[cartermike]

What lab results should I be watching?

by cartermike on Sun Oct 18, 2015 12:52 am

Hello,

I have recently been diagnosed with smoldering multiple myeloma. I have been MGUS since June 2012. When I was first diagnosed with MGUS, my M-spike was 0.2 g/dl. I am now 0.6 g/dl. I had a bone marrow biopsy (BMB) last month.

I have been reading a lot online and trying to determine how it applies to my numbers. Can someone please help me understand more about my numbers and what I should keep an eye out for going forward? How do I know if I am at a higher risk of progressing to multiple myeloma?

Lab Test Result Range
Basophil, percent (BA %) 0.2% 0-1.0
Eosinophil, percent (EO %) 1.7% 0-3.0
Monocyte, percent (MO %) 12.7% 3.0-11.0
Lymphocyte, percent (LY %) 30% 15.0-41.0
Neutrophil, percent (Neu %) 55.4% 40.0-77.0
Mean corpuscular volume (MCV) 88.2 fL 80.0-94.0
(MPV) 9.1 fL 7.4-10.4
Hemoglobin determination (HGB) 14.3 g/dL 14.0-18.0
Hematocrit determination (HCT) 41.9% 40.0-50.0
Red cell distribution width
determination (RDW) 13.8% 10.5-14.5
Mean corpuscular hemoglobin
concentration determination (MCHC) 34.1 g/dL 33.0-37.0
Mean corpuscular hemoglobin
determination (MCH) 30.1 pg 27.0-31.0
Platelet count (PLT) 267 x 10^3/uL 130.0-400.0
Basophil count (BA #) 0 x 10^3/uL 0-0.2
Eosinophil count (EO #) 0.1 x 10^3/uL 0-0.3
Monocyte count (MO #) 0.7 x 10^3/uL 0-1.0
Lymphocyte count (LY #) 1.6 x 10^3/uL 1.2-3.4
Neutrophil count (Neu # (ANC)) 3 x 10^3/uL 1.5-6.5
White blood cell count (WBC) 5.4 x 10^3/uL 4.8-10.8
Red blood cell count (RBC) 4.75 x 10^6/uL 4.7-6.1

Urea nitrogen measurement (BUN) 17 mg/dL 7.0-18.0
Sodium measurement (Sodium) 140 mmol/L 136.0-145.0
Calcium measurement (Calcium) 9.2 mg/dL 8.5-10.1
Alkaline phosphatase
measurement (Alkaline phosphatase) 119 U/L 46.0-116.0
Albumin measurement (Albumin) 3.9 g/dL 3.4-5.0
Protein measurement (Tot. protein) 8.1 g/dL 6.5-8.2
Potassium measurement (Potassium) 3.1 mmol/L 3.5-5.1
Bicarbonate measurement (CO2) 30 mmol/L 21.0-32.0
Glucose measurement (Glucose) 75 mg/dL 74.0-106.0
Creatinine measurement,
serum (Creatinine) 1.5 mg/dL 0.6-1.3
Chloride measurement (Chloride) 100 mmol/L 97.0-107.0
(Total protein electrophoresis) 7.5 g/dL 5.7-8.2

Immunoglobulin G
measurement (IgG, quant) 1220 mg/dL 650-1600
Immunoglobulin M
measurement (IgM, quant) 76 mg/dL 50-300
Immunoglobulin A
measurement (IgA, quant) 404 mg/dL 60-350

(Immunofixation, serum, interpretation) Results Below

(BUN/Creatinine ratio) 11 8-27
Bilirubin, total
measurement (Bilirubin, total) 0.4 mg/dL 0.2-1.0
Aspartate aminotransferase
measurement (AST/SGOT) 33 U/L 15-37
Albumin/Globulin ratio (A/G ratio) 0.9 1.1-2.5
Alanine aminotransferase
measurement (ALT/SGPT) 75 U/L 12-78
Lactate dehydrogenase
measurement (LDH) 250 U/L 85-227
Globulin measurement (Globulin) 4.2 g/dL 1.5-4.5
Estradiol measurement (Estradiol) 32 pg/mL
(Gamma globulin) 1.2 g/dL 0.7-1.5
(Beta globulin) 0.9 g/dL 0.5-1.1
(Alpha-2 globulin) 0.7 g/dL 0.4-1.0
(Alpha-1 globulin) 0.3 g/dL 0.2-0.5

(SPE interpretation) Results Below
(Albumin, SPE) 4.4 g/dL 3.1-5.5
(Paraprotein band, g/dL) 0.6 g/dL


Bone Marrow Biopsy Results

Clinical Information:

Current CBC results:

WBC 5.6
RBC 4.76
HGB 14.1
HCT 42.1
MCV 88.5
MCH 29.6
MCHC 33.5
RDW 14.2
PLT 228
MPV 7.3

Macroscopic Examination:

Specimen A, labeled "aspirate," consists of 1.08 g of coagulum, which is bi­sected and submitted entirely in cassetta A for step sectioning.

