I have a friend recently diagnosed w/ active Myeloma. I'm concerned about mis-diagnosis because of conflicting BM aspirate results and BM biopsy results and the fact that she has no or minimal M-spike. She was diagnosed with MGUS earlier in the year w/ a spike of 8.2, now it is .04. She has had 3 different reads of her BM all w/ different plasma cell percentages. At Sloan the aspirate showed 5% but the biopsy showed 20% - is this disparity concerning? Also, local cancer center showed 7% both aspirate and biopsy, while DF, showed 10% aspirate - biopsy still pending. The local cancer center and DF used the same slides, while Sloan extracted their own specimen. Worth mentioning all specimens were obtained within a few weeks of each other. Also, no bone lesions, but hemolytic anemia with low hemoglobin - the reason for the BM testing.
My question is, how common it is it to get these conflicting results? She went for a 3rd opinion because the first two were so different - one indicating smoldering and the other active. We are still waiting for the BM biopsy from DF but she is being pressured to treat the Myeloma due to anemia.
Is there a chance that the Myeloma is smoldering since there is no longer an M-Spike? Could the anemia have an unrelated causative factor? Concerned about the conflicting test results and induction therapy.
Your assistance is appreciated.
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Re: Diagnosed w/ Myeloma and no M-spike or marginal M-spike
Hi Ice!!
Typically the criteria for multiple myeloma is 10-20% plasma cells in the BM aspirate.
I see why you find the results disconcerning.
The difficulty is that multiple myeloma plasma cells are not equally distributed in the marrow of the bone.
You can hit a 'hot spot" and get high numbers, or if the site has a low number at the site, you can get lower numbers than 10-20% in the aspirate.
Which is why you would need more than SPEP (M-spike), along with B2 microglobin tests IF the multiple myeloma cells are NOT secretory.
If the multiple myeloma cells are NOT secretory, you need a Free Light Chain assay (FLC assay) to give a more definitive response. As it shows more if the cells are not secreting the M-protein that SPEP and B2 would detect.
This site provides more information/explanation on the various tests used:
http://myeloma.org/ArticlePage.action?tabId=1&menuId=204&articleId=3177&aTab=-1&gParentType=menuitem&gParentId=204&parentIndexPageId=107
Hope this helps.
Typically the criteria for multiple myeloma is 10-20% plasma cells in the BM aspirate.
I see why you find the results disconcerning.
The difficulty is that multiple myeloma plasma cells are not equally distributed in the marrow of the bone.
You can hit a 'hot spot" and get high numbers, or if the site has a low number at the site, you can get lower numbers than 10-20% in the aspirate.
Which is why you would need more than SPEP (M-spike), along with B2 microglobin tests IF the multiple myeloma cells are NOT secretory.
If the multiple myeloma cells are NOT secretory, you need a Free Light Chain assay (FLC assay) to give a more definitive response. As it shows more if the cells are not secreting the M-protein that SPEP and B2 would detect.
This site provides more information/explanation on the various tests used:
http://myeloma.org/ArticlePage.action?tabId=1&menuId=204&articleId=3177&aTab=-1&gParentType=menuitem&gParentId=204&parentIndexPageId=107
Hope this helps.
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suzierose - Name: suzierose
- When were you/they diagnosed?: 2 sept 2011
2 posts
• Page 1 of 1