[Jainemac]

MGUS for over 15 years, now multiple myeloma?

by Jainemac on Fri Jul 22, 2016 12:01 am

Hi,

My mum was given a diagnosis of MGUS over 15 years ago and has had regular bloods and yearly bone marrow biopsies.

The only information she was ever given was the "serum protein level," which has stayed stable at 12 or 13 g/L (1.2 or 1.3 g/dL) until earlier this year when is was raised to 19.7 g/L (1.97 g/dL).

They are now talking about her starting treatment in 4 weeks time. I am confused as I thought the level had to be above 30 g/L (3.0 g/dL) for a diagnosis of myeloma?

Her results are:

Serum paraprotein 19.7 g/l
Serum IgM 0.23 g/l (0.35-3.87) Low
Free kappa light chain 317.50 mg/l (3.30-19.40) High
Free lambda light chain 12.50 mg/l (5.71-26.30)
Kappa/lambda ratio 25.40 (0.26-1.65) High
White cell count 3.4 10*9/l (4-11) Low
Haemoglobin (g/l) 104 (115-165) Low
Platelet 115 10*9/l (150-400) Low
Red cell count 3.19 10*12/l (3.8-5.8)
Haematocrit 0.310 (0.37-0.47) Low
Mean cell volume 97.2 (79-100)
Mean cell hgb 32.6. pg (27-32)
Mean cell hgb conc 335 g/l (320-360) High
Red cell dist width 14.1 (11.8-14.8)

Results from the bone marrow:

This is moderate involvement of myeloma. A small clone of CLL cells is also present, this is of uncertain clinical significance.
The aspirate sample appears dilute and may not be representative of the narrow as a whole.
The trephine shows maturing trilineage haemopoiesis but this is reduced and replaced by a diffuse and interstitial infiltrate of neoplastic plasma cells.
Plasma cells = 1.5% of leucocytes and have a neoplastic phenotype CD19- CD56- CD27++ CD45
B-cells = 1.8% of leucocytes of which 15% are progenitors and 25% haves CLL phenotype . The remaining sig + B cells are polyclonal

What do theses results mean and why is it now myeloma?

She is fit and has no complaints and the body scan was clear.

[Multibilly]

Re: MGUS for over 15 years, now multiple myeloma?

by Multibilly on Fri Jul 22, 2016 7:25 am

Hi Jainemac,

Welcome to the forum. Sorry to hear about your mom's situation.

The serum para­protein (aka "M-spike") level doesn't determine if one has SYMPTOMATIC multiple myeloma or not.

However, it appears that many of your mom's various blood counts (white cell, red cell, hemo­globin, hematocrit, platelets) are pretty low and she is becoming anemic. Anemia is the "A" in the multiple myeloma "CRAB" criteria (hyperCalcemia, Renal insufficiency, Anemia, or Bone damage) that is used to determine whether one has symptomatic multiple myeloma or not.

She also has a low IgM level (a condition known as immunoparesis or hypo­gamma­globu­li­nemia in multiple myeloma patients). A low IgM and low white blood cell count (leukopenia) is going to likely make her more prone to infections. Her low platelet level (thrombocytopenia) can make her more prone to uncontrolled bleeding and/or bruising.

I'm therefore guessing that the doctors are considering treatment because of her overall low blood counts and the fact that she is becoming anemic, and not because of her M-spike level.

You might want to also go back and look at her creatinine and calcium levels on her metabolic panel to see how they are doing. They might tell you if she is also suffering from renal (kidney) insufficiency or hypercalcemia, respectively.

Do you know what treatment they are considering?

[Jainemac]

Re: MGUS for over 15 years, now multiple myeloma?

by Jainemac on Fri Jul 22, 2016 10:58 am

Thank you for the reply, most helpful.

She said they were discussing treatment options at the next appointment. I need to research up about the different treatments available before then!