Today we had our oncologist appointment. Finally. I am confused, so perhaps you guys can help me understand. When we went into the doctors office he said that basically he could not decide if my husband was smoldering or in stage 2. Some of his numbers are:
10% myeloma plasma cells from BMB
Kappa free light chain 34.6
Lamba free light chain 17.6 (which I believe is an indicator that myeloma is present)
Immunology / Serology
IgA 75.1
IgG 2270
IgM 41.3
Protein SPE 7.7
M-spike 0.13
Chemistry ldh 224
Beta 2 Microglobulin 5.5.
Okay now I know this is probably confusing, but this is all I can make out on this report. The doctor said that he would put my husband in smoldering but he has a lytic lesion on his arm between his elbow and wrist (no pain), so he is doing a PET scan next Wednesday and if the PET scan shows a myeloma tumor, he will use radiation to get rid of it, and, after this, if he protein is still good he will put him in smoldering.
If the protein does not remain good he will start him on therapy (dex & Velcade). But first he would send him out to MD Anderson in case in the future he needs stem cell replacement, he wants MD Anderson to approve the meds.
Am I making sense? So here I stand, I read somewhere that the lesions do not normally appear where my husbands is. Help please.
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Re: Oncologist visit results
Hi Mildred,
So, we are all on the page and not guessing at any lab values, can you please supply the units of measure (mg/dL, g/dL, etc.) for each of the values listed below, as well as the normal reference ranges (these should all be in your lab reports).
- Kappa free light chain 34.6
- Lambda free light chain 17.6
- IgA 75.1
- IgM 41.3
- IgG: 2270
- M-spike: 0.13
- Beta 2 microglobulin: 5.5
Also, what were his levels for the following (again, with units of measure and the normal reference ranges please)?:
- Hemoglobin (may be listed as "HGB" ... this will be in the CBC report)
- Creatinine (this will be in the comprehensive metabolic panel report)
- Calcium (this will be in the comprehensive metabolic panel report)
Getting a PET/CT is a good next step to help confirm the nature of the lesion (and to see if there are any other lesions in his skeleton). If the lesion is due to multiple myeloma, it will "light up" on the PET/CT.
Getting somebody at MD Anderson to approve any drug treatment (should it prove that he is symptomatic) also sounds like a really good idea.
So, it sounds like your doc is doing the right things.
So, we are all on the page and not guessing at any lab values, can you please supply the units of measure (mg/dL, g/dL, etc.) for each of the values listed below, as well as the normal reference ranges (these should all be in your lab reports).
- Kappa free light chain 34.6
- Lambda free light chain 17.6
- IgA 75.1
- IgM 41.3
- IgG: 2270
- M-spike: 0.13
- Beta 2 microglobulin: 5.5
Also, what were his levels for the following (again, with units of measure and the normal reference ranges please)?:
- Hemoglobin (may be listed as "HGB" ... this will be in the CBC report)
- Creatinine (this will be in the comprehensive metabolic panel report)
- Calcium (this will be in the comprehensive metabolic panel report)
Getting a PET/CT is a good next step to help confirm the nature of the lesion (and to see if there are any other lesions in his skeleton). If the lesion is due to multiple myeloma, it will "light up" on the PET/CT.
Getting somebody at MD Anderson to approve any drug treatment (should it prove that he is symptomatic) also sounds like a really good idea.
So, it sounds like your doc is doing the right things.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Oncologist visit results
It sounds like the oncologist has a good plan for your husband. If the lesion is cancerous and painful, radiation will help to kill the local cancer cells and improve the pain level. Recommending a 2nd opinion from MD Anderson for coordination of his care and possible stem cell transplant in the future is an excellent plan of action.
Bone lesions can appear anywhere in the body with myeloma. I have some in my lower legs in areas that don't normally get scanned when scans are done. The only reason that they were diagnosed is because I complained of severe bone pain in my left lower leg. My oncologist had to order separate scans of my lower legs in addition to the regular scan locations. I had radiation to the painful lesion a couple of years ago and have been basically pain free in that area since.
I wish the best for your husband and for you,
Nancy in Phila
Bone lesions can appear anywhere in the body with myeloma. I have some in my lower legs in areas that don't normally get scanned when scans are done. The only reason that they were diagnosed is because I complained of severe bone pain in my left lower leg. My oncologist had to order separate scans of my lower legs in addition to the regular scan locations. I had radiation to the painful lesion a couple of years ago and have been basically pain free in that area since.
I wish the best for your husband and for you,
Nancy in Phila
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NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
Re: Oncologist visit results
Hi Billy,
Thank you for answering, I am sorry I have not answered sooner but when I got your message I was ready for sleep, long exhausting mentally and physically, I wanted so much to go into the office and get a definite answer but as a cancer survivor friend of mine says "waiting sucks" but it is what we have to do. Okay now for the answers to your questions:
Kappa Free Light Chain 3.3 - 19.4
Lambda Free Light Chain 5.7 - 26.3
IgA 70.0 - 400
IgG 700 - 1600
IgM 40.0 - 230.0
M-spike no range listed
Beta-2 Microglobulin <2,52
Hgb range 10.60 - 14.70
(My husband's Hgb was 6.5)
I cannot find the creatinine report on the flow sheet our oncologist gave us, but on a previous report dated September 12 of this year it says:
Creatinine Urine 45.8 Range 22.0-328.0 mg/dl
Creatinine Urine 24-hr test 1282.4 Range 1000.00-2000.00 mg
Creatinine Clearance 46 Range 97-137 ml/mn
Concerning my husbands kidneys, he is 69 years old and when he was in the second grade which was approximately 61 years ago he was diagnosed with Schonlein purpura which can leave one's kidneys weak, so my husband has always been in mild renal failure but not enough to be concerned with, as I stated my husband was taking iburprofen due to arthritis in his knee and the doctor. concluded that it was the ibuprofen that caused his kidneys to weaken again, when he got off the Ibuprofen his kidneys got better.
