Hi everyone,
I am new to the forum and advocate for my wife, who is going through a process to determine if she has multiple myeloma. I would appreciate any input as to the interpretation of some of the results.
Background: She was diagnosed with multiple sclerosis (MS) in 1998 and has been taking injectable beta interferon since 2003. Her MS has been in remission and has caused little trouble where she has periodic MRIs that monitor any progression of the lesions.
Come March 2015, she has gone through the following (with results indicated) to determine issues she's had with ongoing issues with her osteoporosis:
March 13 2015 Serum Protein Electrophoresis
Total Protein 6.9 g/dL (6.0- 8.2)
Albumin 4.3 g/dL (3.3- 5.4)
Alpha 1 0.3 g/dL (0.1- 0.2) - HIGH
Alpha 2 0.9 g/dL (0.6- 0.9)
Beta 0.8 g/dL (0.6- 1.1)
Gamma 0.7 g/dL (0.7- 1.5)
Paraprotein 1 0.2 g/dL (0.0- 0.0) - HIGH
Interpretation:
The serum protein electrophoretic pattern shows a small peak in the
mid gamma region. Serum IFE studies are consistent with an IgG kappa
monoclonal gammopathy. Correlation with the clinical findings, however,
is recommended.
In April 2015, she had the following tests:
1. X-rays that showed no evidence of multiple myeloma
2. MRI that confirmed the multiple sclerosis was stable and no evidence of multiple myeloma
3. PET scan also confirming the multiple sclerosis condition with no evidence of multiple myeloma
4. Free light chain analyis with following results:
Lambda free light chain 4.74 mg/L (5.71-26.30) LOW
Kappa free light chain 8.21 mg/L (3.30-19.40)
Kappa/lambda free light chain ratio 1.73 (0.26-1.65) HIGH
In May she will have bone marrow aspiration, which hopefully will be conclusive of any evidence of multiple myeloma.
Question: With the blood work done so far, and the MRIs and PET scan, could she have MGUS? Also, does anyone have a background with MS, the use of the interferon (Rebiff - 44 mcg 3x’s per week) and the affect this could have on blood work that has been done?
Perhaps this is a reason for the blood serum Alpha 1 being high (0.3 g/dl) and the serum protein electrophoresis paraprotein high (0.2 g/dl) and a low lambda free light chain of 4.24 mg/L - with the kappa / lambda ratio high at 1.73.
Any input/observations is most appreciated.
John
Forums
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octopus13 - Name: octopus13
- Who do you know with myeloma?: Wife
- When were you/they diagnosed?: Still under investigation
- Age at diagnosis: 61
Re: Have multiple sclerosis, possibly multiple myeloma
Hi Octopus,
Welcome to the forum.
An M-spike of 0.2 g/dL is really a small M-spike. A K/L ratio of 1.73 is also just barely scraping outside the normal range. Based on just these two findings, this does suggest a very mild case of MGUS, but that would need to be confirmed by a bone marrow biopsy (which it sounds like you already have planned).
If a bone marrow biopsy does confirm MGUS, keep in mind that the risk of progressing to symptomatic multiple myeloma is only about 1% per year. Also, your wife's MGUS markers are about the lowest I've ever seen for somebody diagnosed with MGUS.
For completeness, you also want to be checking her calcium, hemoglobin and creatinine levels to see if hypercalcemia, anemia, or any renal issues may possibly be in play.
I am totally unqualfied to comment on how MS or interferon might impact any of these numbers.
Hope this helps a bit.
Welcome to the forum.
An M-spike of 0.2 g/dL is really a small M-spike. A K/L ratio of 1.73 is also just barely scraping outside the normal range. Based on just these two findings, this does suggest a very mild case of MGUS, but that would need to be confirmed by a bone marrow biopsy (which it sounds like you already have planned).
If a bone marrow biopsy does confirm MGUS, keep in mind that the risk of progressing to symptomatic multiple myeloma is only about 1% per year. Also, your wife's MGUS markers are about the lowest I've ever seen for somebody diagnosed with MGUS.
For completeness, you also want to be checking her calcium, hemoglobin and creatinine levels to see if hypercalcemia, anemia, or any renal issues may possibly be in play.
I am totally unqualfied to comment on how MS or interferon might impact any of these numbers.
