Hello all,
Happy Holidays and Best Wishes for a Happy, Healthy, Pain-free, Peaceful New Year!
My mother was diagnosed with multiple myeloma in February of 2015 after multiple compression fractures in her spine. She is 75 years old and had surgery involving screws and rods to stabilize her back.
She underwent targeted radiation for more than a month alongside a regimen of Revlimid and dexamethasone.
After six rounds of this combination of these drugs that definitely took their toll on her, we decided that her numbers had looked good enough at her last blood test (3 months earlier) that she needed a break from the drugs.
At the same time she saw her oncologist and found out that she was in remission. I'm not sure if she was in total remission, but I know that there was no presence of an M-spike. So it seemed like things had finally turned a corner.
She had a very rough time with the pain the fractures caused and the side effects of all of the medicines. Now she has received the bad news that the M-spike is back.
I was wondering if anyone could help me understand the following abnormal results in her bloodwork?
To me it indicates that the myeloma is back, but due to the low total protein reading she has that the myeloma is in her organs and not in her bones?
I would appreciate any help/opinions anyone has to share regarding her results.
Thank you,
Scott
ESR - high - 38
Total protein - low - 6.3
Beta 2 microglobulin - high 3.25
Bun/creatinine ratio - high - 21.1
IgM - low - 37
Albumin - low - 3.6
Alpha I globulin - high - 0.5
Gamma globulin - low - 0.6
Abnormal protein - 0.3 (M-spike)
Lambda light chain - high - 57.4
Kappa/lambda free ratio - low - 0.17
Forums
6 posts
• Page 1 of 1
Re: Meaning of abnormal lab results?
Hi Scott,
Welcome to the forum. You may want to consider registering on the forum site, since it makes it much easier to respond to folks in future posts and to quickly see their disease history. You can do this anonymously.
I'm not a doc, so please check all of these items with yours.
First, multiple myeloma does not really move from one's "bones" to one's organs. It all starts in one's bone's marrow and can cause various organ damage along the way - which sometimes can include bone damage, kidney damage, anemia, and/or hypercalcimia. But the disease still remains and is generated in one's bone marrow over time.
Secondly, there are many different classes of remission when it comes to multiple myeloma. See:
https://myelomabeacon.org/forum/remission-what-does-it-mean-t1554.html#p8173
So, without knowing the patient's previous M-spike, it's really impossible to say what kind of remission was in effect or is present now. It's really about trends when it comes to tracking multiple myeloma, so it would be good to graph her M-spike and free light chains throughout out all of her lab tests. You should also be tracking her serum creatinine, hemogolobin and calcium levels to see if any other kind of organ damage is occurring. You can find these numbers on the CBC and metabolic panel tests.
Her albumin level is low, which could be dragging down her total protein level marker. A low albumin level can be seen with reduced kidney function (another possible symptom of multiple myeloma that one always wants to keep an eye one), inflammation (a high ESR also suggests inflammation), liver disease, etc. A low albumin level is another good reason to go back and check here creatinine level for any possible reduction in kidney function. There has also been at least one study done that attempts to correlate low albumin levels with the severity of multiple myeloma disease:
https://myelomabeacon.org/news/2009/11/29/serum-albumin-levels-indicate-severity-of-multiple-myeloma/
https://labtestsonline.org/understanding/analytes/albumin/tab/test/
A low gamma globulin level will also drag down the total protein value and can be due to a number of different conditions, including various immune deficiencies, malnutriion, etc.
Her IgM is low, which could be signalling a condition called immunoparesis, where one or more of the "uninvolved Immunogloublins" are suppressed. Note that her M-spike is due to an increase in the "involved immunoglobulin" (which is probably the IgG or IgA immunoglobulin), which you can find noted on her serum immunofixation test results. This can have prognostic significance.
Clearly, her disease is still around given her M-spike and free light chain numbers. While there is nothing wrong with a drug "holiday", you may want to consider discussing a reduced dosage regimen and/or a different mix of drugs to help minimize the drug's effects, especially if her numbers are back on the rise. Also, if your mom isn't already working with a top multiple myeloma specialist, I would really encourage you to seek one out. There's a fair amount going on with these numbers and a multiple myeloma specialist is best suited to comment. If you let us know what city your mom is in, folks can make some recommendations.
Lastly, when you post any lab results, it's really helpful if you also post the units of measure and the standard reference ranges.
Hope this helps a bit.
