Hi all,
It's that time of year where I do my testing and I've got all the associated anxiety and go and read all the literature and get all freaked out again. Who's with me?
I was diagnosed in October 2014 with IgG MGUS. I had an M-spike of 0.2 g/dL (2 g/L). They originally did the testing because I had facial numbness. I also came back with an elevated ANA. They never did figure out the numbness, but it's slowly been fading over time.
In October 2014, my IgM was 32 (low) (range 63-277). IgG was 783 (range 723-1685), IgA was 86 (range 63-382) - both normal, but on the low side.
In February 2015 I was retested. No M spike. IgM (36) and IgA (56) were both low; IgG a bit higher at 860.
In August 2015, still no M spike. IgM lower (22), IgA (71) and IgG (783) normal low-ish. Doctor moved me to 9 month testing.
In May 2016, no M spike. IgM low (29), IgA (74) and IgG (753) normal low-ish.
The M spike seems to have disappeared for the time being. This visit I saw the PA. I asked if it was something that could possibly have just gone away and she said no, because the other numbers were out of kilter. I asked what caused that, and she wasn't very clear on it.
All my other numbers look pretty good. I'm a little concerned about amyloidosis, mainly because some of the symptoms line up with some of what has been going on with me. The PA said there would be other lab numbers that would indicate if that were the case. Would they?
Why did my M spike go away? Do I need to worry about the IgM/IgA being low? Does that fall into the CRABI risk factor if I don't have monoclonal proteins anymore?
Basically, how much do I need to worry?
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Re: M-spike - now you see it, now you don't
Zabaglione,
Welcome to the forum.
You also need to be tracking your serum free light chains, not just your M-spike. What have your free light chains done during this period?
I'm not an expert on amyloidosis, but there are no definitive urine or serum markers that can be used to make a diagnosis for amyloidosis. If amyloidosis were to impact your kidney function (which does happen quite often, but is not a given) then the result of your impaired kidney function would likely show up on your serum and urine tests (excess protein in your urine, low serum albumin, etc) . The only way to reliably test for amyloidosis is via a biopsy or, depending on which organs and parts of the body the amyloidosis is affecting, a SAP scan.
Welcome to the forum.
You also need to be tracking your serum free light chains, not just your M-spike. What have your free light chains done during this period?
I'm not an expert on amyloidosis, but there are no definitive urine or serum markers that can be used to make a diagnosis for amyloidosis. If amyloidosis were to impact your kidney function (which does happen quite often, but is not a given) then the result of your impaired kidney function would likely show up on your serum and urine tests (excess protein in your urine, low serum albumin, etc) . The only way to reliably test for amyloidosis is via a biopsy or, depending on which organs and parts of the body the amyloidosis is affecting, a SAP scan.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: M-spike - now you see it, now you don't
Actually come to think of it, I have recently had two lip biopsies for something totally unrelated. I would think they would pick up on amyloidosis unless it's something they specifically have to test for. I'll have to call my oral surgeon and ask.
Good point about the light chains. Here they are. Only one number is out of ref, and that's a 24 hour urine ratio:
Oct 2014
Kappa 13.4 mg/L (3.3-19.4)
Lambda 12.1 (5.71-26.3)
K/L ratio 1.11 (0.26-1.65)
Oct 2014 Urine -
Kappa 24h 0.64 mg/L (0.14-2.42)
Lambda 24h 0.04 (0.02-0.67)
**K/L 24h 16 (2.04-10.37)**
Free kappa excretion/day - 11.84 mg/d (no ref)
Free lambda excretion/day - 0.74 mg/d (no ref)
(Albumin, Alpha-1, Alpha-2, Beta globulin, and Gamma all listed as "detected." UPE Alpha 2 globulin 0%.)
Feb 2015
Kappa 1.775 mg/dL (0.33-1.94)
Lambda 1.31 mg/dL (0.57-2.63)
K/L 1.36 (0.26-1.65)
Aug 2015
Kappa 1.308 mg/dL (0.33-1.94)
Lambda 0.904 mg/dL (0.57-2.63)
K/L 1.45 (0.26-1.65)
Good point about the light chains. Here they are. Only one number is out of ref, and that's a 24 hour urine ratio:
Oct 2014
Kappa 13.4 mg/L (3.3-19.4)
Lambda 12.1 (5.71-26.3)
K/L ratio 1.11 (0.26-1.65)
Oct 2014 Urine -
Kappa 24h 0.64 mg/L (0.14-2.42)
Lambda 24h 0.04 (0.02-0.67)
**K/L 24h 16 (2.04-10.37)**
Free kappa excretion/day - 11.84 mg/d (no ref)
Free lambda excretion/day - 0.74 mg/d (no ref)
(Albumin, Alpha-1, Alpha-2, Beta globulin, and Gamma all listed as "detected." UPE Alpha 2 globulin 0%.)