Hope this helps a bit.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Have multiple sclerosis, possibly multiple myeloma
Hi Multibilly,
Thank you for your input - this is very helpful. I am really in a research mode before we see the doctor after her bone marrow biopsy - planned in mid May. The blood work that was done on her is extensive and all others seem within range, with:
Calcium Serum 9.6 mg/dL (8.4- 10.2)
Hemoglobin 12.7 g/dL (12.0- 16.0)
Creatinine Serum 0.68 mg/dL (0.60- 1.00)
Her white blood cell count, though, is all over the map, with recent being low - below, and others within normal range - RBC is normal - her MS doctor attributes the WBC issue with the MS drug.
White Blood Cell Count 3.5 L K/uL (4.0- 11.0)
Question: if the bone marrow biopsy comes back and shows no issue (i.e. no reading), then would this conclude she does not have MGUS as well?
Thank you very much for your help.
Thank you for your input - this is very helpful. I am really in a research mode before we see the doctor after her bone marrow biopsy - planned in mid May. The blood work that was done on her is extensive and all others seem within range, with:
Calcium Serum 9.6 mg/dL (8.4- 10.2)
Hemoglobin 12.7 g/dL (12.0- 16.0)
Creatinine Serum 0.68 mg/dL (0.60- 1.00)
Her white blood cell count, though, is all over the map, with recent being low - below, and others within normal range - RBC is normal - her MS doctor attributes the WBC issue with the MS drug.
White Blood Cell Count 3.5 L K/uL (4.0- 11.0)
Question: if the bone marrow biopsy comes back and shows no issue (i.e. no reading), then would this conclude she does not have MGUS as well?
Thank you very much for your help.
-
octopus13 - Name: octopus13
- Who do you know with myeloma?: Wife
- When were you/they diagnosed?: Still under investigation
- Age at diagnosis: 61
Re: Have multiple sclerosis, possibly multiple myeloma
A bone marrow biopsy can sometimes be inconclusive when it comes to a diagnosis of a monoclonal gammopathy. This is because the disease may not be spread evenly throughout one's skeleton and the biopsy can therefore sometimes hit a "dry spot" where there are no monoclonal plasma cells, even though a patient may indeed have the disease. This happens even with patients that have far greater levels of monoclonal protein than what your wife is currently registering.
If the bone marrow biopsy does confirm MGUS, your doctor would probably ask your wife to get her blood re-checked in a few months to a year. But if the bone marrow biopsy shows no sign of a monoclonal gammopathy, your doctor would still probably suggest getting a new set of blood tests in a few months to a year ... and take it from there.
At least this would be my guess as a layman. But obviously your doctor is in the best position to comment on all this.
If the bone marrow biopsy does confirm MGUS, your doctor would probably ask your wife to get her blood re-checked in a few months to a year. But if the bone marrow biopsy shows no sign of a monoclonal gammopathy, your doctor would still probably suggest getting a new set of blood tests in a few months to a year ... and take it from there.
At least this would be my guess as a layman. But obviously your doctor is in the best position to comment on all this.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Have multiple sclerosis, possibly multiple myeloma
Thank you - I understand - we will go through the protocol and take it from there.
I would like to thank you and this forum for the great service you are providing in understanding multiple myeloma in what seems to me, a complex medical condition I was not aware of.
I would like to thank you and this forum for the great service you are providing in understanding multiple myeloma in what seems to me, a complex medical condition I was not aware of.
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octopus13 - Name: octopus13
- Who do you know with myeloma?: Wife
- When were you/they diagnosed?: Still under investigation
- Age at diagnosis: 61
Re: Have multiple sclerosis, possibly multiple myeloma
I'm not a doctor, but the free light chain ratio is a bit odd because the lambda is low, but the kappa is still in the normal range. I would not interpret this as the usual myeloma "high," where kappa or lambda would be elevated.
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Anonymous
Re: Have multiple sclerosis, possibly multiple myeloma
I'm not a doctor either, and am also puzzled on the importance of this ratio. For her case, the ratio would be 8.21 / 4.74 = 1.73.
Intuitively, having a low lambda protein would seem better than having it on the high range, but the ratio is evidently an indication of a potential monoclonal gammopathy.
Thanks for your observation.
