Hi all. I have posted here about my mother before, but here is a short recap:
Symptoms started with severe back pain November 2007.
Multiple myeloma diagnosed January 2008.
CyBorD [cyclophosphamide, Velcade, dex] therapy commenced and auto SCT [stem cell transplant] done in June 2008.
Complete remission achieved thereafter with no maintenance for five years.
A protein (forgive my lack of specificity here) started to rise in August 2013. Further testing in February 2014 revealed an extramedullary plasmacytoma near her uterus, resting on the sciatic nerve and causing numbness and a foot drop in her right foot (she was unable to raise up on her toes).
She had yet another course of CyBorD from February to early September. A PET in July revealed that the plasmacytoma was gone.
Now it appears that her IgA protein has risen considerably. She will have a PET and BMB on Monday.
Does anyone know what might be causing this? Other than this protein, her doctor says her blood work looks good, and she continues to feel good.
Thank you for your insights!
Forums
Rise in IgA - what's it mean?
Last edited by BeatMyeloma on Wed Oct 29, 2014 5:07 pm, edited 1 time in total.
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BeatMyeloma - Name: BeatMyeloma
- Who do you know with myeloma?: My mother
- When were you/they diagnosed?: Jan. 2008
- Age at diagnosis: 54
Re: Rise in IgA - what's it mean?
FYI, what my mother told me is that her IgA number was 87 back in August 2013. In February it was 300 and as of today 850.
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BeatMyeloma - Name: BeatMyeloma
- Who do you know with myeloma?: My mother
- When were you/they diagnosed?: Jan. 2008
- Age at diagnosis: 54
Re: Rise in IgA - what's it mean?
What is her M spike? The M spike measures the malignant part of her IgA levels.
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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: Rise in IgA - what's it mean?
I'm not sure about her M spike. I asked her this summer what it was and she said her doctor told her that she didn't have an M spike. Very odd.
I am wondering if the rise in IgA levels indicates.that her plasmacytoma is back. (Hoping not!)
I am wondering if the rise in IgA levels indicates.that her plasmacytoma is back. (Hoping not!)
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BeatMyeloma - Name: BeatMyeloma
- Who do you know with myeloma?: My mother
- When were you/they diagnosed?: Jan. 2008
- Age at diagnosis: 54
Re: Rise in IgA - what's it mean?
First off, I'm not a doc, so your doc really needs to make the call here.
I'm assuming that the second round of CyBorD completely knocked down the disease again, right? And I am also assuming that she still doesn't have an M-Spike (I would really confirm if that is still the case). The additional tests she will be getting should also supply some important clues. Also note that IgA-type M-spikes can sometimes be a little tricky to measure, but it seems like this is quite a significant jump in the underlying total IgA (at least, to this layman).
IgA is an important antibody that is a key element of your front line defense against various invaders. It can rise if there is a chronic infection or inflammation going on.
If there is no M-spike, an elevated IgA could mean something along these lines, but a doctor really needs to make this sort of determination:
http://www.gpnotebook.co.uk/simplepage.cfm?ID=147849251
Causes of increased IgA levels include:
chronic infections
chronic liver disease
rheumatoid arthritis with high titres of rheumatoid factor
SLE (occurs in some patients)
sarcoidosis (occurs in some patients)
Wiskott-Aldrich syndrome
I'm assuming that the second round of CyBorD completely knocked down the disease again, right? And I am also assuming that she still doesn't have an M-Spike (I would really confirm if that is still the case). The additional tests she will be getting should also supply some important clues. Also note that IgA-type M-spikes can sometimes be a little tricky to measure, but it seems like this is quite a significant jump in the underlying total IgA (at least, to this layman).
IgA is an important antibody that is a key element of your front line defense against various invaders. It can rise if there is a chronic infection or inflammation going on.
If there is no M-spike, an elevated IgA could mean something along these lines, but a doctor really needs to make this sort of determination:
http://www.gpnotebook.co.uk/simplepage.cfm?ID=147849251
Causes of increased IgA levels include:
chronic infections
chronic liver disease
rheumatoid arthritis with high titres of rheumatoid factor
SLE (occurs in some patients)
sarcoidosis (occurs in some patients)
Wiskott-Aldrich syndrome
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Rise in IgA - what's it mean?
