Have had some extensive lab work done because of back pain, rib pain and other weird stuff that suddenly appeared several months ago. Blood work all came back negative for myeloma. No paraprotein found, no blasts, including immunofixation test. I did have an MRI of the spine a couple of months ago. No lesions were detected, just a large amount of degenerative disk disease. No one has an explanation for why my ribs ache.
After reading more here, I've discovered that some people have had myeloma that did not show up in blood tests. Were they blood tests that were specifically looking for myeloma? Should I perhaps get an MRI of my ribs since xray may not show any lesions and a spine MRI doesn't include the ribs?
Mind you, I'm not looking to be diagnosed with multiple myeloma, but want to make sure they haven't missed anything, since I don't have a diagnosis for anything but perhaps that I am a hypochondriac.
JK
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Re: Can multiple myeloma not show up in blood tests?
You are correct that there are forms of myeloma that don't show up on various tests such as the serum protein electrophoresis (SPEP). I have light chain only myeloma (about 20% of myeloma). My SPEP's are always normal and thus my disease is tracked by the serum free light chain (FLC) assay. I don't have a traditional M-spike but I do have the blasted disease!
There are others who have true nonsecretory myeloma which is much harder to track (bone marrow biopsies, PET CTs, etc., are necessary) and their blood and urine doesn't contain paraproteins.
Hopefully, you have something completely benign and unrelated to cancer. Good luck.
There are others who have true nonsecretory myeloma which is much harder to track (bone marrow biopsies, PET CTs, etc., are necessary) and their blood and urine doesn't contain paraproteins.
Hopefully, you have something completely benign and unrelated to cancer. Good luck.
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terryl1 - Name: Terry
- Who do you know with myeloma?: self
- When were you/they diagnosed?: August 10, 2011
- Age at diagnosis: 49
Re: Can multiple myeloma not show up in blood tests?
So, if I were to try to rule out multiple myeloma altogether, I would suggest getting a bone marrow biopsy and also get your get your free light chains assayed via a blood serum test (sFLC assay).
I'd personally want to do those tests before getting bombarded with a full body xray or PET/CT scan, both of which expose you to a lot of radiation (MRI is also an option, but each exam type has its pluses and minuses).
But, if your bone marrow biopsy or serum free light chain assays show signs of multiple myeloma, then you would want to get some sort of follow up full-body radiological exam to see if you have any bone lesions hanging out anywhere.
I personally can do blood, urine and bone marrow biopsies any day of the week (some people find the bone marrow biopsies pretty painful, others like me don't at all), but I worry about getting too many radiological procedures done to my already screwed up cells
I'd personally want to do those tests before getting bombarded with a full body xray or PET/CT scan, both of which expose you to a lot of radiation (MRI is also an option, but each exam type has its pluses and minuses).
But, if your bone marrow biopsy or serum free light chain assays show signs of multiple myeloma, then you would want to get some sort of follow up full-body radiological exam to see if you have any bone lesions hanging out anywhere.
I personally can do blood, urine and bone marrow biopsies any day of the week (some people find the bone marrow biopsies pretty painful, others like me don't at all), but I worry about getting too many radiological procedures done to my already screwed up cells
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Can multiple myeloma not show up in blood tests?
JK -
The tests we do for myeloma in blood (SPEP, serum immunofixation, and serum free light chains) and in urine (UPEP and urine immunofixation) will pick up an abnormal protein in about 98% of myeloma patients. Thus, only about 2% of myeloma patients are truly "nonsecretory", which means they can only have their disease identified by imaging studies and/or bone marrow biopsy.
Even if you did have nonsecretory myeloma, if your pain was due to myeloma bone disease, we would almost always see some abnormalities seen on MRI.
So if you've had all of the above tests and they've been negative, myeloma would be very unlikely and I think a bone marrow biopsy would be very low yield.
Plain xrays of the ribs are actually pretty low radiation exposure and may be a reasonable next step, as would consultation with an orthopedist or musculoskeletal specialist to look for alternative causes of your pain.
Hope this helps.
The tests we do for myeloma in blood (SPEP, serum immunofixation, and serum free light chains) and in urine (UPEP and urine immunofixation) will pick up an abnormal protein in about 98% of myeloma patients. Thus, only about 2% of myeloma patients are truly "nonsecretory", which means they can only have their disease identified by imaging studies and/or bone marrow biopsy.
Even if you did have nonsecretory myeloma, if your pain was due to myeloma bone disease, we would almost always see some abnormalities seen on MRI.
So if you've had all of the above tests and they've been negative, myeloma would be very unlikely and I think a bone marrow biopsy would be very low yield.
Plain xrays of the ribs are actually pretty low radiation exposure and may be a reasonable next step, as would consultation with an orthopedist or musculoskeletal specialist to look for alternative causes of your pain.
Hope this helps.
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Dr. Adam Cohen - Name: Adam D. Cohen, M.D.
Beacon Medical Advisor
Re: Can multiple myeloma not show up in blood tests?
Hi Jk60.
The following were the clues that lead to my diagnosis.
1. Had a basic blood test and my kidney numbers were off - GFR was around 33
2. Skeletal survey - x-ray of all bones looking for lesions was "ambiguous"
2. Fat pab biopsy came back negative - no amyloidosis
3. Bone marrow biopsy came back "ambiguous"
Finally had biopsy of kidney itself and found it was 75% destroyed by light chains, so they immediately started me on dex and thalidomide, then added subcutaneous Velcade shots.
Had stringent complete remission in November 2012, but my kappa light chains are already abnormal, so I started Revlimid this week.
The following were the clues that lead to my diagnosis.
1. Had a basic blood test and my kidney numbers were off - GFR was around 33
2. Skeletal survey - x-ray of all bones looking for lesions was "ambiguous"
2. Fat pab biopsy came back negative - no amyloidosis
3. Bone marrow biopsy came back "ambiguous"
Finally had biopsy of kidney itself and found it was 75% destroyed by light chains, so they immediately started me on dex and thalidomide, then added subcutaneous Velcade shots.
Had stringent complete remission in November 2012, but my kappa light chains are already abnormal, so I started Revlimid this week.
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antelope1225 - Name: Cathy1225
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: May 25 2012
- Age at diagnosis: 55
Re: Can multiple myeloma not show up in blood tests?
Hi,
I am concerned as you are too. I have had a radiology report from a current MRI for post op one year microdiscectomy that now show diffuse marrow signal at the L4-5 and L3-4 levels and my neurosurgeon says its not likely cause it should have like hole punched out lesions.
However,my back hurts not only in the lumbar area but in the upper back too, as well as the stomach fullness on the left side when I eat and I had a big weight loss about a year and half back for no reason. Moreover my energy levels are steadily declining.
I had a CBC and chem panel which were all normal values.
I'm concerned about the myeloma because of family history for bone cancer, liver cancer, and leukemia that were all fatal.
I am concerned as you are too. I have had a radiology report from a current MRI for post op one year microdiscectomy that now show diffuse marrow signal at the L4-5 and L3-4 levels and my neurosurgeon says its not likely cause it should have like hole punched out lesions.
However,my back hurts not only in the lumbar area but in the upper back too, as well as the stomach fullness on the left side when I eat and I had a big weight loss about a year and half back for no reason. Moreover my energy levels are steadily declining.
I had a CBC and chem panel which were all normal values.
I'm concerned about the myeloma because of family history for bone cancer, liver cancer, and leukemia that were all fatal.
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Michael L
6 posts
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