I also just received her urine protein electrophoresis results back and they all seem, to me, ok – with the exception of the further interpretation / analysis by the lab -
See below - any comments appreciated:
Urine Protein Electrophoresis
Urine Protein 4 mg/dL (1-14)
Urine Total Volume 2475 mL
Urine Collection Time 24 HOURS
Urine Protein in Total Volume 99 mg/TV (50-100)
Albumin, Urine 49.5 % (33.0-50.0)
Globulin, Urine 50.5 % (50.0-66.0)
Urine Protein Electrophoresis Interpretation:
The urine protein electrophoretic pattern shows no a faint indistinct
linear density near the junction of the fast gamma and mid gamma
regions. If a Bence-Jones proteinuria is suspected clinically, serum
free light chain and urine IFE studies are recommended.
Followed by what appears to be an IFE study interpretation:
Immunofixation Electrophoresis, Urine
Suspicious for kappa
Urine Immunofixation Interpretation:
The urine protein immunofixation electrophoretic patterns
obtained with the use of antisera against IgG, IgA, IgM, bound
kappa and bound lambda light chains, free kappa and free lambda
light chain proteins are suspicious for a kappa Bence-Jones
proteinuria.
Thank you - I appreciate anyone's comments / input.
Intuitively, having a low lambda protein would seem better than having it on the high range, but the ratio is evidently an indication of a potential monoclonal gammopathy.
Thanks for your observation.
I also just received her urine protein electrophoresis results back and they all seem, to me, ok – with the exception of the further interpretation / analysis by the lab -
See below - any comments appreciated:
Urine Protein Electrophoresis
Urine Protein 4 mg/dL (1-14)
Urine Total Volume 2475 mL
Urine Collection Time 24 HOURS
Urine Protein in Total Volume 99 mg/TV (50-100)
Albumin, Urine 49.5 % (33.0-50.0)
Globulin, Urine 50.5 % (50.0-66.0)
Urine Protein Electrophoresis Interpretation:
The urine protein electrophoretic pattern shows no a faint indistinct
linear density near the junction of the fast gamma and mid gamma
regions. If a Bence-Jones proteinuria is suspected clinically, serum
free light chain and urine IFE studies are recommended.
Followed by what appears to be an IFE study interpretation:
Immunofixation Electrophoresis, Urine
Suspicious for kappa
Urine Immunofixation Interpretation:
The urine protein immunofixation electrophoretic patterns
obtained with the use of antisera against IgG, IgA, IgM, bound
kappa and bound lambda light chains, free kappa and free lambda
light chain proteins are suspicious for a kappa Bence-Jones
proteinuria.
Thank you - I appreciate anyone's comments / input.
-
octopus13 - Name: octopus13
- Who do you know with myeloma?: Wife
- When were you/they diagnosed?: Still under investigation
- Age at diagnosis: 61
Re: Have multiple sclerosis, possibly multiple myeloma
Hi John,
My take on the UPEP results is that they mainly confirm what you already learned through the bloodwork that your wife had done, which is that there is some sign of IgG kappa monoclonal gammopathy.
The next step is really what Multibilly suggested earlier, which is to have your wife get a bone marrow biopsy to determine the percentage of monoclonal plasma cells in her bone marrow. If the percentage comes in at less than 10 percent -- which is what I would expect, given the information you've shared so far -- then your wife's diagnosis is MGUS.
Given that your wife is not showing any signs of organ damage as a result of the monoclonal gammopathy that she appears to have -- her calcium, creatinine, and hemoglobin levels are normal -- it may be worth trying to schedule a bone marrow biopsy to be done at a center where there are myeloma specialists. I would expect the biopsy to be done more professionally at such a center, and you and your wife would then be able to discuss the results with a specialist who could address all the questions you have and come up with a good set of next steps, including regular monitoring.
(The best specialists for people with MGUS to see are, in fact, myeloma specialists, since MGUS, like myeloma, is a plasma cell disorder -- which is what myeloma specialists focus on.)
Again, it's important to realize that MGUS generally does not progress to multiple myeloma. Please keep that in mind.
A myeloma specialist will also be the person best able to answer any questions you may have about the impact of your wife's interferon treatment on MGUS. I doubt it matters much one way or another, but a specialist will know better.