Hi Multibilly,
That's interesting information, thank you so much! I just talked with Mom and asked her to tell me her M spike. She said that her doctor at Mayo told her again yesterday that she does not have one (weird). She also said that all her other numbers look great. It's just the IgA that is going up.
It does make me nervous since a rising IgA was the catalyst to finding her plasmacytoma. The CyBorD did knock that out (started in March, last dose September 5). A PET in late July showed that the mass had disappeared. And her right foot feels good. Because the tumor was resting on the sciatic nerve, it had caused numbness and a foot drop, and Mom was unable to raise up on her toes. She can do that now though!
The whole thing seems weird to me (and that's what Mom's hematologist said too). I'm going to attend her appointment with her Monday, so will be sure to quiz her doctor on everything.
That's interesting information, thank you so much! I just talked with Mom and asked her to tell me her M spike. She said that her doctor at Mayo told her again yesterday that she does not have one (weird). She also said that all her other numbers look great. It's just the IgA that is going up.
It does make me nervous since a rising IgA was the catalyst to finding her plasmacytoma. The CyBorD did knock that out (started in March, last dose September 5). A PET in late July showed that the mass had disappeared. And her right foot feels good. Because the tumor was resting on the sciatic nerve, it had caused numbness and a foot drop, and Mom was unable to raise up on her toes. She can do that now though!
The whole thing seems weird to me (and that's what Mom's hematologist said too). I'm going to attend her appointment with her Monday, so will be sure to quiz her doctor on everything.
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BeatMyeloma - Name: BeatMyeloma
- Who do you know with myeloma?: My mother
- When were you/they diagnosed?: Jan. 2008
- Age at diagnosis: 54
Re: Rise in IgA - what's it mean?
Well, your Mom is in fantastic hands with the folks at the Mayo ... so I would suggest trying not to fret about this and second guess things before next week's appointment.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Rise in IgA - what's it mean?
Ironically, she is pretty calm and hopeful (a little disappointed last night). I'm the one who is the mess! But yes, I have lots of faith in Mayo – they're not giving up!
But yes, I have lots of faith in Mayo – they're not giving up!-
BeatMyeloma - Name: BeatMyeloma
- Who do you know with myeloma?: My mother
- When were you/they diagnosed?: Jan. 2008
- Age at diagnosis: 54
Re: Rise in IgA - what's it mean?
BeatMyeloma,
I agree with you that a sudden rise in IgA level is concerning, but if myeloma relapse is confirmed, there are a number of potential options for your mother whose myeloma cells have only seen alkylating agents (cyclophosphamide pre-transplant, and melphalan during transplantation) and a proteasome inhibitor (Velcade) so far.
Also, if more stem cells remain in storage, repeating auto transplantation may be a viable option, especially since she was in prolonged remission with her first transplantation.
Likewise, please do not forget to ask the hematologist about the ongoing clinical trials, which would give her access to newer agents if she is deemed eligible to participate.
Good luck.
Prashant Kapoor
I agree with you that a sudden rise in IgA level is concerning, but if myeloma relapse is confirmed, there are a number of potential options for your mother whose myeloma cells have only seen alkylating agents (cyclophosphamide pre-transplant, and melphalan during transplantation) and a proteasome inhibitor (Velcade) so far.
Also, if more stem cells remain in storage, repeating auto transplantation may be a viable option, especially since she was in prolonged remission with her first transplantation.
Likewise, please do not forget to ask the hematologist about the ongoing clinical trials, which would give her access to newer agents if she is deemed eligible to participate.
Good luck.
Prashant Kapoor
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Dr. Prashant Kapoor - Name: Prashant Kapoor, M.D.
Beacon Medical Advisor
Re: Rise in IgA - what's it mean?
Dr. Kapoor,
As always, your expert guidance to patients on this forum is quite appreciated.
Can there be situations where the quantitative immunoglobulin level can rise significantly with no M-spike present and still be due to multiple myeloma and not some other condition like chronic infection, etc?
As always, your expert guidance to patients on this forum is quite appreciated.
Can there be situations where the quantitative immunoglobulin level can rise significantly with no M-spike present and still be due to multiple myeloma and not some other condition like chronic infection, etc?
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
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