[Jer610]

MGUS with high-risk cytogenetics

by Jer610 on Fri Mar 25, 2016 1:17 pm

Good morning to all and happy Easter weekend.

I have posted on the Beacon Forum this past year with various questions concerning my initial diagnosis with cold agglutinin disease, autoimmune hemolytic anemia and IgG lambda MGUS and test results since diagnosis. I have received some great responses and at times my questions have gone unanswered. Such is the nature of this platform, where we are all trying to make sense of things and as wise folks have pointed out "there are no dumb questions".

My current question has probably been answered some where else in the Forum, but I wish to ask it anyway. This past winter the cytogenetics from my bone marrow biopsy of June 2014 was finally posted on my personal medical page and I had my first chance to view it. It showed a single non-clonal abnormal cell out of a total of 20. The results of the single cell was

44,X,-Y, +del(1)(p12), t(2;13)(q31;q32), add(12)(q13), del(14)(q34q32)), add(14)(q32), -16, -18, del(18)(q21.1), der(21), t(18;21)(q11.1;p12).

The report mentioned the chromosome 1 abnormalities and the 14q32 changes and said that this specimen could represent a low-proliferating plasma disorder. This one cell seems to pack some punch: hypoploidy, chromosome 1 abnormalities, especially the p12 deletion and myeloma-common 14q32 involvement.

With the final draft posted yesterday from ASH concerning high risk cytogenetics putting the deletion of 1p12 on par with 1q21, with these abnormalities deemed secondary events in transformation, am I getting an early look at the evolution of disease state?

I know that the road is a long one from MGUS to multiple myeloma with many twists and turns, but my free light chain ratio has been anywhere from 50-1 to 20-1, and my immunoparesis deepens with every test. My IgA was 34 and my IgM 35 as of December, and my IgG m-spike of 1.4 makes up 80% of my total IgG. MyMm-spike and lambda free light chains have been remarkably consistent since diagnosis with my spike moving from 1.3 to 1.4 and my lambda free light chain levelsteady at about 200. My impression as I approach the "Myeloma Age Zone" is that I am probably looking at further growth of my gammopathy up to the point of multiple myeloma in time.

Can anything be taken way from the report on this single cell that would relate to evolution of my gammopathy?