Interferon ALPHA, by the way, was used in the past as a treatment for multiple myeloma, but it is no longer in regular use. Interferon alpha is also a different interferon that the interferon BETA used to treat MS. I have not found any evidence that interferon beta has ever been used to treat multiple myeloma.
Good luck!
My take on the UPEP results is that they mainly confirm what you already learned through the bloodwork that your wife had done, which is that there is some sign of IgG kappa monoclonal gammopathy.
The next step is really what Multibilly suggested earlier, which is to have your wife get a bone marrow biopsy to determine the percentage of monoclonal plasma cells in her bone marrow. If the percentage comes in at less than 10 percent -- which is what I would expect, given the information you've shared so far -- then your wife's diagnosis is MGUS.
Given that your wife is not showing any signs of organ damage as a result of the monoclonal gammopathy that she appears to have -- her calcium, creatinine, and hemoglobin levels are normal -- it may be worth trying to schedule a bone marrow biopsy to be done at a center where there are myeloma specialists. I would expect the biopsy to be done more professionally at such a center, and you and your wife would then be able to discuss the results with a specialist who could address all the questions you have and come up with a good set of next steps, including regular monitoring.
(The best specialists for people with MGUS to see are, in fact, myeloma specialists, since MGUS, like myeloma, is a plasma cell disorder -- which is what myeloma specialists focus on.)
Again, it's important to realize that MGUS generally does not progress to multiple myeloma. Please keep that in mind.
A myeloma specialist will also be the person best able to answer any questions you may have about the impact of your wife's interferon treatment on MGUS. I doubt it matters much one way or another, but a specialist will know better.
Interferon ALPHA, by the way, was used in the past as a treatment for multiple myeloma, but it is no longer in regular use. Interferon alpha is also a different interferon that the interferon BETA used to treat MS. I have not found any evidence that interferon beta has ever been used to treat multiple myeloma.
Good luck!
-
Jonah
Re: Have multiple sclerosis, possibly multiple myeloma
Jonah,
Thank you for your input - and verification's on where we are in the process.
She has a bone marrow aspiration/biopsy planned for May 11 – the location she will have at specializes in multiple myeloma, so we feel pretty fortunate to have that – the doctor also is a specialist in this.
We'll have to see on what affect the MS medication has, one way or the other – interesting, as there aren't many with this issue (her MS doctor says she's the first she has seen).
Thanks again.
John
Thank you for your input - and verification's on where we are in the process.
She has a bone marrow aspiration/biopsy planned for May 11 – the location she will have at specializes in multiple myeloma, so we feel pretty fortunate to have that – the doctor also is a specialist in this.
We'll have to see on what affect the MS medication has, one way or the other – interesting, as there aren't many with this issue (her MS doctor says she's the first she has seen).
Thanks again.
John
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octopus13 - Name: octopus13
- Who do you know with myeloma?: Wife
- When were you/they diagnosed?: Still under investigation
- Age at diagnosis: 61
Re: Have multiple sclerosis, possibly multiple myeloma
Dear all,
I am relatively new to the forum (April) and am an advocate for my wife (diagnosed with Multiple Sclerosis ~ 15 years ago) who is undergoing tests for diagnosis of Multiple Myeloma.
She has had the requiste blood work done, that confirms:
Serum Protein Electro:
SERUM PRO ELECT ALPHA 1 0.3 H g/dL (0.1- 0.2)
SERUM PRO ELECT PARAPROTEIN 1 0.2 H g/dL (0.0- 0.0)
Free Light Chain:
FREE LAMBDA LIGHT CHAIN 4.74 L mg/L L (5.71- 26.30)
FREE KAPPA LIGHT CHAIN 8.21 mg/L (3.30- 19.40)
FREE KAPPA/LAMBDA RATIO 1.73 H (0.26- 1.65
Her PET/CAT scans and MRI’s came out negative - showing no apparent myeloma related issues.
We are waiting the Bone Marrow test results and will see the multiple myeloma doctor - specialist next week.
