I was diagnosed with IgG lambda MGUS in 2005, and my counts remained relatively stable. I began more consistent "wait and watch" follow-ups in 2014, going every 6 months for lab results.
This round seems to have a few areas that have taken a more significant turn, and I'm wondering if this is expected in someone who may be transitioning from MGUS to perhaps smoldering myeloma.
For those who may be interested or have any comment, I have provided my latest labs, including the reference ranges, with my results to the far right. The previous results are listed first followed by the current results listed in parentheses. (As a side note: I started receiving IVIG treatments in June 2017; not sure if that would affect any of these labs or not.)
IgG mg/dL 717-1411 2150 (2580)
IgA mg/dL 78-391 44 (45)
IgM mg/dL 53-334 40 (45)
M-Spike g/dL 0 1.35 (1.78)
Bone Marrow (5% in 2014)
Beta-2 Microglobulin 0.8-2.2 mg/L 2.3 (2.1)
Kappa lt chn, free, serum mg/dL
534-1267 (3.3-19.4 mg/L) 531-14.6 (552-9.6)
Lambda lt chn, free, serum mg/dL
253-653 (5.7-26.3 mg/L) 1480-51.3 (1710-47.8)
K/L lt chn ratio, free, serum
0.26-1.65 0.28 (0.20)
HGB 11.5-15.5 12.5 (13.4)
HCT 36-46 38 (40)
RBC 3.9-4.2 4.03 (4.34)
Platelets 150-400 188 (238)
WBC 3.7-11 5.33 (7.38)
Gamma Glob 0.7-1.44 1.99 (2.52)
Beta Glob 0.84-1.36 0.98 (1.15)
Alpha-1 Glob 0.18-.31 0.24 (0.32)
Alpha-2 Glob 0.52-.97 0.66 (0.83)
eGFR 55 (56)
Creatinine 0.58-0.96 0.92 (1.03)
BUN 7-21 12 (13)
Albumin 3.9-4.9 4.2 (4.3)
Albumin (SPE) 3.37-4.23 3.84 (3.88)
Total Protein 6.3-8.0 7.3 (8.9)
Calcium 8.5-10.4 9.2 (9.2)
Glucose 74-99 133 (80)
Protein Electrophoresis 24H UR W/M Spike
Protein Concn, 24Hr 0-20 mg/dL 5 (5)
Protein, 24H UR (UEPG24) <.16 gm/24H 0.14 (0.09)
Albumin, %, 24H % 37.9 (35.7)
Alpha 1 Globulin %, 24H % 6.7 (5.1)
Alpha 2 Globulin %, 24H % 17.6 (16.3)
Beta Globulin %, 24H % 27.9 (24.4)
Gamma Globulin %, 24H % 10 (18.4)
M Spike Quant, 24H 0.0 gm/24H 0 (0.01)
Interpretation (UPEG24):
No M protein (M protein identified)
Forums
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sgridley - Who do you know with myeloma?: Me
- When were you/they diagnosed?: MGUS 2005, Smoldering 2018
- Age at diagnosis: 41
Re: MGUS with autoimmune diseases
Hi Susie,
Which of your lab results are causing you concern?
Also, I don't believe I've seen serum free light chain results presented the way you've presented them. I'm probably missing something because it's early on a Sunday, but there seem to be more numbers than necessary. As best I can tell, your most recent kappa and lambda numbers were:
Kappa: 14.6 (9.6)
Lambda: 51.3 (47.8)
Ratio: 0.28 (0.20)
But there are a lot of other numbers with the kappa and lambda results that don't seem to have any meaning. Do you know what they mean?
Which of your lab results are causing you concern?
Also, I don't believe I've seen serum free light chain results presented the way you've presented them. I'm probably missing something because it's early on a Sunday, but there seem to be more numbers than necessary. As best I can tell, your most recent kappa and lambda numbers were:
Kappa: 14.6 (9.6)
Lambda: 51.3 (47.8)
Ratio: 0.28 (0.20)
But there are a lot of other numbers with the kappa and lambda results that don't seem to have any meaning. Do you know what they mean?
