low IgG level, then a doctor might consider administering intravenous immunoglobliln (IVIG) or starting multiple myeloma treatment. But I don't believe a doctor would administer IVIG unless one was definitely experiencing complications as result of the low IgG.
I also believe that kidney problems can potentially lower one's IgG number. To start to eliminate that possibility based on the tests you already have in hand, you would first look at your serum creatinine and BUN levels to see how well your kidneys were functioning.
But these are just the various speculations of a layman. I'd really talk this over with your doctor. It's good you are seeing a top specialist. Others on the forum may have some additional ideas.
Your low IgM can be due to a condition called immunoparesis, where one or more of the uninvolved immunolgobulins (in your case, your IgM) can be suppressed. This can sometimes suggest a stronger likelihood for progression to multiple myeloma. See this article:
"Levels Of Uninvolved Immunoglobulins Linked To Prognosis In Newly Diagnosed Multiple Myeloma," The Myeloma Beacon, March 24, 2014
I'm not sure what the prognostic implications are if one's "healthy" involved immunoglobuin level (in your case, your IgG) is suppressed. But if one were experiencing a lot of infections and had a very low IgG level, then a doctor might consider administering intravenous immunoglobliln (IVIG) or starting multiple myeloma treatment. But I don't believe a doctor would administer IVIG unless one was definitely experiencing complications as result of the low IgG.
I also believe that kidney problems can potentially lower one's IgG number. To start to eliminate that possibility based on the tests you already have in hand, you would first look at your serum creatinine and BUN levels to see how well your kidneys were functioning.
But these are just the various speculations of a layman. I'd really talk this over with your doctor. It's good you are seeing a top specialist. Others on the forum may have some additional ideas.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Increase in M-spike with decrease in IgG?
Multibilly,
Just out of interest, how did you discover that the Quest Diagnostics numbers were off?
I'm with Kaiser in Hawaii, so most of my labs are done locally onsite. The exceptions, as you've probably already guessed, are SPEP, serum kappa / lambda light chains, immunoglobulins, all are sent to Quest on the mainland.
I am currently awaiting the results of my latest SPEP, hopefully later today. Last month my IgG decreased – I'm IgG kappa light chain del(17p), IgA and IgM also increased, yet my M-spike increased. This doesn't fit my understanding of how M-spike is calculated?
I should mention that I relapsed last June with active multiple myeloma in my thoracic spine and all my numbers were within normal ranges and M-spike was very low. My doctors. have been trying ever since to find a way too monitor my condition since my blood work was not helpful –PET/CT and full body MRI are vague at best. With that in mind, my current numbers are the highest they've been since initial diagnosis back in January 2013 and I expect my M-spike to be even higher today.
Component Your Value Standard Range
PROTEIN ELECTROPHORESIS 7.2 g/dl 6.1 - 7.9 g/dl
ALBUMIN, ELECTROPHORESIS 4.66 g/dl 3.7 - 5.3 g/dl
ALPHA 1 GLOBULIN EP 0.17 g/dl 0.1 - 0.25 g/dl
ALPHA 2 GLOBULIN EP 0.66 g/dl 0.4 - 1.00 g/dl
BETA GLOBULIN ELECTROPHORESIS 0.73 g/dl 0.6 - 1.1 g/dl
GAMMA GLOBULIN, ELECTROPHORESIS 0.99 g/dl 0.6 - 1.40 g/dl
IgG kappa M protein = 0.24 g/dL or 240 mg/dL
The monoclonal immunoglobulin (M-protein) concentration is estimated from serum electrophoretic tracing.
Protein Electrophoresis Interpretation:
Known patient with a faint IgG Kappa monoclonal band and a monoclonal free lambda light chain band, however note IFE studies from 11/14/15 reveal only an IgG kappa monoclonal band. Compared with the 02/01/16 studies, the total IgG level has decreased from 1510 mg/dL to 1470 mg/dL and the M protein concentration has increased from 190 mg/dL to 240 mg/dL. The electrophoretic pattern continues to reveal the presence of the monoclonal immunoglobulin band.
Reviewed and interpreted on 03/02/16.
Thanks
Daniel
Just out of interest, how did you discover that the Quest Diagnostics numbers were off?
