So my dad, who is 57 and has always been healthy, went in for his physical. Well, his bloodwork came back with high total protein of like 8.7 so his GP ordered some more tests, and they came back as M-spike of 2.3 g/dL (23 g/l) and IgG of 3700 mg/dL. His calcium was perfectly in range, creatinine perfectly in range and hemoglobin in range. His GP said that, as of then, it was MGUS, but other things had to be ruled out via bone scans, 24-hour urine test, more extensive blood testing, and after those results come back, possibly bone marrow biopsy.
Well, my dad went to the hematologist today, who mind you is not an MGUS specialist, and he made him even more worried then before. He wasn't compassionate and said that the M-spike level of 3 or less means nothing and he doesn't even know where that came from.
My dad does not have any symptoms with the exception of back pain because of two slipped disks that he has had for years, and has an MRI to show that two years ago but he feels great. My first task is going to be to find a specialist nearby in Maryland that actually knows what they are talking about. This hematologist was throwing the cancer word around, scaring my parents to death.
So they did the X-rays/ scan today and also took more blood. He is to do the urine test the next day and then meet back with this doctor next Monday to discuss results.
I could use some prayers that this is truly MGUS. My dad just started taking 6 g of curcumin daily as well as his omega fish oil and vitamin D3 with turmeric paste to wash it down. I just have to keep thinking positive thoughts.
Is it possible, or likely, to have numbers like my fathers and the diagnosis still be MGUS?
Bless you all.
Forums
Re: M-spike of 2.3 g/dL - is it likely to be just MGUS?
Hi and welcome!
I'm sorry to hear about your dad's findings. It is great that you are looking into a myeloma specialist. Once his results come back, you'll have a better ideal of what your dealing with. If it is MGUS, it's something along the lines of 1%-2% of people with MGUS develop a malignancy per year. So really the odds are in our favor.
I'm sending prayers your way and please let us know what they find!
All the best, Jodi
I'm sorry to hear about your dad's findings. It is great that you are looking into a myeloma specialist. Once his results come back, you'll have a better ideal of what your dealing with. If it is MGUS, it's something along the lines of 1%-2% of people with MGUS develop a malignancy per year. So really the odds are in our favor.
I'm sending prayers your way and please let us know what they find!
All the best, Jodi
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countrygirl - Name: Countrygirl
- Who do you know with myeloma?: IgG MGUS
- When were you/they diagnosed?: September 2016
- Age at diagnosis: 35
Re: M-spike of 2.3 g/dL - is it likely to be just MGUS?
Yesterday at the hematologist my father was told all of his CRAB symptoms are perfect. He had a bone scan and no lytic lesions found. He is scheduled for a bone marrow biopsy next Monday. His kappa-lambda ratio is 130. Is there any other reason besides multiple myeloma that could make it so high?
I am scared to death. I was planning on him being diagnosed with smoldering multiple myeloma that hopefully smoldered for a while, but now see that the ratio is over 100. He is a very healthy and active 57 year old without symptoms.
I am scared to death. I was planning on him being diagnosed with smoldering multiple myeloma that hopefully smoldered for a while, but now see that the ratio is over 100. He is a very healthy and active 57 year old without symptoms.
Re: M-spike of 2.3 g/dL - is it likely to be just MGUS?
Hi abg613,
Glad to hear that your dad isn't experiencing any of the CRAB criteria! That's good news.
I need to ask a couple of questions in order to help you with your question about the kappa / lambda ratio.
Was this kappa / lambda ratio value of 130 from a serum free light chain assay?
If so, what were the actual serum kappa and lambda free light chain values (including the units of measure)?
Glad to hear that your dad isn't experiencing any of the CRAB criteria! That's good news.
I need to ask a couple of questions in order to help you with your question about the kappa / lambda ratio.
Was this kappa / lambda ratio value of 130 from a serum free light chain assay?
If so, what were the actual serum kappa and lambda free light chain values (including the units of measure)?
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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 of 2.3 g/dL - is it likely to be just MGUS?
Hi Multibilly,
So I am not sure if it was serum free or not but the results read like this:
Free Kappa Lt Chains, S - 474.66
Free Lambda Lt Chains, S - 3.63
Yes I have read the new guidelines for "symptomatic myeloma" and saw that they now do the "SLIM CRAB," but I have also read that technically even though they changed the guidelines, he could still be smoldering and just have a high chance of it progressing in the next two years. So that is why I am doing all the research I can to "try" and keep him off conventional medicine as long as possible.