Welcome to the forum. You may want to consider registering on the forum site, since it makes it much easier to respond to folks in future posts and to quickly see their disease history. You can do this anonymously.
I'm not a doc, so please check all of these items with yours.
First, multiple myeloma does not really move from one's "bones" to one's organs. It all starts in one's bone's marrow and can cause various organ damage along the way - which sometimes can include bone damage, kidney damage, anemia, and/or hypercalcimia. But the disease still remains and is generated in one's bone marrow over time.
Secondly, there are many different classes of remission when it comes to multiple myeloma. See:
https://myelomabeacon.org/forum/remission-what-does-it-mean-t1554.html#p8173
So, without knowing the patient's previous M-spike, it's really impossible to say what kind of remission was in effect or is present now. It's really about trends when it comes to tracking multiple myeloma, so it would be good to graph her M-spike and free light chains throughout out all of her lab tests. You should also be tracking her serum creatinine, hemogolobin and calcium levels to see if any other kind of organ damage is occurring. You can find these numbers on the CBC and metabolic panel tests.
Her albumin level is low, which could be dragging down her total protein level marker. A low albumin level can be seen with reduced kidney function (another possible symptom of multiple myeloma that one always wants to keep an eye one), inflammation (a high ESR also suggests inflammation), liver disease, etc. A low albumin level is another good reason to go back and check here creatinine level for any possible reduction in kidney function. There has also been at least one study done that attempts to correlate low albumin levels with the severity of multiple myeloma disease:
https://myelomabeacon.org/news/2009/11/29/serum-albumin-levels-indicate-severity-of-multiple-myeloma/
https://labtestsonline.org/understanding/analytes/albumin/tab/test/
A low gamma globulin level will also drag down the total protein value and can be due to a number of different conditions, including various immune deficiencies, malnutriion, etc.
Her IgM is low, which could be signalling a condition called immunoparesis, where one or more of the "uninvolved Immunogloublins" are suppressed. Note that her M-spike is due to an increase in the "involved immunoglobulin" (which is probably the IgG or IgA immunoglobulin), which you can find noted on her serum immunofixation test results. This can have prognostic significance.
Clearly, her disease is still around given her M-spike and free light chain numbers. While there is nothing wrong with a drug "holiday", you may want to consider discussing a reduced dosage regimen and/or a different mix of drugs to help minimize the drug's effects, especially if her numbers are back on the rise. Also, if your mom isn't already working with a top multiple myeloma specialist, I would really encourage you to seek one out. There's a fair amount going on with these numbers and a multiple myeloma specialist is best suited to comment. If you let us know what city your mom is in, folks can make some recommendations.
Lastly, when you post any lab results, it's really helpful if you also post the units of measure and the standard reference ranges.
Hope this helps a bit.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Meaning of abnormal lab results?
Hello everyone,
My name is Paula. Scott, the poster of the original question, is my brother. We appreciate all the information and help. It has been an incredibly long year watching my mom fight this disease. Scott has done extensive research. It can be frustrating because the doctors have not been the most informative or forthcoming with information. Sadly, in this day and age, choices of medical care are limited, so we are trying to get as much help from real people as possible so our mom can make her own decisions.
We appreciate the honest and straightforward opinions of you all. The watching of my mom's decline has been beyond difficult, as I know you all can relate. Thank you for your time and I wish all of you a happy, pain-free New Year!
Paula
My name is Paula. Scott, the poster of the original question, is my brother. We appreciate all the information and help. It has been an incredibly long year watching my mom fight this disease. Scott has done extensive research. It can be frustrating because the doctors have not been the most informative or forthcoming with information. Sadly, in this day and age, choices of medical care are limited, so we are trying to get as much help from real people as possible so our mom can make her own decisions.
We appreciate the honest and straightforward opinions of you all. The watching of my mom's decline has been beyond difficult, as I know you all can relate. Thank you for your time and I wish all of you a happy, pain-free New Year!
Paula
Re: Meaning of abnormal lab results?
Hi Paula,
I'm sorry to hear that your mom's doctors haven't been that forthcoming with information. I don't pretend to know your mom's insurance situation and access to specific doctors. But again if you let us know what city she is in, folks might be able to put you in touch with more communicative multiple myeloma specialists. Also note that many folks on this forum consult with specialists that aren't in their local community, but then have treatment administered locally under the specialist's guidance.
There are a lot of great and experienced folks on this forum, but none of us are a substitute for working with a solid multiple myeloma specialist.