Feb 2015
Kappa 1.775 mg/dL (0.33-1.94)
Lambda 1.31 mg/dL (0.57-2.63)
K/L 1.36 (0.26-1.65)
Aug 2015
Kappa 1.308 mg/dL (0.33-1.94)
Lambda 0.904 mg/dL (0.57-2.63)
K/L 1.45 (0.26-1.65)
Re: M-spike - now you see it, now you don't
You have to specifically be looking for amyloidosis in a biopsy to detect its presence. It requires that the pathologist first highlight the specimen with a Congo red stain and then inspect it under a microscope with special lighting.
You currently have no M-spike and your free light chains are normal. I suppose there is the fairly rare possibility that you could have a nonsecretory form of multiple myeloma that could be causing your suppressed IgM and low IgA without the presence of an M-spike or abnormal free light chain levels. Have you ever had a bone marrow biopsy to determine your bone marrow plasma percentage?
In any case, I would ask your hematologist and not your PA why your IgA and IgM might be suppressed under the circumstances and whether something like amyloidosis might be a possibility.
You currently have no M-spike and your free light chains are normal. I suppose there is the fairly rare possibility that you could have a nonsecretory form of multiple myeloma that could be causing your suppressed IgM and low IgA without the presence of an M-spike or abnormal free light chain levels. Have you ever had a bone marrow biopsy to determine your bone marrow plasma percentage?
In any case, I would ask your hematologist and not your PA why your IgA and IgM might be suppressed under the circumstances and whether something like amyloidosis might be a possibility.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: M-spike - now you see it, now you don't
No bone marrow biopsy. Because my M-spike was low, my hematologist said to stick with the CT scan for the time being. I will make sure my appointment is with her next time and not her assistant, and I'll ask about the numbers.
I had a whole enormous workup of tests when the facial numbness hit and there were irregularities, but all the docs just sort of threw up their hands and said, "Eh, we don't think it's anything too serious." A little frustrating and scary when there are 4 different docs in 4 different specialties who are all puzzled. I've just got to take their word that everything's _probably_ okay. At least for the moment.
I had a whole enormous workup of tests when the facial numbness hit and there were irregularities, but all the docs just sort of threw up their hands and said, "Eh, we don't think it's anything too serious." A little frustrating and scary when there are 4 different docs in 4 different specialties who are all puzzled. I've just got to take their word that everything's _probably_ okay. At least for the moment.
Re: M-spike - now you see it, now you don't
I'm wondering where my MGUS is heading.
My test this week once again showed no monoclonal peaks or paraprotein, so hooray! However, I've got the following out of range:
IgG, quant 836 mg/dL (681.0 - 1648.0)
IgM, quant *25 mg/dL (48.0 - 312.0)
IgA, quant *49 mg/dL (87.0 - 474.0)
K/L ratio, free, serum 1.48 (0.26 - 1.65)
Kappa free *19.615 mg/L (3.3 - 19.4)
Lambda free 13.257 mg/L (5.7 - 26.3)
Albumin, SPE 4.7 g/dL (3.0 - 5.0)
I have only had an M-spike once, in October 2014, and it was 0.2 g/dL. My IgM has been consistently low in each test, and my IgA has either been low or bordered on low.
In 2014 I also had a positive ANA test, but it was subsequently negative. I do have some symptoms like facial numbness and dry eyes; the numbness is what kicked off all the testing to begin with.
What specific questions should I ask my hematologist on Monday about these results? I already asked the false positive question, but she said that's not likely.
My test this week once again showed no monoclonal peaks or paraprotein, so hooray! However, I've got the following out of range:
IgG, quant 836 mg/dL (681.0 - 1648.0)
IgM, quant *25 mg/dL (48.0 - 312.0)
IgA, quant *49 mg/dL (87.0 - 474.0)
K/L ratio, free, serum 1.48 (0.26 - 1.65)
Kappa free *19.615 mg/L (3.3 - 19.4)
Lambda free 13.257 mg/L (5.7 - 26.3)
Albumin, SPE 4.7 g/dL (3.0 - 5.0)
I have only had an M-spike once, in October 2014, and it was 0.2 g/dL. My IgM has been consistently low in each test, and my IgA has either been low or bordered on low.
In 2014 I also had a positive ANA test, but it was subsequently negative. I do have some symptoms like facial numbness and dry eyes; the numbness is what kicked off all the testing to begin with.
What specific questions should I ask my hematologist on Monday about these results? I already asked the false positive question, but she said that's not likely.
6 posts
• Page 1 of 1