[BeachyGal10]

MGUS (or something else?) with hepatitis C

by BeachyGal10 on Tue Jan 26, 2016 3:38 pm

My doctor found an M-spike of 0.04 g/dL and I was told I have MGUS. I was referred to a hematologist and am being followed every three months.

I had extreme fatigue, mild osteo, and have spent many years complaining to doctors for various reasons of not feeling well. I had switched doctors, mentioned a tingling in my fingertips, so he ordered extensive testing.

My kappa is elevated at 5.22, my lambda is normal, and my ratio is elevated at 3.13

I also have mild cryoglobulemnia associated with hepatitis C virus (HCV).

I had the skeletal X-rays that showed one lytic lesion, a bone marrow biopsy that shows negative for multiple myeloma.

I am simply confused.

I was told the MGUS is secondary to HCV, and I am currently on Harvoni (ledipasvir / sofosbuvir) treatment, and almost undetectable, meaning almost cured of the HCV, and my hematologist is hoping the HCV cure will cure the MGUS etc.

With that said, my recent lab work indicates the MGUS labs are increasing while the HCV labs are decreasing (good for HCV to decrease), but I don't understand the MGUS increasing. The doctor says I need to wait until finished with Harvoni, recover, then retest.

Anyone else here with a similar situation?

[Multibilly]

Re: MGUS (or something else?) with hepatitis C

by Multibilly on Tue Jan 26, 2016 5:38 pm

Hi BeachyGal,

Sorry that you find yourself on this forum, but welcome nonetheless.

You might find this article to be on interest,

D Feron et al, "Chronic Infection, a Neglected Cause Of Development Of Monoclonal Gammopathy Of Undetermined Significance (MGUS) and Myeloma", ASH 2013 annual meeting abstract 3116

especially the last sentence in the conclusion section:

Conclusion: Altogether, 22.7% of the 101 MGUS and myeloma patients examined presented a mc Ig specific for HCV, EBV or H. pylori. Thus beside lymphoma and CLL, chronic infection by these 3 germs can also induce MGUS and eventually, trigger the pathogenic processes that lead to myeloma. Efforts should be made to identify the subsets of patients with mc Ig specific for HCV, EBV and H. pylori, preferably at the MGUS stage, as anti-infection treatment is expected to cure MGUS and prevent progression toward myeloma.

I was frankly a little surprised but delighted for you that the authors believe that anti-infection treatment is expected to cure MGUS in this situation.

[BeachyGal10]

Re: MGUS (or something else?) with hepatitis C

by BeachyGal10 on Wed Jan 27, 2016 12:29 pm

Thank you, Multibilly, for the encouragement.

Hoping those labs return to normal. However, I have been told from the doctor it could be two separate issues (my thought if so, I do believe the HCV caused my manifestation of my problems).

[Ellen Harris]

Re: MGUS (or something else?) with hepatitis C

by Ellen Harris on Wed Jan 27, 2016 6:13 pm

This is a very interesting thread to me, since I had mono once in my teens, and when I was about 40, it was either reactivated or I caught it again, and I had Epstein Barr. In my teens, I was quite ill for about a month, with fever and sore throat and swollen glands ... the usual. In my early 40's, it manifested as nausea and extreme fatigue. And through my 40's and 50's I had days where I felt exhausted and nauseous. I always wondered if that was the EBV flaring up. And then, when I was 59, I was diagnosed with symptomatic multiple myeloma. My father also had multiple myeloma, unfortunately, and died in 1969 at age 50. I don't know what type of multiple myeloma he had. I am not even sure if they knew then that there were different types.

Just thinking out loud ... the EBV and the familial connection. Just wonder if my immune system being "busy" with the EBV all those years set the stage for immune system dysfunction and development of multiple myeloma, due to underlying genetics. No way to know. I do know that the EBV is implicated in certain cancers.

Would love comments on this.

[mikeb]

Re: MGUS (or something else?) with hepatitis C

by mikeb on Thu Jan 28, 2016 10:11 pm

Hi BeachyGal10 and others,

Here is another paper that might be of interest – a case study of a patient with a staph infection and transient MGUS. (I'm not sure how reputable this online journal is, though. I'd not heard of it before.)

D Stoimenis et al., “Transient Monoclonal Gammopathy Induced by Disseminated Staphylococcus aureus Infection,” Case Reports in Medicine, vol. 2012, Article ID 607104, 5 pages, 2012 (full text of article)

That said, there's something in your post, BeachyGal10, that surprised me a little - that x-rays found one lytic lesion, but the bone marrow biopsy was negative for multiple myeloma. Just curious, what was the percentage of plasma cells found in the bone marrow biopsy?

Good luck, BeachyGal10. I hope your MGUS is transient too. Please let us know how things go. You've got an interesting case.

Mike