[Joana]

M-spike was in beta-2 region, now in gamma: meaning?

by Joana on Sat Jul 07, 2018 11:01 am

Hello everyone,

First let me start by saying how lucky I feel that I came across this forum, I'm sure it brings solace to so many people.

My mom has had IgG kappa MGUS since 2010, and has been monitoring it closely since 2015. It's always been obvious that it was slowly but steadily progressing to multiple myeloma. Her IgG in 2015 was 1450 (within the normal range) 1600 in 2016, 2116 in 2017 and recently hit 2660. Her kappa-lambda ratio was 24 in 2015, dropped to 5 in 2016 (no idea why) and has now reached 497. She was diagnosed with multiple myeloma yesterday. The biopsy showed bone marrow plasma cells 80%, however her MRI was totally clean, no bone lesions, holes, fractures, tumors, nothing at all. Her kidney function is perfect, her iron, calcium, albumin levels, everything normal, nothing that would indicate multiple myeloma, yet the disease is there and it's now active. For someone with an autoimmune disease, she hardly ever gets sick, not even with the flu.

I'm just trying to give you a general idea here, so I apologize for my long post.. Her hematologist, well regarded here in Greece, is very very calm and optimistic and that has put my mind at ease a bit. I'm trying to be strong and rational and there for my mom, despite the occasional panic attacks that I've been getting lately and that constant burning sensation in my stomach from stress.

My question to you, and trust me I have looked everywhere for an answer and I can't find any info for the life of me, is the following: My mom's M-spike was always in the beta-2 region, the highest at 1.47 g/dL (14.7 g/l). Since her MGUS has progressed to multiple myeloma and according to her latest blood test 2 weeks ago, her M-spike has moved to the gamma region and is at 2.61 (26.1 g/l) at the moment.

Is that even possible?

Also, the beta-2 value is missing, it is left blank, I don't know if it's undetectable or it has merged with the gamma,

I'm struggling to understand why. I know that at this stage it probably doesn't even matter anymore, but it's like a thorn stuck in my throat, I just have to know.

Thanks to anyone who takes the time to read my post, I really really appreciate it.

[Multibilly]

Re: M-spike was in beta-2 region, now in gamma: meaning?

by Multibilly on Sat Jul 07, 2018 1:59 pm

Hi Joana,

There may be several explanations for this:

1. It may be a one-time lab error. You would know if this is the case once she gets retested.

2. Did you check if she is still has an IgG-kappa isotype via her serum immunofixation and serum free light chain results? Isotype switching is not unheard of, although this usually occurs after treatment.

3. I believe that IgG M-spikes can potentially migrate from region to region as one's paraprotein evolves over time. IgG M-spikes typically exist in the gamma region, so it's a bit unusual that her IgG M-spike used to live in the beta region (where IgA and IgM M-spikes tend to hang out). I'm also one of those oddballs that has an IgG M-spike in the beta region.

Note that it's not a given that the beta region on an electrophoresis graph will be split into two different beta regions (beta-1 and beta-2). Because of this, her lab results probably don't list any reference ranges for the beta-1 and beta-2 values, but will list a reference range for the total beta region.

In any case, I don't believe this M-spike migration is anything to worry about. But her doctor is really the person that is qualified to make this call.

Lastly, it's pretty great that she has no CRAB symptoms with a bone marrow plasma cell percentage of 80%. Needless to say, she should probably get re-tested fairly frequently with such a high bone marrow plasma cell percentage. Some (but not all) doctors would consider initiating treatment based on the fact that a bone marrow plasma cell percentage of 80% is technically a "Myeloma Defining Event".

[Joana]

Re: M-spike was in beta-2 region, now in gamma: meaning?

by Joana on Sat Jul 07, 2018 3:07 pm

Thank you so much for your reply, it kinda makes sense now. I forgot to mention that her beta-1 is listed, currently at 4.03 g/L, so probably it is as you say, it didn't split between two regions.

However, it has indeed migrated from beta-2 to gamma, and I don't think it's a lab error due to the fact that these past few weeks she has been tested more than 3 times.

I also forgot to mention that she's starting treatment on Tuesday and had her DNA sequenced. Her doctor spoke of "targeted treatment." I don't know if that's a good thing, but I'll know more this week. She also said that 80% is nothing to worry about, it might have just been that specific spot, either way she didn't look concerned. I honestly don't know.

[Multibilly]

Re: M-spike was in beta-2 region, now in gamma: meaning?

by Multibilly on Sat Jul 07, 2018 8:27 pm

If I were to guess at what "targeted treatment" might mean, I would say that she might be receiving a monoclonal antibody treatment such as Darzalex or Elotuzumab. It's pretty cool that she's getting her DNA sequenced as opposed to just FISH testing...it sounds like she must be working with a research hospital or research university in Greece?

[Joana]

Re: M-spike was in beta-2 region, now in gamma: meaning?

by Joana on Tue Jul 17, 2018 7:05 am

Hi Multibilly,

Sorry for my late reply. The only thing I know so far is that the haematology department is part of the Athens University Hospital called “Laiko.” Her DNA results aren't out yet, they told us it usually takes a month.

I'll let you know if I have more questions in the future, as I'm new to all of this, and I would like to thank you for taking the time to read and reply to my post