Hello,
I apologize in advance for the length of this post, but there are a lot of numbers from recent tests that have me more and more confused as I try to figure out what is going on in my body and as I read test results posted by others on this forum. I feel totally knocked into left field by the possibility of having multiple myeloma, as I am otherwise quite healthy and productive at 67 years old.
My journey began about six weeks or so ago. I had been having what I called "sinking spells" where the energy just seemed to drain from my body. I initially thought it was low blood sugar or low blood pressure, but the spells began occurring more frequently. I went from only needing 5-6 hours of sleep a night to unable to get enough sleep and being "bone-tired" all the time.
Also around the time the energy drains started, I woke up one morning with what felt like a large wad of gum stuck under the skin on the ball of my foot. It didn't hurt but seemed to come out of nowhere. It has now begun to burn slightly, but at night in bed not when I am awake and walking.
Then two weeks ago I went to the emergency room thinking I was having a heart attack, with irregular heart beat and chest pressure. Fortunately it was not my heart, but the blood tests showed some 17 values out of range. I went to my PCP to get a second test assuming the first was a mistake. But two more tests later, I have three sets of consistent numbers.
My PCP was very efficient and immediately ordered the tests I see recommended on this forum. Here are the numbers from those tests.
SPEP Test from March 20, 2017
Total Protein Electrophoresis 10.30 g/dL H (6.00-8.30)
Albumin 4.27 g/dL (3.75-5.01)
Alpha 1 Globulin 0.32 g/dL (0.19-0.46)
Alpha 2 Globulin 0.68 g/dL (0.48-1.05)
Beta Globulin 0.56 g/dL (0.48-1.10)
Gamma 4.47 g/dL H (0.62-1.51)
SPEP/IFE Interpretation - See Note
M-spike in the gamma region. The monoclonal protein peak accounts for 4.37 g/dL of the total 4.47 g/dL of protein in the gamma region. Suggest IFE to identify the monoclonal protein. Immunofixation electrophoresis (IFE) is a more sensitive technique for the identification of small M-proteins.
(The graph which I was unable to copy and paste showed what I observed as a very large spike relative to three or four smaller ones on the graph. The test results did not report a number for this spike, so I don't have that information to share.)
Immunofixation Elecrophoresis, IgD and IgE, Serum
Immunofixation IgD
See report
IFE gel is negative for monoclonal IgD and IgE. IFE gel shows a band in lambda suggestive of a free lambda light chain monoclonal protein with an additional very faint band in lambda. This assumes an IFE for IgG, IgA, and IgM heavy chains has been performed and shows no association with the monoclonal lambda protein. A Bence-Jones protein on a 24-hour urine collection may also be of diagnostic value.
Immunofixation IgE
See report - Refer to IFE IgD for interpretive comments.
Kappa/Lambda Quantitative Free Light Chains with Ratio, Serum
Kappa Qnt Free Light Chains 0.76 mg/dl (0.33-1.94)
Lambda Qbt Free Light Chains 30.50 mg/dl H (0.57-2.63)
Kappa/Lambda Free Light Chain Ratio 0.02 L (0.26-1.65)
(The Immunofixation (IFE) gel Image only had two hand-written notes: 1303 and D E.
CBC
WBC 3.4 L
RBC 3.38 L
HGB 10.5 L
HCT 32.2 L
CMP
NA 133 L
TPm 10.3 H
ALBm 3.2 L
Globulin 7.1 H
A/G 0.5 L
Calcium = Normal
Iron = Normal
Kidney Function = Normal
LDH = Normal
Okay, so that is a lot of numbers and I am lost in trying to decipher exactly what they mean. I was referred to an oncologist for further testing. But I don't even have that appointment set yet, waiting to hear from his office.
I have found the posts on this forum to be very informative and am hoping someone can calm my concerns about the very high lambda free light chain level, the kappa-lambda ratio of 0.02 and the high gamma reading with an M-Spike in the gamma region. I understand a normal or healthy kappa-lambda ratio is 1.0. I appear to only have two cents left from my dollar.
I know you can't make medical diagnosis on a forum such as this, but perhaps someone can explain these numbers for me.
Thanks so much for reading through this. I appreciate any wise words you can share.
Forums
4 posts
• Page 1 of 1
Re: M-spike & low kappa-lambda ratio: is it myeloma?
Hi Jeannaja,
Welcome to the forum. I understand your anxiety and we've all been there. I'm not a doctor and only a doctor can diagnose you. But here are some observations from a layman:
1. You have an M-spike of 4.37 g/dL. That is a fairly significant M-spike, and that alone would likely suggest a diagnosis of at least something like smoldering multiple myeloma.
2. Your involved / uninvolved free light chain (FLC) ratio is lambda/kappa = 30.5/0.76 = 40. That is a moderately high FLC ratio. For now, you should focus of your lambda/kappa ratio, but also keep the lambda figure in mind if the ratio changes quite a bit.
3. I'm not sure what's going on with your immunofixations (IFEs). It looks like they ran an IFE for IgD and IgE, but not an IFE for IgG, IgA, and IgM. Long story short, you really want an IFE for IgG, IgA and IgM (the most commonly affected immunoglobulins in myeloma, in that order). IgD and IgE-type myeloma are extremely rare and I'm not sure why your doctor ordered that IFE and not one for IgG / IgA / IgM.
