Good afternoon,
My name is Travis Bevers, I am a 37-year-old old male that was diagnosed with MGUS in 2011, and I have been doing the normal testing every 6 months since 2011.
The last 6 months I have been feeling very tired, went to the doctor and had a new bone marrow biopsy done. The FISH result came back with a deletion of 14q32 IGH. I have never seen this before, is this significant?
Also came back with "near diploid with lambda light chain excess in 10% of all cells with a cig index of 13". Not sure what this is either.
My remaining test results are below.
My question is: Have I progressed to smoldering myeloma or full-blown myeloma?
Bone Marrow Exam:
Bone Marrow Aspirate and Biopsy:
Hypocellular bone marrow for age (50% cellularity); involved by plasma cell neoplasm (13% plasma cells on aspirate; 5-10% on core biopsy).
Immunostains for mast cell tryptase, CD117, CD2 and CD25 performed on AZF-fixed, paraffin-embedded sections of the bone marrow biopsy reveal mast cell hyperplasia, expressing mast cell tryptase, CD117, CD25, comprising about ~5% of the cellularity, distributed in small aggregates and single interstitial cells .
Protein Electropheresis:
Albumin 4.3 g/dL
Alpha 1 Region 0.33 g/dL
Alpha 2 Region 0.5 g/dL
Beta Region 0.5 g/dL
Gamma Region 1.4 g/dL
M Component, Serum 1.0 g/dL
M-Protein/Alb.Ratio 0.23 Ratio
Path Comment - M-protein is present in the gamma region at 1.2 g/dL.
Total Protein Serum 7.0 g/dL 6.4-8.3 g/dL
Kappa/Lambda Free Serum:
Kappa Free Light Chain 1.21 mg/dL
Lambda Free Light Chain 4.85 mg/dL
Lambda/Kappa Ratio, Free LC 4.01
K/L Ration, Free LC 0.25
CBC:
WBC 5.27 K/uL
RBC 5.17 M/uL
Hemoglobin 15.2 g/dL
Hematocrit 45.5 %
MCV 88.0 fL
MCH 29.4 pg
MCHC 33.4 g/dL
RDW 13.2 %
Platelet 70 K/µL
MPV 11.3 fL
ANC 3.3 K/uL
Nucleated RBC 0.0 #/100 WBC
Neutrophils, Auto 62.0 %
Lymphs, Auto 30.0 %
Monocytes, Auto 4.4 %
Eosinophils, Auto 2.1 %
Basophils, Auto 0.9 %
Immature Grans, Auto 0.6 %
Neutrophils, Absolute 3.27 K/uL
Lymphocytes, Absolute 1.58 K/uL
Monocytes, Absolute 0.23 K/uL
Eosinophils, Absolute 0.11 K/uL
Basophils, Absolute 0.05 K/uL
Immature Grans, Absolute 0.03 K/uL
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Re: Has my MGUS progressed?
Hi Tbevers,
Welcome to the forum.
First, in order to be diagnosed with "full-blown" myeloma, you must meet one or more of the CRAB criteria or one or more of the recently added "myeloma-defining events" (MDEs). See this article to better understand these criteria and terms:
"Rajkumar, SV, "New Criteria For The Diagnosis Of Multiple Myeloma And Related Disorders," The Myeloma Beacon, Oct 26, 2014
This forum post also may be helpful:
"Criteria for a multiple myeloma diagnosis"
To exclude all of the criteria, you would need to have the results of skeletal survey, whole body MRI or PET/CT, as well as know you calcium and creatinine levels from your metabolic panel test results. Your hemoglobin level looks fine, so you don't have the "A" in CRAB.
But given your relatively good free light chain ratio of 4 and fairly low M-protein (m-spike) level of 1.2 g/dL, it's likely that you don't meet any of the CRAB and additional MDE criteria and therefore don't have full blown (symptomatic) myeloma. But only your doctor can make that call after reviewing all of your test results.
That leaves you with your bone marrow plasma cell percentages (BMPC) : "Hypocellular bone marrow for age (50% cellularity); involved by plasma cell neoplasm (13% plasma cells on aspirate; 5-10% on core biopsy)." Generally, between the aspirate and core biopsy plasma cell percentages, the core percentage tends to be the higher of the two values and this is one of the values used to determine the break between MGUS and smoldering myeloma. A core BMPC >=10% means you technically have a diagnosis of smoldering multiple myeloma (barring meeting any of the CRAB or MDE criteria). It will be up to your doctor to determine which of the plasma cell percentages to use diagnosis-wise given your overall situation.
A CIG index is a measure of cytoplasmic immunoglobulin in the plasma cells and is sometimes used for prognostic purposes. In general, you worry when that index value gets down into the low single digits. But this would also be another good topic to discuss with your doctor.
If you aren't working with a myeloma specialist, I'd strongly encourage you to seek one out. If you let us know what city you are in, folks on this site can make some recommendations. Good luck.
Welcome to the forum.
First, in order to be diagnosed with "full-blown" myeloma, you must meet one or more of the CRAB criteria or one or more of the recently added "myeloma-defining events" (MDEs). See this article to better understand these criteria and terms:
"Rajkumar, SV, "New Criteria For The Diagnosis Of Multiple Myeloma And Related Disorders," The Myeloma Beacon, Oct 26, 2014
This forum post also may be helpful:
"Criteria for a multiple myeloma diagnosis"
To exclude all of the criteria, you would need to have the results of skeletal survey, whole body MRI or PET/CT, as well as know you calcium and creatinine levels from your metabolic panel test results. Your hemoglobin level looks fine, so you don't have the "A" in CRAB.
But given your relatively good free light chain ratio of 4 and fairly low M-protein (m-spike) level of 1.2 g/dL, it's likely that you don't meet any of the CRAB and additional MDE criteria and therefore don't have full blown (symptomatic) myeloma. But only your doctor can make that call after reviewing all of your test results.
That leaves you with your bone marrow plasma cell percentages (BMPC) : "Hypocellular bone marrow for age (50% cellularity); involved by plasma cell neoplasm (13% plasma cells on aspirate; 5-10% on core biopsy)." Generally, between the aspirate and core biopsy plasma cell percentages, the core percentage tends to be the higher of the two values and this is one of the values used to determine the break between MGUS and smoldering myeloma. A core BMPC >=10% means you technically have a diagnosis of smoldering multiple myeloma (barring meeting any of the CRAB or MDE criteria). It will be up to your doctor to determine which of the plasma cell percentages to use diagnosis-wise given your overall situation.
A CIG index is a measure of cytoplasmic immunoglobulin in the plasma cells and is sometimes used for prognostic purposes. In general, you worry when that index value gets down into the low single digits. But this would also be another good topic to discuss with your doctor.
If you aren't working with a myeloma specialist, I'd strongly encourage you to seek one out. If you let us know what city you are in, folks on this site can make some recommendations. Good luck.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Has my MGUS progressed?
Thanks for the response, Multibilly. I am in the Dallas area so I am seeking out a multiple myeloma specialist as we speak.
3 posts
• Page 1 of 1