On 16 December, 2016, my mother was diagnosed with multiple myeloma. Her bone marrow reports were depicting 75% plasma cells. She was showing excellent treatment response, blood indicators have improved, bone pain has reduced significantly, M-spike has turned 0 from 4.58.
On 31st May 2017, she went for another bone marrow aspiration and it showed 30-35% plasma cells with 0 M-spike, haemoglobin level was 13. Doctors were discussing that her bone marrow results are not parallel with M-spike (since M-spike was 0 and plasma cells were 30-35%).
She has received six rounds of Velcade, thalidomide, and dexamethasone therapy till 18th June, 2017. Now, she is feeling good, can work her own work, like she can take bath without any help, wash clothes in washing machines, cook food for three members of home including herself.
Despite all good news and improved conditions, doctors decided for another bone marrow aspiration and bone marrow biopsy on 4th July 2017. This time test results were very frightening and disappointing, with 90% plasma cells.
She is not reporting any pain and discomfort except foamy urine.
Test reports as on 25 June 2017:
S. free kappa light chains - 11.07 mg/L
S. free lambda light chains - 63.56 mg/L
S. free kappa / lambda ratio - 0.17
Urea - 18 mg/dL
Creatinine - 0.4 mg/dL
HB - 13.2 g/dL
Platelet - 86 10^3/µL
HCT - 38.4 %
TLC - 8.55 10^3/µL
ANC - 5.67 10^3/µL
Serum M band electrophoresis:
No M band seen in serum protein electrophoresis.
Normal polyclonal gamma globulin is present.
Bone marrow aspiration on 25 May 2017:
Cellular bone marrow aspirate shows haematopoietic cells of all series along with ~ 30 - 35% plasma cells including many abnormal forms. Peripheral smear is unremarkable.
Bone marrow aspiration on 4 July 2017 :
Cellular bone marrow touch preparation shows 90% abnormal plasma cells.
I'm scared by her last bone marrow report with 90% plasma cells. Is it possible?
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Bala devi - Name: Vikas Nehra
- Who do you know with myeloma?: My mother
- When were you/they diagnosed?: 23/12/2016, Delhi (India)
- Age at diagnosis: 45
Re: Plasma cell percentage 90% after 6 rounds of VTD?
Have her doctor check her plasma cells to see if she shows CD20 expression. If there is CD20 expression, they might want to try another treatment such as Rituxan (rituximab, Mabthera).
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BMaryHosier
Re: Plasma cell percentage 90% after 6 rounds of VTD?
The 90% abnormal plasma cell percentage does not seem credible given the rest of her tests. Basically it indicates that the bone marrow is producing predominantly abnormal plasma cells, so there would be an expectation of suppression of all other plasma cells. However, her hematocrit (HCT) and hemoglobin (HB) are near normal. Further, her neutrophil (ANC) white cells are either high end of normal or just above normal depending on the lab. I do note that her platelets are low, normal is 130 to 400, and hers is 86. However, that level is not considered alarmingly low.
All the above readings are inconsistent with 90% myeloma cells in the plasma.
The serum free light chain (sFLC) numbers you presented were showing something a bit different. The normal ranges for the tests are:
Kappa 3.3-19.4 mg/L
Lambda 5.71-26.30 mg/L
Ratio .27-1.65
Based on her test results, both her kappa and lambda levels are high. The ratio is low (it is simply dividing the kappa by the lambda, thus the 0.17 reading). I also note that her creatinine level is below normal. Sometimes patients with both high kappa and lambda light chains indicate something other than multiple myeloma, such as a possible kidney disease.
I am not a doctor so all I can do is speculate, which may not be helpful. She needs to have these tests looked into. It is possible that there is something else going on not related to multiple myeloma.
All the above readings are inconsistent with 90% myeloma cells in the plasma.
The serum free light chain (sFLC) numbers you presented were showing something a bit different. The normal ranges for the tests are:
Kappa 3.3-19.4 mg/L
Lambda 5.71-26.30 mg/L
Ratio .27-1.65
Based on her test results, both her kappa and lambda levels are high. The ratio is low (it is simply dividing the kappa by the lambda, thus the 0.17 reading). I also note that her creatinine level is below normal. Sometimes patients with both high kappa and lambda light chains indicate something other than multiple myeloma, such as a possible kidney disease.
I am not a doctor so all I can do is speculate, which may not be helpful. She needs to have these tests looked into. It is possible that there is something else going on not related to multiple myeloma.
