Hi,
Can someone here please tell me if these numbers mean MGUS, smoldering multiple myeloma, or multiple myeloma? After trying to research the numbers myself, I am confused because they seem positive to me but the doctor says we are in "wait and watch mode" with reevaluation of SPEP, etc, in 3 months.
I am giving here only abnormal results to make this note shorter. (normal ref range in parentheses).
IgA 4200 mg/dL (82-453)
M protein 3.7 g/dL (not given)
FLC K 16.5 mg/L (6.7 - 22.4)
FLC L 56.5 mg/L (8.3 - 27.0)
K/L ratio 0.29 (0.31 - 1.56)
Hb 10.2 g/100mg (12 - 17)
Calcium 11.9 mg/dL (8.5 - 11)
Chloride 95 mEq/L (99 - 109)
Bone marrow plasma cell population 18%.
Thank you very much for your help.
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6 posts
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Lillyput189 - Who do you know with myeloma?: Self
- When were you/they diagnosed?: MGUS 2011, multiple myeloma 2014
- Age at diagnosis: 54
Re: MGUS, smoldering myeloma, or multiple myeloma?
Hi Lillyput189,
Your doctor -- assuming he or she is someone with a good amount of knowledge of blood cancers such as myeloma -- probably is the best judge of how best to interpret your test results. Also, please definitely take with a grain of salt what I'm about to write, because I am definitely NOT a doctor. My opinion is based just on the information you'll find here and other places on the Internet.
That said, and as much as I don't like having to say this, it seems to me like you at least have smoldering myeloma, and may well have multiple myeloma.
I always suggest that people consult this section of the Wikipedia article for the diagnostic criteria for distinguishing between MGUS, smoldering myeloma, and multiple myeloma.
http://en.wikipedia.org/wiki/Multiple_myeloma#Diagnostic_criteria
As you may have read recently here at the MB, the criteria for distinguishing between MGUS, smoldering myeloma, and multiple myeloma are being revised. But, right now, the criteria are as described in the Wikipedia section I just mentioned. They are as follows:
1. Symptomatic myeloma (multiple myeloma):
A. Clonal plasma cells >10% on bone marrow biopsy or (in any quantity) in a biopsy from other tissues (plasmacytoma)
B. A monoclonal protein (paraprotein) in either serum or urine (except in cases of true non-secretory myeloma)
C. Evidence of end-organ damage felt related to the plasma cell disorder (related organ or tissue impairment, ROTI, commonly referred to by the acronym "CRAB"):
- HyperCalcemia (corrected calcium >2.75 mmol/L)
- Renal insufficiency attributable to myeloma
- Anemia (hemoglobin <10 g/dL)
- Bone lesions (lytic lesions or osteoporosis with compression fractures)
2. Asymptomatic myeloma (smoldering myeloma):
A. Serum paraprotein >30 g/L (3 g/dL) AND/OR
B. Clonal plasma cells >10% on bone marrow biopsy AND
C. NO myeloma-related organ or tissue impairment
3. Monoclonal gammopathy of undetermined significance (MGUS):
A. Serum paraprotein <30 g/L AND
B. Clonal plasma cells <10% on bone marrow biopsy AND
C. NO myeloma-related organ or tissue impairment.
Now, given your paraprotein (M-spike) level of 3.7, and given the fact that you have a bone marrow plasma cell percentage of 18 percent, you are at least in the smoldering myeloma category.
Plus, you have some anemia (low hemoglobin) and somewhat elevated calcium levels. So there would be some basis for saying that you have symptomatic multiple myeloma, not just smoldering myeloma.
Did you have a skeletal survey or any other imaging work done to see whether you have signs of bone lesions? Also, what do the measures of your kidney function show -- measures like creatinine levels or GFR?
I hope this helps. I definitely think you should discuss the results in more detail with your doctor.
Your doctor -- assuming he or she is someone with a good amount of knowledge of blood cancers such as myeloma -- probably is the best judge of how best to interpret your test results. Also, please definitely take with a grain of salt what I'm about to write, because I am definitely NOT a doctor. My opinion is based just on the information you'll find here and other places on the Internet.