Specimen B, labeld "bone marrow biopsy," consists of a cylindrical segment of bone and ad­herent coagulum measuring 25 m​m in length and 1 m​m in diameter, The specimen is sub­mitted entirely in cassette B following briend decalcification.

Microscopic Diagnoses:

Bone marrow (biopsy, clot sections, aspirate smears and blood smear): Cellular marrow with increased plasma cells and a lambda light chain excess, highly suspicious for a plasma cell neoplasm (see comment).

Comment:

The marrow is cellular (55%) and contains all usual hematopoietic elements Immuno­peroxi­dase stains for CD138 demonstrate increased plasma cells with approximately 15-20% of cells staining. In situ hybridization for kappa and lambda light chains demonstrates and increased proportion of lambda-producing light chains with a kappa:lambda ratio of 1:2. This increase of plasma cells with a lambda light chain skew is highly suspicious for a plasma cell neo­plasm. Flow cytometry performed at UT Southwestern Medical Center does not demonstrate this lambda light chain skew. It does, however, demonstrate a small subset of plasma cells with immuno­pheno­typic aberrancey but does not definitively identify a monotypic plasma cell population. The myeloid : erythroid ratio is within normal (3:1) and the maturation of both cell lines is un­remarkable. No increase of blasts or maturational arrest is seen. Adequate numbers of morphologically unremarkable megakaryocytes are present. A small, apparently non-para­trabecular lymphoid aggregate composed of small mature-appearing lymphocytes is seen in clot section.

Special stains for iron (performed on the biopsy, clot section, and aspirate smears) demonstrates 2+ iron with no increase of ringed sidero­blasts. All special stains performed on the biopsy.

[Multibilly]

Re: What lab results should I be watching?

by Multibilly on Sun Oct 18, 2015 9:36 am

Hi Mike,

Sorry to see you join this club, but I'm glad you found this forum and welcome!

Below are the key markers that I would monitor at the MGUS stage and graph in a spreadsheet over time. But note that you are missing your serum free light chain numbers, which are very important to be monitoring. Also note that I'm assuming you are IgA-Lambda type MGUS since your IgA is elevated.

Have you had a PET/CT or whole-body MRI performed, and were any FISH tests done to look for genetic variations when you had your bone marrow biopsy?

Also, are you under the care of a multiple myeloma specialist or just a hematologist/oncologist that has some familiarity with multiple myeloma? I'd really encourage you to seek out a top multiple myeloma specialist, if only to see that specialist once a year or two (or if your markers deteriorate) while you get routinely monitored by your other doctor. If you let us know what city you are in, folks on this forum can make some recommendations as where to find these specialists.

Key Test Results to Monitor
------------------------

*For Possible Anemia Issues (you don't want these to go down):

HGB 14.1

Red blood cell count (RBC) 4.75 x 10^6/uL 4.7-6.1

*For Possible Renal Issues (you don't want these to go up)

Creatinine measurement,
serum (Creatinine) 1.5 mg/dL 0.6-1.3

Urea nitrogen measurement (BUN) 17 mg/dL 7.0-18.0

*For Possible Bone Issues (you don't want your calcium level to go up)

Calcium measurement (Calcium) 9.2 mg/dL 8.5-10.1

*For Ongoing Monoclonal Protein Issues

Immunoglobulin G (check to see if this goes down over time)
measurement (IgG, quant) 1220 mg/dL 650-1600

Immunoglobulin M (check to see if this goes down over time)
measurement (IgM, quant) 76 mg/dL 50-300

Immunoglobulin A (check to see if this goes up over time)
measurement (IgA, quant) 404 mg/dL 60-350

(Paraprotein band, g/dL) 0.6 g/dL (check to see if this goes up over time)

[cartermike]

Re: What lab results should I be watching?

by cartermike on Sun Oct 18, 2015 7:43 pm

Thank you for your quick reply. So far, I have not had the full body scan, FISH, or PET/CT. I am working with a general hematologist/oncologist. I am in the process of getting a second opinion from a specialist for multiple myeloma. My current doctor is waiting till my next visit in January to do the full body scan. I don't think that I should wait for 3 months in order to do the full-body scan since I have a lot of pain areas right now and am always tired (more so than normal).

One other thing that I forgot to mention in my initial post is that I had one kidney removed due to kidney cancer last year. They think the higher numbers for the creatinine numbers are high due to the nephrectomy last year.

I hope to get into the specialist soon and see what they have to say.

I will keep monitoring those numbers going forward.

Thanks again!

[Multibilly]

Re: What lab results should I be watching?

by Multibilly on Sun Oct 18, 2015 8:03 pm

OK, great you are seeking out a specialist. Again, if you want any recommendations for specialists/institutions from folks on this forum, just let us know what city or general area of the country you are in. This site will also give you a reasonable place to start a search.

https://myelomabeacon.org/resources/treatment-centers/