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Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
Re: Plasma cell percentage 90% after 6 rounds of VTD?
Not sure what to make of it either, but perhaps this meant that among plasma cells 90% is abnormal plasma cells, and not that 90% of all bone marrow cells are plasma cells?
Bone marrow biopsy report is very hard to understand, but it sure does not seem likely that if you have 90% of bad cells that you could have normal blood counts.
One thing to remember is that sample is extracted from one spot, so even if 90% of all cells are plasma cells, it's only at that spot, i.e., it may be bad luck?
Mine had below:
"showed that CD138+ plasma cells are diffusely increased and estimated to comprise 120% of overall cellularity; the plasma cells show a markedly elevated kappa:lambda ratio consistent with a monoclonal kappa plasma cell population. There is a greater degree of plasma cell infiltration apparent on the immunostains of the core biopsy than in the aspirate differential count."
Good luck!
Bone marrow biopsy report is very hard to understand, but it sure does not seem likely that if you have 90% of bad cells that you could have normal blood counts.
One thing to remember is that sample is extracted from one spot, so even if 90% of all cells are plasma cells, it's only at that spot, i.e., it may be bad luck?
Mine had below:
"showed that CD138+ plasma cells are diffusely increased and estimated to comprise 120% of overall cellularity; the plasma cells show a markedly elevated kappa:lambda ratio consistent with a monoclonal kappa plasma cell population. There is a greater degree of plasma cell infiltration apparent on the immunostains of the core biopsy than in the aspirate differential count."
Good luck!
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Dimamar - When were you/they diagnosed?: June, 2016
- Age at diagnosis: 54
Re: Plasma cell percentage 90% after 6 rounds of VTD?
Hi,
I'll just build on what the others have already posted by saying that it seems to me that one of two things is going on.
First, perhaps your mother's myeloma is very localized, so she has a high myeloma burden where the bone marrow biopsy was done, but not much elsewhere.
Second, perhaps your mother's myeloma has become "oligosecretory", meaning that it does not produce very many monoclonal proteins, including monoclonal free light chains. People with oligosecretory disease can have quite a bit of multiple myeloma in their body, but not have very high M-spikes or free light chain ratios (kappa-lambda, or lambda-kappa).
Some of the the results Ron mentioned suggest the first of the two options that I listed (i.e., the disease is very localized). I think it would be useful, however, to do further testing to determine what exactly is going on. For example, imaging -- such as a PET/CT scan -- could show both whether your mother's disease is very localized, and whether it is extensive or not.
(Of course, there is also a third possibility, which is that there was a mistake in the processing of your mother's bone marrow biopsy sample, and the 90 percent result is an error. Additional testing, such as a PET/CT scan, would be one check to see whether that was the case.)
Good luck, and please update us when you can about what your mother's doctors find out about her disease, and how they decide to proceed.
I'll just build on what the others have already posted by saying that it seems to me that one of two things is going on.
First, perhaps your mother's myeloma is very localized, so she has a high myeloma burden where the bone marrow biopsy was done, but not much elsewhere.
Second, perhaps your mother's myeloma has become "oligosecretory", meaning that it does not produce very many monoclonal proteins, including monoclonal free light chains. People with oligosecretory disease can have quite a bit of multiple myeloma in their body, but not have very high M-spikes or free light chain ratios (kappa-lambda, or lambda-kappa).
Some of the the results Ron mentioned suggest the first of the two options that I listed (i.e., the disease is very localized). I think it would be useful, however, to do further testing to determine what exactly is going on. For example, imaging -- such as a PET/CT scan -- could show both whether your mother's disease is very localized, and whether it is extensive or not.
(Of course, there is also a third possibility, which is that there was a mistake in the processing of your mother's bone marrow biopsy sample, and the 90 percent result is an error. Additional testing, such as a PET/CT scan, would be one check to see whether that was the case.)
Good luck, and please update us when you can about what your mother's doctors find out about her disease, and how they decide to proceed.
Re: Plasma cell percentage 90% after 6 rounds of VTD?
Cheryl G wrote:
That's the first thing which entered my mind as well when I saw the 90% number yet read she can do chores around the house.
perhaps your mother's myeloma is very localized, so she has a high myeloma burden where the bone marrow biopsy was done, but not much elsewhere.
That's the first thing which entered my mind as well when I saw the 90% number yet read she can do chores around the house.
