[Melody]

Need help interpreting bone marrow biopsy lab results

by Melody on Thu Dec 19, 2013 2:49 am

My world has been ROCKED, my husband was diagnosed with Waldenstrom's Macroglobulinemia Monoclonal gammopathy of unknown significance.

I'm having great difficulty trying to interpret the numbers.. any help would be greatly appreciated.

10/25/13 SPEP M-spike: 1.8g/dl. Random protein electrophoresis: 100% albumin, negative for monoclonal light chain.

11/7/13 - IgM-kappa type: IgG: 572; IgA: 110; IgM: 2,505
(What do these numbers mean....is the IgM protein elevated?)

11/19/13 - Bone Marrow Biopsy - Lymphoplasmacytic Lymphoma, showing 23% lymphocytes and 15% plasma cells for a total abnormal cellularity of approximately 40%. Cytogenetics:
Normal mal karyotype.

(Does this mean 40% of his cells are abnormal?)

11/20/13 - SPEP M-spike: 1.7g/dl. Immunofixation: Monoclonal gammopathy, IgM kappa type. IgG: 565; IgA: 108; IgM: 2,495. Serum free kappa light chain: 276.26; lambda: 6.06; ratio: 45.59. Beta2 microglobulin: 1.5

Per the oncologist, he does have history of bilateral lower extremity weakness, evidence of motor neuropathy, which we usually see in Waldenstrom's, therefore the contribution of his Waldenstrom's to the overall neurological status is not quite clear to me. He also does not have any significant symptoms of hyperviscosity. He does report having colder hands and feet. His CBC is completely within normal limits with no evidence of cytopenias.

I understand there is no known cure for WM at this time, but there are a number of options that have shown some success in controlling the disease.

[Cheryl G]

Re: Need help interpreting bone marrow biopsy lab results

by Cheryl G on Thu Dec 19, 2013 8:38 am

Sorry to hear about your husband's WM diagnosis, Melody. As you said, however, there are a number of treatment options for the disease.

Since this is a forum for patients with myeloma (and earlier stages of the disease, like smoldering myeloma), none of us here really know very much about WM, other than the fact that it has some similarities to myeloma. So it's probably best if you look for a similar forum for WM patients to get the best answers to your questions.

However, in the meantime, this web page should help you understand which of your husband's Ig numbers are in the normal range and which are not:

http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8156

and this site has a lot of information about serum free light chain tests:

http://www.wikilite.com

Also, the Wikipedia page about WM may help you understand more about both the diagnosis of WM and treatment:

http://en.wikipedia.org/wiki/Waldenstr%C3%B6m's_macroglobulinemia

Good luck!

[Multibilly]

Re: Need help interpreting bone marrow biopsy lab results

by Multibilly on Thu Dec 19, 2013 9:19 am

I’m not a doc, but let me try to boil this down for you in more understandable terms.

The M-Spike tells you how much of a monoclonal (cancerous) immunoglobulin one has in their serum. A normal reading is 0. There are several different kinds of immunoglobulins in your body (IgA, IgG, IgM, etc). Waldenstrom’s tends to specifically effect the IgM and this is why this specific immunoglobulin is reading high at 2,495 (normal range is 55 -375 mg/dL, depending on the lab performing the test). The excess IgM level is also what is causing the hyperviscosity of the blood.

With Waldenstrom’s you also have cancerous lymphocytes (a type of white blood cell) which can show up throughout one’s body, including one’s bone marrow. This is why you are getting that lymphocyte reading in the bone marrow.

On the bone marrow biopsy, one normally has less than 5% plasma cells inside your bone. In this case, you have a higher reading of 15% plasma cells because there is an excess of plasma cells due to the disease. The reason for this is because there are now monoclonal versions of the plasma cells (unhealthy, nonfunctioning copies) that are making malfunctioning copies of themselves and not dying a normal death like normal cells are supposed to (the typical nature of a cancer).

An immunogloblobulin like IgM is what is called a heavy chain. There are also what are called immunogloblulin light chains in your blood serum. There are two kinds of light chains, kappa and lambda. When one of the heavy chains goes crazy (in this case IgM), one of the two light chains often go crazy along with it. In this case, the Kappa lite chain is now also in excess at 276.26 mg/L (normal range is 3.3 – 19.4 mg/L). This is also why your Kappa/Lambda ratio is high at 45.59 (normal ratio is 0.26-1.65).

The disease is rare, but it is absolutely treatable. If you aren’t already working with a specialist that lives and breathes this specific class of disease on a daily basis (not a general oncologist with limited experience about this disease), I’d suggest you seek one out. Hope this helps and best of luck to you.

