I have done a great deal of reading on the phenomenon know as secondary MGUS or atypical serum immunofixation patterns. There have been a number of questions about this topic in the forums recently. Listed below are links to the articles and studies on the topic that I have found. Happy to discuss with any who are interested.
C Fernández de Larrea et al., "Emergence Of Oligoclonal Bands In Patients With Multiple Myeloma In Complete Remission After Induction Chemotherapy: Association With The Use Of Novel Agents," Haematologica, January 2011 (full text of article)
N Tovar et al, "Natural History And Prognostic Impact Of Oligoclonal Humoral Response In Patients With Multiple Myeloma After Autologous Stem Cell Transplantation: Long-Term Results From A Single Institution," Haematologica, July 2013 (full text of article)
C Fernández de Larrea et al., "Abnormal serum free light chain ratio in patients with multiple myeloma in complete remission has strong association with the presence of oligoclonal bands: implications for stringent complete remission definition," Blood, December 2009 (full text of article)
T Mark et al., "Atypical serum immunofixation patterns frequently emerge in immunomodulatory therapy and are associated with a high degree of response in multiple myeloma," British Journal of Haematology, December 2008 (full text of article)
RK Wadhera et al, "Incidence, clinical course, and prognosis of secondary monoclonal gammopathy of undetermined significance in patients with multiple myeloma," Blood, Sep 15, 2011 (full text of article)
D Zou et al, "Secondary Monoclonal Gammopathy of Undetermined Significance Is Frequently Associated with High Response Rate and Superior Survival in Patients with Plasma Cell Dyscrasias," Biology of Blood and Marrow Transplantation, March 2014 (full text of article)
DV Manson, "Secondary MGUS after autologous hematopoietic progenitor cell transplantation in plasma cell myeloma: a matter of undetermined significance," Bone Marrow Transplantation, December 2011 (full text of article)
C Guimarães et al, "Prognostic value of unrelated atypical serum immunofixation patterns during Multiple Myeloma therapy," Journal of Hematology & Oncology, June 2012 (full text of article)
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Re: Secondary MGUS - articles
Andrew,
In your reading, have you run across anyone else in which the secondary MGUS after transplant actually turned into myeloma-producing plasma cell? Like in my case. For brevity, I'm not repeating all the details here now, so let me know if you need more info to answer the question ...
Tracy
In your reading, have you run across anyone else in which the secondary MGUS after transplant actually turned into myeloma-producing plasma cell? Like in my case. For brevity, I'm not repeating all the details here now, so let me know if you need more info to answer the question ...
Tracy
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Tracy J - Name: Tracy Jalbuena
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 2014
- Age at diagnosis: 42
Re: Secondary MGUS - articles
Andrew,
This is an extremely valuable contribution. Thanks for taking the time to bring it together in one place for all of us.
This is an extremely valuable contribution. Thanks for taking the time to bring it together in one place for all of us.
Re: Secondary MGUS - articles
Tracy,
The problem with this topic is that the information is very limited and I have not seen any publication that includes follow-up. The studies are basically a snapshot in time based on a retrospective examination of records, usually at a single institution.
The problem with this topic is that the information is very limited and I have not seen any publication that includes follow-up. The studies are basically a snapshot in time based on a retrospective examination of records, usually at a single institution.
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goldmine848 - Name: Andrew
- When were you/they diagnosed?: June 2013
- Age at diagnosis: 60
Re: Secondary MGUS - articles
Tracy,
I took a closer look at one of the studies, and Table 1 in this one may answer your question:
D Zou et al, "Secondary Monoclonal Gammopathy of Undetermined Significance Is Frequently Associated with High Response Rate and Superior Survival in Patients with Plasma Cell Dyscrasias," Biology of Blood and Marrow Transplantation, March 2014 (full text of article)
I took a closer look at one of the studies, and Table 1 in this one may answer your question:
D Zou et al, "Secondary Monoclonal Gammopathy of Undetermined Significance Is Frequently Associated with High Response Rate and Superior Survival in Patients with Plasma Cell Dyscrasias," Biology of Blood and Marrow Transplantation, March 2014 (full text of article)
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goldmine848 - Name: Andrew
- When were you/they diagnosed?: June 2013
- Age at diagnosis: 60
Re: Secondary MGUS - articles
Hi Andrew,
Wow. I think your article and post may be what is happening to my husband, but it's so complicated and new, I'm not sure. It's a lot of worry.
My husband was diagnosed IgA kappa, t(4;14) myeloma Nov. 2014. With Revlimid, Velcade, and dexamethasone (RVD), he reached stringent complete response by March 31, 2015. Stem cell transplant early May 2015.
July 2015 immunofixation showed "oligoclonal gammopathy with faint comigrating IgG kappa AND lambda paraproteins". Electrophoresis showed "2 M spikes". As of his last visit to his multiple myeloma specialist, the faint oligoclonal banding remains.
He is on "RVD light" as maintenance. His kappa was knocked down to 9 mg/L with the transplant and has been creeping up ever since. It is now over the norm at 25.2. mg/L His ratio is just within the norm at 1.58 mg/L and also creeping higher. All other numbers are normal except for the IgM, which is low at 25. We don't see the hem/onc until April 19th to ask some questions. We see the multiple myeloma specialist in mid May.
So what is it that is happening with that kappa light chain? Is it the IgA cancer clone, or could it be that IgG that showed up in July?
I'm baffled.
Wow. I think your article and post may be what is happening to my husband, but it's so complicated and new, I'm not sure. It's a lot of worry.
My husband was diagnosed IgA kappa, t(4;14) myeloma Nov. 2014. With Revlimid, Velcade, and dexamethasone (RVD), he reached stringent complete response by March 31, 2015. Stem cell transplant early May 2015.
July 2015 immunofixation showed "oligoclonal gammopathy with faint comigrating IgG kappa AND lambda paraproteins". Electrophoresis showed "2 M spikes". As of his last visit to his multiple myeloma specialist, the faint oligoclonal banding remains.
He is on "RVD light" as maintenance. His kappa was knocked down to 9 mg/L with the transplant and has been creeping up ever since. It is now over the norm at 25.2. mg/L His ratio is just within the norm at 1.58 mg/L and also creeping higher. All other numbers are normal except for the IgM, which is low at 25. We don't see the hem/onc until April 19th to ask some questions. We see the multiple myeloma specialist in mid May.
So what is it that is happening with that kappa light chain? Is it the IgA cancer clone, or could it be that IgG that showed up in July?
I'm baffled.
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KLR - Name: KLR
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: November 2014
- Age at diagnosis: 58
Re: Secondary MGUS - articles
You are right that it is confusing. I am no expert, so I hesitate to offer an opinion. The kappa numbers that you are quoting are the light chains. Your husband's initial diagnosis involved the kappa light chain, so it is important to ask your doctor if the rise indicates relapse.
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goldmine848 - Name: Andrew
- When were you/they diagnosed?: June 2013
- Age at diagnosis: 60
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