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Little Monkey - Name: Little Monkey
- Who do you know with myeloma?: Father-stage 1 multiple myeloma
- When were you/they diagnosed?: March/April of 2015
Re: Plasma cell percentage 90% after 6 rounds of VTD?
I also wonder about some sort of error in the biopsy results. I had my involved light chain number suddenly appear to jump by nearly a factor of 10 in one month, which was discomforting, to say the least. The next month, it appeared to drop back down to normal again. I think it was clear that there was a decimal point error in the result, making (for instance) a result of 20 to appear to be 200. I don't know if that's as likely for a bone marrow test as I believe it's more of a manual process. Nonetheless, any number that gets entered can get entered incorrectly. It would be worth checking with her doctor on that possibility.
The inconsistent nature of myeloma cells in the bone marrow is certainly also a possibility. I've not had a biopsy since the one that confirmed my diagnosis despite that fact that I went into remission some time ago. My doctor basically said that she doesn't consider it to be all that reliable a test.
The inconsistent nature of myeloma cells in the bone marrow is certainly also a possibility. I've not had a biopsy since the one that confirmed my diagnosis despite that fact that I went into remission some time ago. My doctor basically said that she doesn't consider it to be all that reliable a test.
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Mike F - Name: Mike F
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: May 18, 2012
- Age at diagnosis: 53
Re: Plasma cell percentage 90% after 6 rounds of VTD?
Thanks to all great souls from the bottom of my heart for giving me insights and explaining results.
Yesterday, I went to the oncologist with all further test reports and analysis.
Reports as on 13th, July 2017:
M-spike
Dense and narrow M band is present in beta-gamma Interzone. Polyclonal gamma globulin is reduced.
M-Band: =18.8% = 1.5 g/dl (was coming out 0 from last three months)
Urea 17 mg/dL
Creatinine 0.4 mg/dL
Glucose F 106 mg%
HB 10.9 g/dL
Platelet 75 10^3/µL
HCT 34.3 %
TLC 6.45 10^3/µL
ANC 3.80 10^3/µL
RBC 3.68 10^6/µL
The oncologist has reviewed all the reports and he wants to start VAD therapy because VTD is not bringing better results.
Yesterday, I went to the oncologist with all further test reports and analysis.
Reports as on 13th, July 2017:
M-spike
Dense and narrow M band is present in beta-gamma Interzone. Polyclonal gamma globulin is reduced.
M-Band: =18.8% = 1.5 g/dl (was coming out 0 from last three months)
Urea 17 mg/dL
Creatinine 0.4 mg/dL
Glucose F 106 mg%
HB 10.9 g/dL
Platelet 75 10^3/µL
HCT 34.3 %
TLC 6.45 10^3/µL
ANC 3.80 10^3/µL
RBC 3.68 10^6/µL
The oncologist has reviewed all the reports and he wants to start VAD therapy because VTD is not bringing better results.
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Bala devi - Name: Vikas Nehra
- Who do you know with myeloma?: My mother
- When were you/they diagnosed?: 23/12/2016, Delhi (India)
- Age at diagnosis: 45
Re: Plasma cell percentage 90% after 6 rounds of VTD?
BMaryHosier wrote:
Mary,
What do you mean by CD20 expression? Can you please elaborate?
Thanks and obliged.
Have her doctor check her plasma cells to see if she shows CD20 expression.
Mary,
What do you mean by CD20 expression? Can you please elaborate?
Thanks and obliged.
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Bala devi - Name: Vikas Nehra
- Who do you know with myeloma?: My mother
- When were you/they diagnosed?: 23/12/2016, Delhi (India)
- Age at diagnosis: 45
Re: Plasma cell percentage 90% after 6 rounds of VTD?
Bala,
All I know is my specialist was into myeloma research. When I still showed high plasma cells after intense treatment, he had the pathologist check the plasma cells for CD20 expression, and they showed it. At that time I went through 4 treatments with Rituxan (rituximab, MabThera), and my plasma cell count went down to less then 10%.
Good luck,
Mary
All I know is my specialist was into myeloma research. When I still showed high plasma cells after intense treatment, he had the pathologist check the plasma cells for CD20 expression, and they showed it. At that time I went through 4 treatments with Rituxan (rituximab, MabThera), and my plasma cell count went down to less then 10%.
Good luck,
Mary
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BMaryHosier
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