So I am not sure if it was serum free or not but the results read like this:
Free Kappa Lt Chains, S - 474.66
Free Lambda Lt Chains, S - 3.63
Yes I have read the new guidelines for "symptomatic myeloma" and saw that they now do the "SLIM CRAB," but I have also read that technically even though they changed the guidelines, he could still be smoldering and just have a high chance of it progressing in the next two years. So that is why I am doing all the research I can to "try" and keep him off conventional medicine as long as possible.
Re: M-spike of 2.3 g/dL - is it likely to be just MGUS?
Are those numbers expressed in mg/L or mg/dL? Also, there should be a normal reference range listed for each value. What are those ranges?
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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 of 2.3 g/dL - is it likely to be just MGUS?
Measured in mg/L
And range for kappa 3.30-20
Range for lambda 5.71-26
So yes, the kappa was way out of range as you can see.
And range for kappa 3.30-20
Range for lambda 5.71-26
So yes, the kappa was way out of range as you can see.
Re: M-spike of 2.3 g/dL - is it likely to be just MGUS?
Yeah, his kappa FLC is high. But his lambda FLC is also low, which is exaggerating his k/l ratio. The combination of a high kappa FLC, low lambda FLC and high FLC ratio suggests bone marrow suppression- but he isn't on any treatment that would cause that.
Given the aforementioned, I would suggest repeating the test in a few weeks. These lab tests are often subject to error. As my specialist likes to say "If you don't like your lab results, just repeat them"
After you get the results of the next test, if it does turn out that he meets one of the new MDEs (specifically the "L" in SLiM CRAB) as explained here https://myelomabeacon.org/news/2014/10/26/new-multiple-myeloma-diagnostic-criteria/, then I would keep in mind Dr. Rajkumar's last statement in the above article:
"Finally, no written criteria can substitute clinical judgment. In many cases, physicians will need to continue to use judgment in making decisions on which patients need immediate therapy, and in deciding when continued observation will be in the patients’ best interests."
In particular, my specialist would not likely initiate treatment based on the presence of a SLiM MDE without there being an indication that it were causing or immediately threatening end-organ damage (I'm putting words in mouth here, but I've heard him say statements along these lines). Other specialists may and do differ in that opinion. I'm not saying who is right in this regard. But a second opinion may be something you would want to consider if your dad's doc wants to initiate treatment based solely on an FLC ratio > 100.
Given the aforementioned, I would suggest repeating the test in a few weeks. These lab tests are often subject to error. As my specialist likes to say "If you don't like your lab results, just repeat them"
After you get the results of the next test, if it does turn out that he meets one of the new MDEs (specifically the "L" in SLiM CRAB) as explained here https://myelomabeacon.org/news/2014/10/26/new-multiple-myeloma-diagnostic-criteria/, then I would keep in mind Dr. Rajkumar's last statement in the above article:
"Finally, no written criteria can substitute clinical judgment. In many cases, physicians will need to continue to use judgment in making decisions on which patients need immediate therapy, and in deciding when continued observation will be in the patients’ best interests."
In particular, my specialist would not likely initiate treatment based on the presence of a SLiM MDE without there being an indication that it were causing or immediately threatening end-organ damage (I'm putting words in mouth here, but I've heard him say statements along these lines). Other specialists may and do differ in that opinion. I'm not saying who is right in this regard. But a second opinion may be something you would want to consider if your dad's doc wants to initiate treatment based solely on an FLC ratio > 100.
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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 of 2.3 g/dL - is it likely to be just MGUS?
Thank you Multibilly. These are our thoughts exactly. What a blessing it would be to retest and have the numbers lowered. Either way, we are most certainly going with a second opinion. Until then, say a little prayer the ratio goes down and that his bone marrow biopsy has the best results it can. Thank you for talking me off the ledge a bit.
Re: M-spike of 2.3 g/dL - is it likely to be just MGUS?
My dad is getting his bone marrow biopsy tomorrow. If anyone who reads this could send up good thoughts and prayers for good results, less than 10% is what I'm praying for! Thank you!
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