[mrswrench]

Not sure if lab results indicate multiple myeloma

by mrswrench on Wed Jan 11, 2017 10:15 am

Although not officially diag­nosed with multiple myeloma, we have been told by the hema­tolo­gist / oncologist that multiple myeloma is suspected, but are waiting for the results. However, the doctor is out of town and we already have received his results and are waiting for a follow up. Some of his results are listed below. Although he doesn't appear to have CRAB, I am won­dering how the Bence Jones and his iron deficiency fit in.

• IgG M spike 3.08 g/dL
• One large focal lesion on S1, 3 small in humerus head but those possibly may be degenerative
• Urine free Kappa light chains 7621 mg/d
• Urine kappa/lambda ratio 6350
• Serum kappa/lambda ratio 66
• Bone marrow biopsy shows 50% involvement of plasma cells with diffuse involvement by atypical vacuolated cells
• Total iron 55 ug/dl (ref 65-175 ug/dl)

I am wondering about the relationship between serum and urine free light chain levels. In one month, his urinary light chains rose over 2000 mg/d, from 5300 to 7600, while the serum kappa-lambda ratio dropped 20. I can't find any information regarding the significance of the urine free light chain levels, but it seems to rise as his serum ratio drops. I also cannot find any information on others who have both an M-spike and urine free light chain levels that high.

I also am wondering about the iron deficiency. His hemoglobin and hematocrit are in normal range, albeit at the very low end. Calcium, B2, LDH, are all normal and creatinine on upper edge of normal. Does the iron deficiency mean that he is anemic even though his hemoglobin and hematocrit are in range?

We don't know how much we need to worry about the urine light chains. Other articles we've found make them seem insignificant, but with the amount he is putting out each day, we are worried about kidney damage although his other labs don't seem to indicate damage as of yet.

[Multibilly]

Re: Not sure if lab results indicate multiple myeloma

by Multibilly on Wed Jan 11, 2017 11:48 am

Hi mrswrench,

Welcome to the forum, but sorry to hear you are dealing with this.

Given your 50% bone marrow plasma cell percentage, 3.08 g/dL IgG M-spike, 66 free light chain ratio, and the presence of a large focal lesion with several smaller lesions (the "B" in CRAB, assuming these lesions are confirmed to be myeloma-related), this does indeed sound like multiple myeloma.

Personally, I wouldn't get hung up on your urine free light chain values, nor try to correlate them with your serum free light chain values. Urine free light chain measurements are notoriously unreliable, and factors such as how our kidneys process these little beasts can impact your urine free light chain numbers. Let the serum free light chain lab test be your primary guide - it's a much more reliable way to track your free light chain values over time.

Multiple myeloma can muck with one's iron metabolism and can result in lowering one's iron level. While your hemoglobin and hematocrit levels may be in the normal range, you do mention they appear suppressed. But rather than speculate if the myeloma itself is causing your low iron count, I would suggest discussing this with your oncologist and see if this is something you might want to address with diet, supplements, and / or IV treatment, or if the oncologist thinks that myeloma treatment will help resolve the iron deficiency.

Good luck and let us know how things go.

[mrswrench]

Re: Not sure if lab results indicate multiple myeloma

by mrswrench on Mon Jan 16, 2017 9:26 pm

Thanks for your response Multibilly,

Well, it is official. My husband does have multiple myeloma and he starts treatment next week and has a stem cell transplant consult in two.

I had a hard time trying to find info on his large amounts of light chains along with his M-spike. Most of the information I could find was only regarding serum free light chains. It turns out that his large amounts of urinary light chains (over 7 g per day - 7600 mg / 24 hours) had a great deal to do with starting treatment right away. His urinary light chains have been increasing every couple of weeks and the oncologist said continuing that amount every day could damage his kidneys. His creatinine is still in range, 1.3 (ref 0.7-1.3), but we want to prevent damage at this point. With the kidneys, you can have normal results until 70% of the nephrons in the kidneys are damaged. We are already at the upper end, so we certainly want to prevent that.

Best of luck to all those out there. We were very surprised to find out that this is a life-long journey. We thought a few rounds of treatment and we'll be done. Today we found out that it never ends, for the most part, the oncologist said treatment will be to some extent for life. That was quite a shock. But hopefully it will be a long journey with a great improved quality of life!