Re: MGUS with autoimmune diseases
Hi Cheryl,
The larger numbers for kappa and lambda that I included are the totals from the SPEP. The numbers I believe my doctor is more interested in are from the kappa-lambda free light chain assay, and these are the most current counts. For the first time ever, my ratio has fallen below the normal reference range.
Kappa 9.6
Lambda 47.8
Kappa-lambda ratio free, serum 0.20
The other results that I am questioning include:
Susie
The larger numbers for kappa and lambda that I included are the totals from the SPEP. The numbers I believe my doctor is more interested in are from the kappa-lambda free light chain assay, and these are the most current counts. For the first time ever, my ratio has fallen below the normal reference range.
Kappa 9.6
Lambda 47.8
Kappa-lambda ratio free, serum 0.20
The other results that I am questioning include:
- The total number of lambda light chains on SPEP has jumped a bit more than usual this time around.
- My total proteins have jumped more than usual.
- For the first time, my 24-hour urine, UPEP detected an M-spike, which seems very low thankfully (I'm not sure what level of Bence Jones protein is clinically significant, or what the reference range is).
- My serum M-spike took a bigger jump than ever before as well.
- I know my doctor watches the creatinine level from the SPEP, which is just slightly over the reference range for where I go, but I am discouraged that my eGFR is remaining in the mid 50's, which according to my reading indicates the kidney function is moderately impaired (stage 3A
Susie
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sgridley - Who do you know with myeloma?: Me
- When were you/they diagnosed?: MGUS 2005, Smoldering 2018
- Age at diagnosis: 41
Re: MGUS with autoimmune diseases
Hi Susie,
If I were you, I would hesitate to draw too many conclusions based on just one or two test results. Do you have graphs of your free light chain and M-spike results? If so, what are they showing about the trends in the results?
Your M-spike looks like it is on an upward trend, but that's based mainly on comparing your recent results with those from the time of your diagnosis. If your M-spike has bounced around a lot in between, what seems like an uptick may just be noise.
If you look, for example, at Multibilly's graphs of his lab results, you'll see that all his key results have bounced around a lot since his smoldering diagnosis more than five years ago. His M-spike originally was 1.6 or 1.7 g/dL, then went as high as 2.6 g/dL, and is now down around 2.2 g/dL.
Similarly, his free light chain ratio (lambda/kappa in his case) has gone over 40 yet settled down in the mid teens.
So, again, look at the trends and take into account how much variability there has been in the results.
As for your kidney function, I'm not a physician, but I have to wonder if something else is going on that might be compromising your kidney function. Neither your M-spike nor your free light chain levels seem high enough to be the source of the elevated creatinine levels.
Have your doctors made any suggestions about what could be causing the elevated creatinine level?
Also, what were your hemoglobin levels around the time you were diagnosed? How has your hemoglobin level changed over the years?
Take care,
Cheryl
If I were you, I would hesitate to draw too many conclusions based on just one or two test results. Do you have graphs of your free light chain and M-spike results? If so, what are they showing about the trends in the results?
Your M-spike looks like it is on an upward trend, but that's based mainly on comparing your recent results with those from the time of your diagnosis. If your M-spike has bounced around a lot in between, what seems like an uptick may just be noise.
If you look, for example, at Multibilly's graphs of his lab results, you'll see that all his key results have bounced around a lot since his smoldering diagnosis more than five years ago. His M-spike originally was 1.6 or 1.7 g/dL, then went as high as 2.6 g/dL, and is now down around 2.2 g/dL.
Similarly, his free light chain ratio (lambda/kappa in his case) has gone over 40 yet settled down in the mid teens.
So, again, look at the trends and take into account how much variability there has been in the results.
As for your kidney function, I'm not a physician, but I have to wonder if something else is going on that might be compromising your kidney function. Neither your M-spike nor your free light chain levels seem high enough to be the source of the elevated creatinine levels.
Have your doctors made any suggestions about what could be causing the elevated creatinine level?
Also, what were your hemoglobin levels around the time you were diagnosed? How has your hemoglobin level changed over the years?
