[Ginny1]

Multiple M spikes and hot flashes

by Ginny1 on Tue Dec 09, 2014 10:07 pm

Does anyone know why someone has multiple M-spikes? I had one spike on first test, then 2 on second one, and 3 on the last.

Secondly I've started having hot flashes. I'm 64 and not on treatment!

Any info will be appreciated . Thanks!

[Ian]

Re: Multiple M spikes and hot flashes

by Ian on Wed Dec 10, 2014 7:41 am

Hello Ginny,

Have you been diagnosed with MGUS? I assume so, given that you posted in the MGUS part of the forum, but I just wanted to check.

Also, when were you diagnosed and what was your M-spike at the time (and, if you remember, what was the type of your M-spike -- for example, IgG kappa)?

[Ginny1]

Re: Multiple M spikes and hot flashes

by Ginny1 on Wed Dec 10, 2014 11:03 pm

Yes I have MGUS IgG lambda.

First one 0.9 g/dL
Second 0.5 and 3.0 g/dL
Third 0.5, 0.3, 0.1 g/dL

[TerryH]

Re: Multiple M spikes and hot flashes

by TerryH on Thu Dec 11, 2014 10:05 pm

Hi Ginny,

Following up on Ian's question. I'm not sure I understand the numbers you've given.

I'm guessing your first M-spike was 0.9 g/dL and IgG type.

But the second and third lines confuse me a bit. Are the first numbers in those lines the IgG M-spike and the additional numbers for other M-spikes that were measured?

If so, what type were those additional M-spikes (IgA, IgM, etc.), and which values apply to them in the numbers that you listed?

[Ginny1]

Re: Multiple M spikes and hot flashes

by Ginny1 on Wed Dec 17, 2014 9:18 pm

Hi, yes the 0.9 was one spike on the first test.

Then there were 3 spikes on the next test as I listed.

The interpretation was "abnormal protein bands. Lambda IgG monoclonal."

[Multibilly]

Re: Multiple M spikes and hot flashes

by Multibilly on Wed Dec 17, 2014 9:46 pm

I'm not a doc and I may certainly be off-base here, but this sounds like oligoclonal banding to me. You typically hear about this phenomenon following treatment, but note the following:

"Different M-Spike After Stem Cell Transplantation Linked To Improved Survival (ASH 2012)," Myeloma Beacon, Jan 16, 2013.

... When the original M-spike disappears and several new M-spikes appear simultaneously, this is known as oligoclonal banding.

... Dr. Jimenez-Zepeda explained that while more than one M-spike may be present AT DIAGNOSIS and a switch from one M-protein type to another may occur at disease relapse, the type of M-protein normally stays constant throughout the disease.

He added that if a change in M-protein occurs, the change was thought to be transient. However, there has been increasing evidence that the change can last for years"

In any case, you ought to check with your doc since I may be totally wrong about this.

[TerryH]

Re: Multiple M spikes and hot flashes

by TerryH on Thu Dec 18, 2014 12:46 am

Hi Ginny,

Multibilly brings up a good point that what could be happening is oligoclonal banding. However, I'm not 100 percent certain that's the situation here. It depends on the exact definition of oligoclonal banding and what exactly your latest lab results show.

My understanding is that oligoclonal banding occurs when at least two types of monoclonal protein are detected in the immunofixation electrophoresis (IFE) lab results -- like IgG lambda and IgA kappa -- instead of just one.

But, based on your most recent posting, it seems that your most recent lab results are still reporting just a single type of monoclonal protein (IgG lambda).

So, instead, I wonder if what is happening is similar to what you see in these (French) lab results posted earlier this year in the forum:

https://myelomabeacon.org/forum/mother-with-smoldering-myeloma-france-t3174.html#p17874

There, the patient, who has smoldering myeloma, has one type of immunoglobulin (IgA lambda) reported on the IFE, but it shows up as two peaks in the SPEP (serum protein electrophoresis) part of the lab results.

But I believe this patient would still be considered to have just one type of M-spike and therefore would not have oligoclonal banding.

I may be wrong about this, however, if I am misinterpreting the definition of oligoclonal banding.

In any case, is there any chance you could post your complete most recent SPEP and IFE lab results, including comments, so we could pin down exactly what is happening?

[Multibilly]

Re: Multiple M spikes and hot flashes

by Multibilly on Thu Dec 18, 2014 9:06 am

Terry,

Thanks for chiming in.

I have to admit that I find the literature to be confusing on this subject and I'm still not quite clear if oligoclonal banding has to be represented by multiple AND different heavy/light chain pairs or not? I did get the impression from this article that one could have multiple spikes in the same region on an IFE and still have it be considered to be an oligoclonal gammopathy.

http://www.journalagent.com/tjh/pdfs/TJH_27_2_126_127.pdf

"Serum protein electrophoresis showed four clonal bands on the gamma region. Capillary
immunofixation of the serum revealed the presence of IgA lambda oligoclonal gammopathy (Figure 1).".

Again, I'm not at all clear about all this.

[TerryH]

Re: Multiple M spikes and hot flashes

by TerryH on Thu Dec 18, 2014 4:51 pm

Thanks, Multibilly, for the additional information.

I'm certainly no expert on this. I checked a couple of sources before I posted my reply above and, in the papers I checked, there always seemed to be an indication that oligoclonal banding occurs when you have more than one heavy & light chain pair (i.e., IgG lambda and IgA kappa, not just IgG lambda). But I didn't see the paper you pointed out, and there may be others out there indicating that oligoclonal banding can occur with just a single heavy & light chain pair.

I still think it would be helpful to see Ginny's complete SPEP and IFE so we can really pin down what's going on in her case.

[Multibilly]

Re: Multiple M spikes and hot flashes

by Multibilly on Thu Dec 18, 2014 5:44 pm

Hey Terry,

Well, I'm no expert either. But after reading a bit further I now think there are indeed two types of oligoclonal banding that can occur: oligoclonal banding with and without isotype switching. I remember Dr. Libby talking about this at one point and I finally found the relevant thread:

Dr. Edward Libby, "Re: Now have two m-spikes - IgA kappa & IgG kappa," posting in the Beacon forum, Jul 28, 2014

I agree it would be helpful to have the IFE and SPEP test results.

Ginny, sorry for the academic discussion. I'm sure you were just looking for a simple answer From everything I have read in the past on this subject, there is no negative impact on prognosis if you have multiple M-Spikes ... which I'm guessing is what you are most concerned with.