[mikepatti44]

What defines MGUS versus multiple myeloma?

by mikepatti44 on Tue Apr 12, 2016 4:10 pm

My husband was recently diagnosed with MGUS. So, now we enter the "watchful waiting" time. We are finding this waiting pretty hard. In the meantime, I have been searching and reading online. I'm only using reputable sources. I'm finding myself questioning if he was correctly diagnosed by the hem/once he saw. (She is very well respected in our area and I have had several family members who highly recommended her). I do trust her, but thought I'd post my husband's numbers and see if any of you have any insight on where we should go from here. I'm having difficulty understanding what criteria defines MGUS vs multiple myeloma.

My husband has been dealing with acquired angioedema for six years. His C4 was 8 mg/dL a year ago. (During a rather severe attack.) All other complements were normal. Not sure if this is related to the MGUS. At this same time he also began experiencing mild anemia with a hemoglobin of 12.6 with a low RBC of 4.16. Total protein was high at 8.5 gm/dL.

We switched PCPs from a GP to an internist at this time and the new doctor decided to follow up with repeat blood tests in 4 months. All of his iron testing was normal as was his B12. Hemoglobin still slightly low at 12.9 and RBCs 4.3. It was decided to simply try a multivitamin and recheck in 6 months. At this time total protein was 9.3 - this was not addressed.

Follow up labs were last month.

Hemogolboin now in normal range at 14.1. RBWs normal at 4.57. Total protein up to 10.0. BUN now up to 21, creatinine normal but B/C ratio high at 23. Internist had also ordered microalbumin which was high at 5.2 mg/dL and microalbumin / creat ratio high at 47.7.

He orders electrophoresis, done the next day. Serum shows M spike in gamma fraction at 2.9 g/dL. Gamma-globulin high at 3.4 g/dL. Immunofixation monoclonal IgG lambda.

Referred to hem/onc. Additional labs just prior to seeing her:

RBCs low at 4.49,
HGB low normal at 13.9
Creatinine low at 0.8,
BUN normal at 14 (no B/C ratio given)
Beta 2 microalbumin normal at 1.8
Kappa / lambda free light chain normal at 1.44
Protein electrophoresis of blood shows M protein at 2.9 g/dL
Protein electrophoresis of urine PEP URN states "protein is undetectable"
Immunofixation electrophoresis urine states "An IgG lambda monoclonal protein is present in the urine. Negative for monoclonal free light chains (Bence/Jones protein)

She ordered a skeletal survey, which was negative for lesions but showed a calcification in one kidney. She wants to follow up in 3 months

Questions:

1. Isn't the M spike rather high? I read that an M spike of 3 indicates multiple myeloma.
2. Is the low grade anemia enough to be considered related to multiple myeloma?
3. Is the skeletal survey sensitive enough to pick up small lesions?
4. Should he have a CT or MRI? Bone marrow biopsy?
5. Should we pursue a second opinion at, say, a myeloma clinic?
6. If so, where? We live in Michigan. We are not adverse to going to neighboring states or even Mayo, but if nearer clinics are good, would prefer them.

Sorry for the lengthy post. Just searching for answers. If we must just sit back and watch and wait, we will learn to do that. But, on the other hand, do not want to miss something that may need treatment.

Any insight is very welcome at this point! Thank you!