4. You didn't include your reference (normal) ranges for your lab numbers, but you appear to be anemic. Anemia is a common side effect of smoldering multiple myeloma and active (symptomatic) multiple myeloma. If your hemoglobin (Hgb) is 2.0 g/dL under the lower limit of the lab's reference range, then you would technically meet the anemia standard for having symptomatic multiple myeloma. This is also known as the "A" in the myeloma "CRAB" criteria (CRAB = hyperCalcemia, Renal dysfunction, Anemia, Bone damage via lytic lesions). From your lab results, it looks like you don't have the "C" or "R" in the CRAB criteria, which is good news. So, depending on what your normal reference range is for Hgb, coupled with an M-spike of 4.37 g/dL, that could peg you with a diagnosis of symptomatic multiple myeloma. But you would really need a bone marrow biopsy and an IFE for IgG / IgA / IgM to 100% confirm a diagnosis of multiple myeloma or some other related plasma cell disorder.
5. When you see the hematologist, he/she should be ordering a bone marrow biopsy and either a whole-body MRI or PET/CT scan to confirm your diagnosis and to look for any bone damage, respectively.
The most important advice I can give you is to seek out a hematologist that specializes in multiple myeloma. If you let us know what city you are in, folks on this forum can make some recommendations of treatment centers near you that have myeloma specialists.
Lastly, try not to freak about this. It sounds like you are catching this fairly early before you had any serious bone or kidney damage, which is great. Treatments have really advanced a lot for multiple myeloma in the past few years, and many folks on this forum live quite good and long lives.
Welcome to the forum. I understand your anxiety and we've all been there. I'm not a doctor and only a doctor can diagnose you. But here are some observations from a layman:
1. You have an M-spike of 4.37 g/dL. That is a fairly significant M-spike, and that alone would likely suggest a diagnosis of at least something like smoldering multiple myeloma.
2. Your involved / uninvolved free light chain (FLC) ratio is lambda/kappa = 30.5/0.76 = 40. That is a moderately high FLC ratio. For now, you should focus of your lambda/kappa ratio, but also keep the lambda figure in mind if the ratio changes quite a bit.
3. I'm not sure what's going on with your immunofixations (IFEs). It looks like they ran an IFE for IgD and IgE, but not an IFE for IgG, IgA, and IgM. Long story short, you really want an IFE for IgG, IgA and IgM (the most commonly affected immunoglobulins in myeloma, in that order). IgD and IgE-type myeloma are extremely rare and I'm not sure why your doctor ordered that IFE and not one for IgG / IgA / IgM.
4. You didn't include your reference (normal) ranges for your lab numbers, but you appear to be anemic. Anemia is a common side effect of smoldering multiple myeloma and active (symptomatic) multiple myeloma. If your hemoglobin (Hgb) is 2.0 g/dL under the lower limit of the lab's reference range, then you would technically meet the anemia standard for having symptomatic multiple myeloma. This is also known as the "A" in the myeloma "CRAB" criteria (CRAB = hyperCalcemia, Renal dysfunction, Anemia, Bone damage via lytic lesions). From your lab results, it looks like you don't have the "C" or "R" in the CRAB criteria, which is good news. So, depending on what your normal reference range is for Hgb, coupled with an M-spike of 4.37 g/dL, that could peg you with a diagnosis of symptomatic multiple myeloma. But you would really need a bone marrow biopsy and an IFE for IgG / IgA / IgM to 100% confirm a diagnosis of multiple myeloma or some other related plasma cell disorder.
5. When you see the hematologist, he/she should be ordering a bone marrow biopsy and either a whole-body MRI or PET/CT scan to confirm your diagnosis and to look for any bone damage, respectively.
The most important advice I can give you is to seek out a hematologist that specializes in multiple myeloma. If you let us know what city you are in, folks on this forum can make some recommendations of treatment centers near you that have myeloma specialists.
Lastly, try not to freak about this. It sounds like you are catching this fairly early before you had any serious bone or kidney damage, which is great. Treatments have really advanced a lot for multiple myeloma in the past few years, and many folks on this forum live quite good and long lives.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: M-spike & low kappa-lambda ratio: is it myeloma?
Thank you so much for that very informative reply. My PCP called this morning and after consultation with another doctor thinks this could be multiple myeloma with amyloidosis due to my high free light chain numbers. She got me in this morning for a skeletal survey and more blood tests. She also ordered a 24-hour urine collection. The oncologist finally called and I have an appointment Monday morning. I am grateful for the speed with which these additional evaluations are occurring. Just breathing in and out. Again I really appreciate the prompt and useful reply.
Re: M-spike & low kappa-lambda ratio: is it myeloma?
Sorry to hear that. But better to be diagnosed correctly than not.
A large amount of excess albumin in your 24 hour urine test result would suggest amyloidosis. But you would ultimately need to have what is known as a Congo red stain test on a tissue or bone marrow biopsy sample to confirm a diagnosis of amyloidosis. Good luck and let us know what happens.
A large amount of excess albumin in your 24 hour urine test result would suggest amyloidosis. But you would ultimately need to have what is known as a Congo red stain test on a tissue or bone marrow biopsy sample to confirm a diagnosis of amyloidosis. Good luck and let us know what happens.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
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