[Melody]

Re: Need help interpreting bone marrow biopsy lab results

by Melody on Thu Dec 19, 2013 12:11 pm

Thank You for the response multibilly. You state to seek out a specialist and not an oncologist. What type of specialist would this be? An Internist?

[Multibilly]

Re: Need help interpreting bone marrow biopsy lab results

by Multibilly on Thu Dec 19, 2013 1:22 pm

Sorry I wasn't clear. I meant to say find an oncologist/hematologist that specializes in this disease, if your doc isn't one already. In the case of multiple myeloma, most oncologists don't see that many patients with multiple myeloma each year. There are a lot of nuances and new treatments involved in managing this disease and there is no substitute for working with somebody that has a lot of experience and many patients with this specific disease that they work with on a daily basis. In the case of Waldenstrom's, you are in an even rarer category.

If you need some recommendations on where to find a multiple myeloma specialist or perhaps even a Waldenstrom's specialist in your area, folks on this forum might be able to help if you let us know what city your are in. I would think that finding a multiple myeloma specialist would be a good start given many of the similarities of the two diseases (but again, I'm not a doc).

[Eric Hofacket]

Re: Need help interpreting bone marrow biopsy lab results

by Eric Hofacket on Thu Dec 19, 2013 4:19 pm

In my experience, and building on what Multibilliy just said, I found three levels of experience.:

1. General Oncologist - Treat all sorts of cancers, very infrequently have patients with myeloma.
    
2. Hematologist / Oncologist - Treats all sort of blood cancers, including myeloma. Will have patients with myeloma and experience and training with treating the disease.
    
3. Hematologist / Oncologist specializing in myeloma - Treats myeloma patients exclusively and is very knowledge with treatments, treatment related side effects, research and clinical trials.

Obviously we would all like to treated by (3), a hematologist / oncologist that specializes in myeloma, but they are not accessible to everyone. Some people have insurance that limits the available doctors to those within their plan or HMO. Others may live in rural areas far from the large cites and research hospitals where most of the myeloma specialist are found. I believe that (2) is reasonable and is accessible to most people except maybe those who live in remote and rural areas that have limited medical care.

I believe that (1) for myeloma is a less than ideal situation and it is worth doing whatever it takes to get to a hematologist / oncologist. Given how rare and unusual Waldenstrom's macro­globu­linemia is, I can see why you would like to get treated by 3 with experience with Waldenstrom's macro­globulinemia or at least a second opinion or consultation.

[NStewart]

Re: Need help interpreting bone marrow biopsy lab results

by NStewart on Thu Dec 19, 2013 4:33 pm

Eric -

I disagree with your classifications. I have found that in Philadelphia all oncologists are listed as hematologist/oncologist unless s/he is an orthopedic oncologist. But, the orthopedic oncologist may be listed as a hematologist/oncologist with a specialty in orthopedic oncology.

Nancy in Phila

[Multibilly]

Re: Need help interpreting bone marrow biopsy lab results

by Multibilly on Thu Dec 19, 2013 5:26 pm

So, my understanding is that many oncologists are also hematologists (this is the case for the various multiple myeloma specialists I've met with over the past year). This particular class of doctors tend to specialize in cancers of the blood given their knowledge of hematology. However, there are hematologists that are not oncologists and there are also general oncologists that will treat a wide variety of cancers, not just blood cancers. Anyway, that's the way one of my docs once explained it to me and I just hope that I've remembered this all correctly. I can't really speak to what one would find in the yellow pages.

The bottom line for Melody is to find a doc that lives and breathes this class of disease and ideally Waldenstrom's in particular. In that regard, I always value the doctor recommendations from the folks on this site.

[Nancy Shamanna]

Re: Need help interpreting bone marrow biopsy lab results

by Nancy Shamanna on Thu Dec 19, 2013 6:32 pm

From what I know, most oncologists and hematologists would start with earning an M.D., which takes 3 - 4 years, then doing an internship in internal medicine, a 3 year training. After getting their training in internal medicine, they may apply to do a fellowship in hematology, or in general oncology, another 2 year training. A hematologist may then do another year or two of training in order to specialize in blood cancers. It's a labour of love sometimes, because of the long, long hours and low pay for residents. Anyone who graduates as a hematologist or an oncologist has a great deal of education. There are 'myeloma specialists' in several large medical teaching centres in Canada. i am sure it is the same in the U.S.

Oncologists who treat 'solid tumours' such as liver cancer, lung cancer etc. take a different training than those who do blood cancers, usually.

(How do I know this? One of my daughters is doing her residency in internal medicine now and will be starting a fellowship in hematology next summer. )

[Melody]

Re: Need help interpreting bone marrow biopsy lab results

by Melody on Thu Dec 19, 2013 8:30 pm

Thank You All So Very Much for the wealth of information. I greatly appreciate it.