If your relapsing will it always show on the free light chain (FLC) assay?
My husband sees an multiple myeloma specialist who dismissed his elevated IgA and said his IFE or FLC would show a relapse, not an elevated IgA serum. He has us waiting 2 months to test again.
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blair77 - Who do you know with myeloma?: My husband
- When were you/they diagnosed?: April 2013
- Age at diagnosis: 43
Re: Will relapse always be detected by FLC results?
Blair,
"Always" is not a word I would use since there are exceptions to any generalization.
However, the 3 most common tests that are used to track multiple myeloma are the sFLC assay, IFE and SPEP. The sFLC assay often shows changes before they are detected in a SPEP, which tends to lag. There are also some individuals that do not have a detectable M spike and therefore a SPEP would not really show anything.
In my opinion you need a complete work up to get the full picture. Thus, in addition to the aforementioned tests, a CBC and full chemistry panel also help in determining if you are becoming anemic, having kidney problems, or high calcium that may point toward active bone lesions.
The total protein and immunogoblulin tests, which show the overall level of IgA, IgG and IgM, are useful in determining if the immune system is healthy, but are not normally markers as to whether multiple myeloma is active or not. However, with IgM (a much rarer form of multiple myeloma), an increase in that marker may be significant. Not so with the others.
I hope this helps.
Ron
"Always" is not a word I would use since there are exceptions to any generalization.
However, the 3 most common tests that are used to track multiple myeloma are the sFLC assay, IFE and SPEP. The sFLC assay often shows changes before they are detected in a SPEP, which tends to lag. There are also some individuals that do not have a detectable M spike and therefore a SPEP would not really show anything.
In my opinion you need a complete work up to get the full picture. Thus, in addition to the aforementioned tests, a CBC and full chemistry panel also help in determining if you are becoming anemic, having kidney problems, or high calcium that may point toward active bone lesions.
The total protein and immunogoblulin tests, which show the overall level of IgA, IgG and IgM, are useful in determining if the immune system is healthy, but are not normally markers as to whether multiple myeloma is active or not. However, with IgM (a much rarer form of multiple myeloma), an increase in that marker may be significant. Not so with the others.
I hope this helps.
Ron
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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: Will relapse always be detected by FLC results?
Blair,
I would make a few comments. It is possible to have a relapse without an abnormality of the sFLC. Typically, though, the SFLC will also be abnormal. As has been stated in other posts, measuring IgA myeloma can be harder than measuring IgG myeloma based on technical aspects of the SPEP, the test used to measure the amount of the abnormal protein. If the IgA is elevated because of myeloma, then the IFE (immunofixation) should be abnormal. Sometimes, the IgA is elevated significantly, but the paraprotein still reads as 0. If the IgA is abnormal in those situations, in almost all circumstances the IFE will be abnormal.
I hope this helps. In order to best understand what is going on in your specific situation, I would need to see more details of the tests and your husband's original paraprotein. I assume it was IgA.
Best wishes,
Jlk
I would make a few comments. It is possible to have a relapse without an abnormality of the sFLC. Typically, though, the SFLC will also be abnormal. As has been stated in other posts, measuring IgA myeloma can be harder than measuring IgG myeloma based on technical aspects of the SPEP, the test used to measure the amount of the abnormal protein. If the IgA is elevated because of myeloma, then the IFE (immunofixation) should be abnormal. Sometimes, the IgA is elevated significantly, but the paraprotein still reads as 0. If the IgA is abnormal in those situations, in almost all circumstances the IFE will be abnormal.
I hope this helps. In order to best understand what is going on in your specific situation, I would need to see more details of the tests and your husband's original paraprotein. I assume it was IgA.
Best wishes,
Jlk
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Dr. Jonathan Kaufman - Name: Jonathan Kaufman, M.D.
Beacon Medical Advisor
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