That said, and as much as I don't like having to say this, it seems to me like you at least have smoldering myeloma, and may well have multiple myeloma.
I always suggest that people consult this section of the Wikipedia article for the diagnostic criteria for distinguishing between MGUS, smoldering myeloma, and multiple myeloma.
http://en.wikipedia.org/wiki/Multiple_myeloma#Diagnostic_criteria
As you may have read recently here at the MB, the criteria for distinguishing between MGUS, smoldering myeloma, and multiple myeloma are being revised. But, right now, the criteria are as described in the Wikipedia section I just mentioned. They are as follows:
1. Symptomatic myeloma (multiple myeloma):
A. Clonal plasma cells >10% on bone marrow biopsy or (in any quantity) in a biopsy from other tissues (plasmacytoma)
B. A monoclonal protein (paraprotein) in either serum or urine (except in cases of true non-secretory myeloma)
C. Evidence of end-organ damage felt related to the plasma cell disorder (related organ or tissue impairment, ROTI, commonly referred to by the acronym "CRAB"):
- HyperCalcemia (corrected calcium >2.75 mmol/L)
- Renal insufficiency attributable to myeloma
- Anemia (hemoglobin <10 g/dL)
- Bone lesions (lytic lesions or osteoporosis with compression fractures)
2. Asymptomatic myeloma (smoldering myeloma):
A. Serum paraprotein >30 g/L (3 g/dL) AND/OR
B. Clonal plasma cells >10% on bone marrow biopsy AND
C. NO myeloma-related organ or tissue impairment
3. Monoclonal gammopathy of undetermined significance (MGUS):
A. Serum paraprotein <30 g/L AND
B. Clonal plasma cells <10% on bone marrow biopsy AND
C. NO myeloma-related organ or tissue impairment.
Now, given your paraprotein (M-spike) level of 3.7, and given the fact that you have a bone marrow plasma cell percentage of 18 percent, you are at least in the smoldering myeloma category.
Plus, you have some anemia (low hemoglobin) and somewhat elevated calcium levels. So there would be some basis for saying that you have symptomatic multiple myeloma, not just smoldering myeloma.
Did you have a skeletal survey or any other imaging work done to see whether you have signs of bone lesions? Also, what do the measures of your kidney function show -- measures like creatinine levels or GFR?
I hope this helps. I definitely think you should discuss the results in more detail with your doctor.
Re: MGUS, smoldering myeloma, or multiple myeloma?
Hi Cheryl,
Thanks for your reply. I did not list creatinine in my note because the value was normal. I tried to make my note short - some people don't like long posts
It's difficult for me to understand exactly what the numbers mean especially given that the doctor says we're in "wait and watch mode".
Thanks again for your post & all the info!
Thanks for your reply. I did not list creatinine in my note because the value was normal. I tried to make my note short - some people don't like long posts
It's difficult for me to understand exactly what the numbers mean especially given that the doctor says we're in "wait and watch mode".
Thanks again for your post & all the info!
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Lillyput189 - Who do you know with myeloma?: Self
- When were you/they diagnosed?: MGUS 2011, multiple myeloma 2014
- Age at diagnosis: 54
Re: MGUS, smoldering myeloma, or multiple myeloma?
Sorry, forgot to say that I'm also waiting for MRI results of complete spine.
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Lillyput189 - Who do you know with myeloma?: Self
- When were you/they diagnosed?: MGUS 2011, multiple myeloma 2014
- Age at diagnosis: 54
Re: MGUS, smoldering myeloma, or multiple myeloma?
Are you being seen by a myeloma specialist? If you aren't happy with the course of "watch and wait", have you considered getting a second opinion?
Things to think about.
Nancy in Phila
Things to think about.
Nancy in Phila
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NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
Re: MGUS, smoldering myeloma, or multiple myeloma?
Nancy, Thanks. I will be getting a 2nd opinion.
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Lillyput189 - Who do you know with myeloma?: Self
- When were you/they diagnosed?: MGUS 2011, multiple myeloma 2014
- Age at diagnosis: 54
6 posts
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