I'm sorry to hear that your mom's doctors haven't been that forthcoming with information. I don't pretend to know your mom's insurance situation and access to specific doctors. But again if you let us know what city she is in, folks might be able to put you in touch with more communicative multiple myeloma specialists. Also note that many folks on this forum consult with specialists that aren't in their local community, but then have treatment administered locally under the specialist's guidance.
There are a lot of great and experienced folks on this forum, but none of us are a substitute for working with a solid multiple myeloma specialist.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Meaning of abnormal lab results?
Hello,
You have been so kind and Scott and I appreciate it so much. He and I are not where my mom is right now. Scott went to Pittsburgh where my mom's doctor is. She is with UPMC network for insurance. Scott did the most amazing job of caring for my mom for almost a year. He needed to return to his teaching job and life in Colorado.
We were encouraged by doctors she would have been back to "her quality of life" after 3 rounds of Revlimid. That was after her back was fixed and the Revlimid was started. Fast forward 7 rounds and, while I don't blame anyone (cancer is not cut and dry), we do want to be as proactive as we can at this point.
We are pained to see how her life has changed. This is a woman who was a nurse for over 30 years who took care of everyone. She is now living a life of pain and unable to live as she would want to. She is visiting me in Georgia for a week right now and I am glad for this time, but she is in pain and I don't quite understand why she has been on so many drugs since this started. Lots of morphine, etc. If things are not going in a positive direction she needs to know. Second opinion would be wonderful. Can she seek another doctor within the UPMC network? I am hoping we are able to get a second opinion as it sometimes feels like the doctor she has is not being forthright.
I have not named her current doctor but would love to hear any and all advice from myeloma patients in Pittsburgh, Pennsylvania. Honest and frank advice appreciated.
Thank you,
Paula
You have been so kind and Scott and I appreciate it so much. He and I are not where my mom is right now. Scott went to Pittsburgh where my mom's doctor is. She is with UPMC network for insurance. Scott did the most amazing job of caring for my mom for almost a year. He needed to return to his teaching job and life in Colorado.
We were encouraged by doctors she would have been back to "her quality of life" after 3 rounds of Revlimid. That was after her back was fixed and the Revlimid was started. Fast forward 7 rounds and, while I don't blame anyone (cancer is not cut and dry), we do want to be as proactive as we can at this point.
We are pained to see how her life has changed. This is a woman who was a nurse for over 30 years who took care of everyone. She is now living a life of pain and unable to live as she would want to. She is visiting me in Georgia for a week right now and I am glad for this time, but she is in pain and I don't quite understand why she has been on so many drugs since this started. Lots of morphine, etc. If things are not going in a positive direction she needs to know. Second opinion would be wonderful. Can she seek another doctor within the UPMC network? I am hoping we are able to get a second opinion as it sometimes feels like the doctor she has is not being forthright.
I have not named her current doctor but would love to hear any and all advice from myeloma patients in Pittsburgh, Pennsylvania. Honest and frank advice appreciated.
Thank you,
Paula
Re: Meaning of abnormal lab results?
These are the hem/oncs at UPMC:
http://www.upmccancercenter.com/oneTeam/experts.cfm
I know some folks on this forum have used UPMC. I hope you will hear from them.
Some of these docs presented at ASH 2015 and publish multiple myeloma articles.
You can always approach another doctor within the same institution/network for another opinion or simply to seek a doctor that might be more communicative. But if you really want a fresh opinion, I would suggest going to a different institution for an initial second opinion. Surely your mom's insurance can't be limited to just the UPMC network? Is her insurance limited to in-state doctors only?
Also, keep in mind that a second opinion for an out-of-network doctor's consult is usually only about $150-$200 if you have all of her test results and doctor's writeups already in hand (which are easy enough to secure and are her property).
http://www.upmccancercenter.com/oneTeam/experts.cfm
I know some folks on this forum have used UPMC. I hope you will hear from them.
Some of these docs presented at ASH 2015 and publish multiple myeloma articles.
You can always approach another doctor within the same institution/network for another opinion or simply to seek a doctor that might be more communicative. But if you really want a fresh opinion, I would suggest going to a different institution for an initial second opinion. Surely your mom's insurance can't be limited to just the UPMC network? Is her insurance limited to in-state doctors only?
Also, keep in mind that a second opinion for an out-of-network doctor's consult is usually only about $150-$200 if you have all of her test results and doctor's writeups already in hand (which are easy enough to secure and are her property).
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
6 posts
• Page 1 of 1