I'm with Kaiser in Hawaii, so most of my labs are done locally onsite. The exceptions, as you've probably already guessed, are SPEP, serum kappa / lambda light chains, immunoglobulins, all are sent to Quest on the mainland.
I am currently awaiting the results of my latest SPEP, hopefully later today. Last month my IgG decreased – I'm IgG kappa light chain del(17p), IgA and IgM also increased, yet my M-spike increased. This doesn't fit my understanding of how M-spike is calculated?
I should mention that I relapsed last June with active multiple myeloma in my thoracic spine and all my numbers were within normal ranges and M-spike was very low. My doctors. have been trying ever since to find a way too monitor my condition since my blood work was not helpful –PET/CT and full body MRI are vague at best. With that in mind, my current numbers are the highest they've been since initial diagnosis back in January 2013 and I expect my M-spike to be even higher today.
Component Your Value Standard Range
PROTEIN ELECTROPHORESIS 7.2 g/dl 6.1 - 7.9 g/dl
ALBUMIN, ELECTROPHORESIS 4.66 g/dl 3.7 - 5.3 g/dl
ALPHA 1 GLOBULIN EP 0.17 g/dl 0.1 - 0.25 g/dl
ALPHA 2 GLOBULIN EP 0.66 g/dl 0.4 - 1.00 g/dl
BETA GLOBULIN ELECTROPHORESIS 0.73 g/dl 0.6 - 1.1 g/dl
GAMMA GLOBULIN, ELECTROPHORESIS 0.99 g/dl 0.6 - 1.40 g/dl
IgG kappa M protein = 0.24 g/dL or 240 mg/dL
The monoclonal immunoglobulin (M-protein) concentration is estimated from serum electrophoretic tracing.
Protein Electrophoresis Interpretation:
Known patient with a faint IgG Kappa monoclonal band and a monoclonal free lambda light chain band, however note IFE studies from 11/14/15 reveal only an IgG kappa monoclonal band. Compared with the 02/01/16 studies, the total IgG level has decreased from 1510 mg/dL to 1470 mg/dL and the M protein concentration has increased from 190 mg/dL to 240 mg/dL. The electrophoretic pattern continues to reveal the presence of the monoclonal immunoglobulin band.
Reviewed and interpreted on 03/02/16.
Thanks
Daniel
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DanielR - Name: Daniel Riebow
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: 12/2012
- Age at diagnosis: 59
Re: Increase in M-spike with decrease in IgG?
The way I discovered that Quest was "off" is that they came back with an M-spike that was larger than my involved immunoglobulin (IgG) level. My onc and I both agreed that was simply not possible. So that caused us to question Quest, at least regarding those test results.
Additionally, no other markers had changed and my FLC had remained constant when I got these unexpected results from Quest. I then got re-tested at Labcorp and their IgG and M-spike values lined up far better with my historical numbers, including how much my IgG and M-spike were offset from one another. Both labs returned identical FLC results on my latest tests when I was most recently tested. My onc and I agreed that the Labcorp numbers now looked more believable.
In your case, your IgG M-spike is tiny. So, it wouldn't take much of a decrease in your "healthy" IgG level to outweigh an increase in your M-spike, remembering that
total IgG = ("healthy" IgG) + (IgG M-spike)
One's healthy IgG levels tend to normally fluctuate quite a bit anyway. My healthy IgG level has varied from 760 to ~ 1596 mg/dL over the past 3+ years.
Additionally, no other markers had changed and my FLC had remained constant when I got these unexpected results from Quest. I then got re-tested at Labcorp and their IgG and M-spike values lined up far better with my historical numbers, including how much my IgG and M-spike were offset from one another. Both labs returned identical FLC results on my latest tests when I was most recently tested. My onc and I agreed that the Labcorp numbers now looked more believable.
In your case, your IgG M-spike is tiny. So, it wouldn't take much of a decrease in your "healthy" IgG level to outweigh an increase in your M-spike, remembering that
total IgG = ("healthy" IgG) + (IgG M-spike)
One's healthy IgG levels tend to normally fluctuate quite a bit anyway. My healthy IgG level has varied from 760 to ~ 1596 mg/dL over the past 3+ years.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Increase in M-spike with decrease in IgG?
Multibilly, once again, thanks!
DR
DR
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DanielR - Name: Daniel Riebow
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: 12/2012
- Age at diagnosis: 59
7 posts
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