Take care,
Cheryl
Re: MGUS with autoimmune diseases
Hi Susie,
As usual, Cheryl makes some great points. Regarding your eGFR, I agree with Cheryl that it is unlikely that your only slightly increased lambda free light chains are causing any significant impact to your kidney function. Keep in mind that dehydration, antibiotics, diuretics, anti-inflammatories (ibuprofen, etc) and radiological contrast agents can all reduce kidney function and therefore lower your eGFR. So, this might be something to explore further with your doctor.
As usual, Cheryl makes some great points. Regarding your eGFR, I agree with Cheryl that it is unlikely that your only slightly increased lambda free light chains are causing any significant impact to your kidney function. Keep in mind that dehydration, antibiotics, diuretics, anti-inflammatories (ibuprofen, etc) and radiological contrast agents can all reduce kidney function and therefore lower your eGFR. So, this might be something to explore further with your doctor.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: MGUS with autoimmune diseases
Thanks for the additional input, Multibilly. I always appreciate your comments here.
One thing I should mention is that I usually don't focus on the eGFR when looking at lab results like these. I just look at the creatinine level. If I'm not mistaken, the eGFR is calculated from a formula that depends mainly on the creatinine level, with patient age, gender, and race tweaking the result a bit. Nothing else goes into the formula. So the eGFR result doesn't really provide much additional information beyond what you get with the creatinine level by itself.
One thing I should mention is that I usually don't focus on the eGFR when looking at lab results like these. I just look at the creatinine level. If I'm not mistaken, the eGFR is calculated from a formula that depends mainly on the creatinine level, with patient age, gender, and race tweaking the result a bit. Nothing else goes into the formula. So the eGFR result doesn't really provide much additional information beyond what you get with the creatinine level by itself.
Re: MGUS with autoimmune diseases
Cheryl and Multibilly.
Thank you both for your words of wisdom!
Yes, I keep a spreadsheet and a binder with all of my lab results from the very beginning and have been watching how the levels trend over time. The M-spike has been steadily trending upward, so has the serum lambda free light chains. There have been small ups and downs along the way which I know is daily fluctuation. The creatinine has been very slowly climbing over time. My hemoglobin and calcium have been staying nicely within the reference ranges!
I saw my specialist yesterday and they bumped me up from MGUS to smoldering for the moment. They are also going to order new labs in 3 months to verify the most recent results. I am having an IVIG treatment this week, then they are giving me a break for a few months. The one factor that they want to rule out is the additional immunoglobulin from the IVIG showing up in the labs, skewing the counts.
Regarding the eGFR, my doctor used a different GFR formula to check the level, and where the lab shows 56, the other formula shows 62. As long as the other kidney-related results stay within an acceptable range, they aren't going to worry about the eGFR for now. They will keep an eye on the Bence-Jones proteins that were found this time to see if they increase.
Thankfully I get to stay on the "watchful waiting" plan for the time being. I appreciate you offering your feedback and support!
Susie
Thank you both for your words of wisdom!
Yes, I keep a spreadsheet and a binder with all of my lab results from the very beginning and have been watching how the levels trend over time. The M-spike has been steadily trending upward, so has the serum lambda free light chains. There have been small ups and downs along the way which I know is daily fluctuation. The creatinine has been very slowly climbing over time. My hemoglobin and calcium have been staying nicely within the reference ranges!
I saw my specialist yesterday and they bumped me up from MGUS to smoldering for the moment. They are also going to order new labs in 3 months to verify the most recent results. I am having an IVIG treatment this week, then they are giving me a break for a few months. The one factor that they want to rule out is the additional immunoglobulin from the IVIG showing up in the labs, skewing the counts.
Regarding the eGFR, my doctor used a different GFR formula to check the level, and where the lab shows 56, the other formula shows 62. As long as the other kidney-related results stay within an acceptable range, they aren't going to worry about the eGFR for now. They will keep an eye on the Bence-Jones proteins that were found this time to see if they increase.
Thankfully I get to stay on the "watchful waiting" plan for the time being. I appreciate you offering your feedback and support!
Susie
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sgridley - Who do you know with myeloma?: Me
- When were you/they diagnosed?: MGUS 2005, Smoldering 2018
- Age at diagnosis: 41
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