My question:
She recently went through 24 hour Urine protein tests with results below. I realize that the blood work is more indicative of multiple myeloma, however, my question concerns the amount of information indicated concerning M spike and other markers, as well as the comment in the observation the tests may be suspicious of Bence Jones proteinuria - others on the forum have indicated more information on the test breakdown and how the specimin compares with the norm - thank you for your input -
URINE PROTEIN ELECTROPHORESIS
¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯
URINE PROTEIN 4 mg/dL (1- 14)
URINE TOTAL VOLUME 2475 mL
URINE COLLECTION TIME 24 HOURS
URINE START DATE 15APR15
URINE END DATE 16APR15
URINE PROTEIN IN TOTAL VOLUME 99 mg/TV (50- 100)
ALBUMIN, URINE 49.5 % (33.0- 50.0)
GLOBULIN URINE 50.5 % (50.0- 66.0)
URINE PROTEIN ELECTRO INTERP
The urine protein electrophoretic pattern shows no a faint indistinct
linear density near the junction of the fast gamma and mid gamma regions.
If a Bence-Jones proteinuria is suspected clinically, serum free light
chain and urine IFE studies are recommended.
Other tests ordered on the same accession number are available below.
_____________________________________________
IMMUNOFIXATION, URINE
_____________________________________________
IMMUNOFIXATION ELECTRO, URINE
suspicious for kappa
URINE IMMUNOFIXATION INTERP
The urine protein immunofixation electrophoretic patterns obtained with
the use of antisera against IgG, IgA, IgM, bound kappa and bound lambda
light chains, free kappa and free lambda light chain proteins are
suspicious for a kappa Bence-Jones proteinuria.
Thank you for your input -
John
I am relatively new to the forum (April) and am an advocate for my wife (diagnosed with Multiple Sclerosis ~ 15 years ago) who is undergoing tests for diagnosis of Multiple Myeloma.
She has had the requiste blood work done, that confirms:
Serum Protein Electro:
SERUM PRO ELECT ALPHA 1 0.3 H g/dL (0.1- 0.2)
SERUM PRO ELECT PARAPROTEIN 1 0.2 H g/dL (0.0- 0.0)
Free Light Chain:
FREE LAMBDA LIGHT CHAIN 4.74 L mg/L L (5.71- 26.30)
FREE KAPPA LIGHT CHAIN 8.21 mg/L (3.30- 19.40)
FREE KAPPA/LAMBDA RATIO 1.73 H (0.26- 1.65
Her PET/CAT scans and MRI’s came out negative - showing no apparent myeloma related issues.
We are waiting the Bone Marrow test results and will see the multiple myeloma doctor - specialist next week.
My question:
She recently went through 24 hour Urine protein tests with results below. I realize that the blood work is more indicative of multiple myeloma, however, my question concerns the amount of information indicated concerning M spike and other markers, as well as the comment in the observation the tests may be suspicious of Bence Jones proteinuria - others on the forum have indicated more information on the test breakdown and how the specimin compares with the norm - thank you for your input -
URINE PROTEIN ELECTROPHORESIS
¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯
URINE PROTEIN 4 mg/dL (1- 14)
URINE TOTAL VOLUME 2475 mL
URINE COLLECTION TIME 24 HOURS
URINE START DATE 15APR15
URINE END DATE 16APR15
URINE PROTEIN IN TOTAL VOLUME 99 mg/TV (50- 100)
ALBUMIN, URINE 49.5 % (33.0- 50.0)
GLOBULIN URINE 50.5 % (50.0- 66.0)
URINE PROTEIN ELECTRO INTERP
The urine protein electrophoretic pattern shows no a faint indistinct
linear density near the junction of the fast gamma and mid gamma regions.
If a Bence-Jones proteinuria is suspected clinically, serum free light
chain and urine IFE studies are recommended.
Other tests ordered on the same accession number are available below.
_____________________________________________
IMMUNOFIXATION, URINE
_____________________________________________
IMMUNOFIXATION ELECTRO, URINE
suspicious for kappa
URINE IMMUNOFIXATION INTERP
The urine protein immunofixation electrophoretic patterns obtained with
the use of antisera against IgG, IgA, IgM, bound kappa and bound lambda
light chains, free kappa and free lambda light chain proteins are
suspicious for a kappa Bence-Jones proteinuria.
Thank you for your input -
John
-
octopus13 - Name: octopus13
- Who do you know with myeloma?: Wife
- When were you/they diagnosed?: Still under investigation
- Age at diagnosis: 61
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