[diamondgirl0124]

Do I have multiple myeloma ... or still MGUS?

by diamondgirl0124 on Fri Jan 03, 2014 6:17 am

I recently was referred to a hematologist/oncologist because of pretty severe anemia. Then further blood work brought a diagnosis of MGUS. After treatment for anemia, I was rechecked and the M spike was there and other abnormalities. Urinalysis was normal. But my skeletal survey showed an osteolytic lesion. Now I am waiting on the results of a bone marrow biopsy.

My question is this: once there is bone involvement and anemia, is it multiple myeloma and not MGUS? Or does the distinction still depend on the results from the bone marrow biopsy?

Thanks.

[Multibilly]

Re: Do I have multiple myeloma ... or still MGUS?

by Multibilly on Fri Jan 03, 2014 9:48 am

Sorry to hear that this disease has nipped you.

The bone marrow biopsy is going to give you some good guidance and will help ultimately determine the degree and nature of your disease (and will also provide some key genetic information). I’d suggest waiting to get the results of the bone marrow biopsy before second guessing your exact disease stage.

In general, to have symptomatic multiple myeloma, you first need to have a plasma cell percentage (this comes from your bone marrow biopsy) of >10% or the detection of clonal cells in another tissue (i.e. a biopsy of your bone lesion). You also need to have an M-Spike, which you do have. Assuming you have this information (which you don't yet), this then gets into a discussion of the CRAB criteria (high calcium, renal issues, anemia or bone lesion involvement).

What is your specific hemoglobin level? Technically, if you are sufficiently anemic AND you meet the criteria I outlined above (still pending), that alone would classify you as having symptomatic multiple myeloma. But it also depends on just how anemic you are. The cutoff point for anemia wrt multiple myeloma is generally a hemogloblin level of less than 10 g/dL.

The same goes for bone lesion involvement. If it turns out that the lesion is multiple myeloma related, that by itself (along with bone marrow results and presence of M-spike) would also classify you as having symptomatic multiple myeloma. However, if it is a single, specific type of lesion and you have no other CRAB issues (anemia, etc), that could potentially put you in the unique classification of having a "solitary plasmacytoma", which is usually just treated with radiation of the lesion.

If you meet none of the CRAB criteria and have an M-Spike, then whether you have MGUS or smoldering myeloma will be determined by the plasma percentage from your bone marrow biopsy in combination with your specific m-spike level. What is your M-spike level (be sure to include units of measure whenever you communicate a lab result)?

Hope this helps.

[diamondgirl0124]

Re: Do I have multiple myeloma ... or still MGUS?

by diamondgirl0124 on Fri Jan 03, 2014 11:32 am

Thank you. I do not have high calcium or renal issues. My Hb is 7.9. My M-spike is 1.9 g/dL. Serum lambda 3.3 mg/L, and free kappa/lambda 4.5. IgG is 2368 mg/dL.

[Multibilly]

Re: Do I have multiple myeloma ... or still MGUS?

by Multibilly on Fri Jan 03, 2014 1:14 pm

Well, it certainly looks like you are anemic. Again, If your clonal plasma cell levels from the BMB are > 10%, then you would be symptomatic based on this alone....and you should seek treatment.

Note that there is a fuzzy area wrt diagnosis when your plasma cell level from your BMB is less than 10%. See this thread.

https://myelomabeacon.org/forum/does-my-mother-have-multiple-myeloma-t2643.html

Hopefully, you will get your BMB results soon and you won't be guessing at this any more.

In any case, you definitely want to address these issues with treatment as soon as you have your results.

Best of luck to you.