In February of this year he had total knee replacement with no problems with his blood, total success, upon returning home he could not take the Loratab so he started taking the ibuprofen again, hence what caused the testing again this summer because his kidneys again reacted in a negative way to the ibuprofen.
I so hope all this makes sense. Thank You!
Thank you for answering, I am sorry I have not answered sooner but when I got your message I was ready for sleep, long exhausting mentally and physically, I wanted so much to go into the office and get a definite answer but as a cancer survivor friend of mine says "waiting sucks" but it is what we have to do. Okay now for the answers to your questions:
Kappa Free Light Chain 3.3 - 19.4
Lambda Free Light Chain 5.7 - 26.3
IgA 70.0 - 400
IgG 700 - 1600
IgM 40.0 - 230.0
M-spike no range listed
Beta-2 Microglobulin <2,52
Hgb range 10.60 - 14.70
(My husband's Hgb was 6.5)
I cannot find the creatinine report on the flow sheet our oncologist gave us, but on a previous report dated September 12 of this year it says:
Creatinine Urine 45.8 Range 22.0-328.0 mg/dl
Creatinine Urine 24-hr test 1282.4 Range 1000.00-2000.00 mg
Creatinine Clearance 46 Range 97-137 ml/mn
Concerning my husbands kidneys, he is 69 years old and when he was in the second grade which was approximately 61 years ago he was diagnosed with Schonlein purpura which can leave one's kidneys weak, so my husband has always been in mild renal failure but not enough to be concerned with, as I stated my husband was taking iburprofen due to arthritis in his knee and the doctor. concluded that it was the ibuprofen that caused his kidneys to weaken again, when he got off the Ibuprofen his kidneys got better.
In February of this year he had total knee replacement with no problems with his blood, total success, upon returning home he could not take the Loratab so he started taking the ibuprofen again, hence what caused the testing again this summer because his kidneys again reacted in a negative way to the ibuprofen.
I so hope all this makes sense. Thank You!
Re: Oncologist visit results
Hello Nancy,
My husband has never had any pain anywhere in his body, he had total knee replacement this February and did great. Our oncologist told us that he has had orthopedic surgeons stop in the middle of a knee replacement or hip replacement because they can see the bones are affected by myeloma. I see where you were diagnosed in 2003. What type of treatments have you received? Thank you and I wish you continued good health.
My husband has never had any pain anywhere in his body, he had total knee replacement this February and did great. Our oncologist told us that he has had orthopedic surgeons stop in the middle of a knee replacement or hip replacement because they can see the bones are affected by myeloma. I see where you were diagnosed in 2003. What type of treatments have you received? Thank you and I wish you continued good health.
Re: Oncologist visit results
Hi Mildred,
Thanks for the follow up.
Again, your doc has a good plan here ... and consulting with the folks at MD Anderson is a great thing to do.
However, have you discussed the Hgb level with the doctor? In your earlier posts, you said your husband doesn't have anemia. However, an Hgb level of 6.5 g/dL is quite low. Was this a typo or is it suppressed due to some other condition?
Thanks for the follow up.
Again, your doc has a good plan here ... and consulting with the folks at MD Anderson is a great thing to do.
However, have you discussed the Hgb level with the doctor? In your earlier posts, you said your husband doesn't have anemia. However, an Hgb level of 6.5 g/dL is quite low. Was this a typo or is it suppressed due to some other condition?
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Oncologist visit results
Good Morning, OMG yes that was a typo, his HGB is 13.2 Thank you for all your help, in your experience here do you believe that these numbers represent smoldering?
Re: Oncologist visit results
Mildred,
Well, that's good about the Hgb level. That rules out anemia (the "A" in CRAB).
Smoldering multiple myeloma is simply defined as having a plasma percentage of at least 10% without the presence of any CRAB symptoms. So, since he meets the 10% plasma cell criteria, it then comes down to the CRAB criteria. If he has any CRAB issues, then he would instead be classified as having symptomatic multiple myeloma.
Whether or not your husband has the "B" (bone issues) in CRAB will depend on the results of the PET/CT next week.
Only your doc can say if he has any renal issues (the "R") that are related to multiple myeloma. But it sound like your doc has already ruled out the "R" criteria.
Again, you might also want to check the calcium level (the "C") in the metabolic panel, but I think you said in one of your earlier posts that he didn't have an elevated calcium level.
Hope this helps.
Well, that's good about the Hgb level. That rules out anemia (the "A" in CRAB).
Smoldering multiple myeloma is simply defined as having a plasma percentage of at least 10% without the presence of any CRAB symptoms. So, since he meets the 10% plasma cell criteria, it then comes down to the CRAB criteria. If he has any CRAB issues, then he would instead be classified as having symptomatic multiple myeloma.
Whether or not your husband has the "B" (bone issues) in CRAB will depend on the results of the PET/CT next week.
Only your doc can say if he has any renal issues (the "R") that are related to multiple myeloma. But it sound like your doc has already ruled out the "R" criteria.
Again, you might also want to check the calcium level (the "C") in the metabolic panel, but I think you said in one of your earlier posts that he didn't have an elevated calcium level.
Hope this helps.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
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