I was wondering if doctors watch trends of the lab results or just if they are within normal limits. It seems my total protein, m-proteins are slowing rising. They are no where near where they were a year ago.
How do you determine if you have monoclonal proteins or polyclonal. I now the difference, just don't know how to tell by looking at lab values.
Thanks!
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WeatherNurse13 - Name: Gracie
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: 10/2012
- Age at diagnosis: 49
Re: M-spike - what is important - level or trend?
Hello Weathernurse13,
The oncologist does pay attention to trends in the lab values. The most important lab value is your m-spike. Is it going up, down or is it stable? That is the most important thing you want to know from your doctor. The more myeloma cells you have the higher the m-spike will be.
So ... clearly what you want is no or very few myeloma cells and a very low m-spike level.
The serum protein electrophoresis (SPEP) tells the doctor if a patients has polyclonal immunoglobulins (many spikes) or is monoclonal (a single spike). Monoclonal spikes (single protein spike) is what is seen in multiple myeloma. Patients with polyclonal immunoglobulin spikes do not have multiple myeloma. They often have infections or inflammatory diseases.
Good question ....thank you for sharing it with the Beacon and its readers !
The oncologist does pay attention to trends in the lab values. The most important lab value is your m-spike. Is it going up, down or is it stable? That is the most important thing you want to know from your doctor. The more myeloma cells you have the higher the m-spike will be.
So ... clearly what you want is no or very few myeloma cells and a very low m-spike level.
The serum protein electrophoresis (SPEP) tells the doctor if a patients has polyclonal immunoglobulins (many spikes) or is monoclonal (a single spike). Monoclonal spikes (single protein spike) is what is seen in multiple myeloma. Patients with polyclonal immunoglobulin spikes do not have multiple myeloma. They often have infections or inflammatory diseases.
Good question ....thank you for sharing it with the Beacon and its readers !
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Dr. Edward Libby - Name: Edward Libby, M.D.
Beacon Medical Advisor
Re: M-spike - what is important - level or trend?
Thank you so much for answering my question. You helped me a lot and I understand it so much better.
Can myeloma relapse in a different form, and a m-spike change from beta to gamma? I had primary plasma cell leukemia. Will it return as PCL or could it return as Multiple Myeloma?
My m spike was 4 last year in the beta region. Then was 0.7 before my SCT. 9 months later it is 1.0. My gamma was 0.9 a year ago, 0.5 before transplant and now 1.8.
So the trend is rising slowly it seems. Still waiting on FLC. See my oncologist on Tuesday.
I am thankful for the Myeloma Beacon.
Can myeloma relapse in a different form, and a m-spike change from beta to gamma? I had primary plasma cell leukemia. Will it return as PCL or could it return as Multiple Myeloma?
My m spike was 4 last year in the beta region. Then was 0.7 before my SCT. 9 months later it is 1.0. My gamma was 0.9 a year ago, 0.5 before transplant and now 1.8.
So the trend is rising slowly it seems. Still waiting on FLC. See my oncologist on Tuesday.
I am thankful for the Myeloma Beacon.
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WeatherNurse13 - Name: Gracie
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: 10/2012
- Age at diagnosis: 49
Re: M-spike - what is important - level or trend?
I think it can actually be a somewhat positive sign if a different m-spike, or additional m-spike, develops after treatment -- at least based on evidence for patients who have undergone a stem cell transplant.
There was this article recently in the Beacon that discusses this point:
https://myelomabeacon.org/news/2013/01/16/different-m-spike-after-stem-cell-transplantation-linked-to-improved-survival-ash-2012/
"Different M-Spike After Stem Cell Transplantation Linked To Improved Survival (ASH 2012)"
Here's a couple of paragraphs from the article:
When a patient’s original M-spike disappears and an M-spike of a different monoclonal protein appears, this is known as monoclonal banding. When the original M-spike disappears and several new M-spikes appear simultaneously, this is known as oligoclonal banding.
“Oligoclonal and monoclonal banding are associated with better overall survival and progression-free survival … and are also associated with a better quality of response, with most patients achieving VGPR [a very good partial response] after an autologous stem cell transplant,” said Dr. Victor Hugo Jimenez-Zepeda from the Princess Margaret Hospital in Toronto, Canada, who presented the findings at the American Society of Hematology (ASH) annual meeting in Atlanta last month.
You also may find these articles helpful:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2754999/
"Significance of Abnormal Protein Bands in Patients with Multiple Myeloma following Autologous Stem Cell Transplantation"
and
http://bloodjournal.hematologylibrary.org/content/118/11/2985.full
"Incidence, clinical course, and prognosis of secondary monoclonal gammopathy of undetermined significance in patients with multiple myeloma"
I haven't read them in detail. Perhaps you could skim them and give us quick summaries?
I should add that all these studies focus on patients who were diagnosed with, and treated for, multiple myeloma -- not plasma cell leukemia. I suspect, though, that the findings are still somewhat applicable to patients such as yourself who originally were diagnosed with plasma cell leukemia.
There was this article recently in the Beacon that discusses this point:
https://myelomabeacon.org/news/2013/01/16/different-m-spike-after-stem-cell-transplantation-linked-to-improved-survival-ash-2012/
"Different M-Spike After Stem Cell Transplantation Linked To Improved Survival (ASH 2012)"
Here's a couple of paragraphs from the article:
When a patient’s original M-spike disappears and an M-spike of a different monoclonal protein appears, this is known as monoclonal banding. When the original M-spike disappears and several new M-spikes appear simultaneously, this is known as oligoclonal banding.
“Oligoclonal and monoclonal banding are associated with better overall survival and progression-free survival … and are also associated with a better quality of response, with most patients achieving VGPR [a very good partial response] after an autologous stem cell transplant,” said Dr. Victor Hugo Jimenez-Zepeda from the Princess Margaret Hospital in Toronto, Canada, who presented the findings at the American Society of Hematology (ASH) annual meeting in Atlanta last month.
You also may find these articles helpful:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2754999/
"Significance of Abnormal Protein Bands in Patients with Multiple Myeloma following Autologous Stem Cell Transplantation"
and
http://bloodjournal.hematologylibrary.org/content/118/11/2985.full
"Incidence, clinical course, and prognosis of secondary monoclonal gammopathy of undetermined significance in patients with multiple myeloma"
I haven't read them in detail. Perhaps you could skim them and give us quick summaries?
I should add that all these studies focus on patients who were diagnosed with, and treated for, multiple myeloma -- not plasma cell leukemia. I suspect, though, that the findings are still somewhat applicable to patients such as yourself who originally were diagnosed with plasma cell leukemia.
Re: M-spike - what is important - level or trend?
Hi WeatherNurse13,
Multiple myeloma can relapse as plasma cell leukemia. However, plasma cell leukemia will not relapse as multiple myeloma. In general the immunoblobulin phenotype will not change e.g. kappa to lambda. Some multiple myeloma patients can transform from the standard form in which their monoclonal spike can be meased by an SPEP to a free light chain only form of myeloma, this is termed "light chain escape".
Multiple myeloma can relapse as plasma cell leukemia. However, plasma cell leukemia will not relapse as multiple myeloma. In general the immunoblobulin phenotype will not change e.g. kappa to lambda. Some multiple myeloma patients can transform from the standard form in which their monoclonal spike can be meased by an SPEP to a free light chain only form of myeloma, this is termed "light chain escape".
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Dr. Edward Libby - Name: Edward Libby, M.D.
Beacon Medical Advisor
5 posts
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