So I had my second bone marrow and labs.
My bone marrow showed and increase plasma cells of 40-50%. (first marrow was 30%)
My serum M spike is stable at 0.3g/dl.
If my percentage is increasing why isnt my M spike?
Thanks
Forums
4 posts
• Page 1 of 1
-
mrsv118 - Name: Kate
- Who do you know with myeloma?: ME
- When were you/they diagnosed?: 7/19/12
- Age at diagnosis: 48
Re: putting it all together
Ok, just noticed that my last M spike was 0.2g/dl. So I guess it is going up together.
Any other explanation of this relationship would be great!
Any other explanation of this relationship would be great!
-
mrsv118 - Name: Kate
- Who do you know with myeloma?: ME
- When were you/they diagnosed?: 7/19/12
- Age at diagnosis: 48
Re: putting it all together
Dear Mrsv118,
The amount of myeloma in your bone marrow is notable given the fact that your M-spike is relatively low. This could mean one of several things: 1) you have what we would call "oligosecretory disease." In other words, the myeloma cells are not making much antibody -- one step away from non-secretory myeloma; 2) your M-spike is either free kappa or free lambda light chain antibodies. The M-spike levels as measured by serum protein electrophoresis are typically not high for light chain myeloma -- the serum free light chain test and 24-hour urine protein electrophoresis are a better way to quantitate light chain antibodies; or 3) your M-spike is an intact antibody (for example IgG kappa or IgA lambda) but the myeloma is also making an excess of free light chains. Have you had serum free light chain testing performed or 24-hour urine studies?
It is important to recognize that these tests are imperfect. In the vast majority of instances (not all, but most), an M-spike increase from 0.2 to 0.3 would not raise alarms -- the difference is within the margin of error for the test. Additionally, the level of marrow involvement from one area to the next can vary to some extent, which could explain a difference of 30 to 40-50%. Lastly, it is important to know how the level of marrow involvement was assessed, and if the percentages of involvement were determined using the same method from one marrow to the next. There is the aspirate differential -- this is where the pathologist looks at all of the bone marrow cells under the microscope and determines what proportion of the cells are plasma cells (myeloma cells). You can also "stain" the bone marrow biopsy to highlight the myeloma cells. The stain typically used is an antibody to CD138, a protein highly expressed on the surface of myeloma cells. Lastly, flow cytometry is frequently performed and can give you an assessment of degree of marrow involvement with multiple myeloma. In general, flow cytometry tends to report lower levels of involvement (due to technical issues of sample dilution) and CD138 immunohistochemical staining the highest.
I hope this helps. Thanks!
Pete V.
The amount of myeloma in your bone marrow is notable given the fact that your M-spike is relatively low. This could mean one of several things: 1) you have what we would call "oligosecretory disease." In other words, the myeloma cells are not making much antibody -- one step away from non-secretory myeloma; 2) your M-spike is either free kappa or free lambda light chain antibodies. The M-spike levels as measured by serum protein electrophoresis are typically not high for light chain myeloma -- the serum free light chain test and 24-hour urine protein electrophoresis are a better way to quantitate light chain antibodies; or 3) your M-spike is an intact antibody (for example IgG kappa or IgA lambda) but the myeloma is also making an excess of free light chains. Have you had serum free light chain testing performed or 24-hour urine studies?
It is important to recognize that these tests are imperfect. In the vast majority of instances (not all, but most), an M-spike increase from 0.2 to 0.3 would not raise alarms -- the difference is within the margin of error for the test. Additionally, the level of marrow involvement from one area to the next can vary to some extent, which could explain a difference of 30 to 40-50%. Lastly, it is important to know how the level of marrow involvement was assessed, and if the percentages of involvement were determined using the same method from one marrow to the next. There is the aspirate differential -- this is where the pathologist looks at all of the bone marrow cells under the microscope and determines what proportion of the cells are plasma cells (myeloma cells). You can also "stain" the bone marrow biopsy to highlight the myeloma cells. The stain typically used is an antibody to CD138, a protein highly expressed on the surface of myeloma cells. Lastly, flow cytometry is frequently performed and can give you an assessment of degree of marrow involvement with multiple myeloma. In general, flow cytometry tends to report lower levels of involvement (due to technical issues of sample dilution) and CD138 immunohistochemical staining the highest.
I hope this helps. Thanks!
Pete V.
-
Dr. Peter Voorhees - Name: Peter Voorhees, M.D.
Beacon Medical Advisor
Re: putting it all together
these two samples were done at different facilities. One in Delaware and the other at NIH.
I am told I have IGG Kappa smoldering myeloma.
IGA=14
IGG=549
IGM=11
Kappa=33-3mg/dl
lambda=0.1mg/dl
the most recent sample processed by the NIH showed two results as far as plasma cells, so I assume one is the aspirate differential which was 99%. The other was a note regarding# of plasma cells which basically said, they saw 30-60% plasma cells overall which averaged 40-50%
My 24hr urine was not repeated, so this is from the first set of labs where I had a plasma cell level of 30% and an m spike of 0.2.
monoclonal spike seen in the gamma region=43%.
I am told I have IGG Kappa smoldering myeloma.
IGA=14
IGG=549
IGM=11
Kappa=33-3mg/dl
lambda=0.1mg/dl
the most recent sample processed by the NIH showed two results as far as plasma cells, so I assume one is the aspirate differential which was 99%. The other was a note regarding# of plasma cells which basically said, they saw 30-60% plasma cells overall which averaged 40-50%
My 24hr urine was not repeated, so this is from the first set of labs where I had a plasma cell level of 30% and an m spike of 0.2.
monoclonal spike seen in the gamma region=43%.
-
mrsv118 - Name: Kate
- Who do you know with myeloma?: ME
- When were you/they diagnosed?: 7/19/12
- Age at diagnosis: 48
4 posts
• Page 1 of 1