I have written previously in this space about what I and my doctor believe is my secondary MGUS following induction with Velcade, Revlimid, and dexamethasone (VRD) and an auto transplant.
Originally, I was diagnosed with IgG lambda myeloma and at some point I switched over to IgG kappa. For many months now I have had an M-spike ranging from 100-400 mg/dl (0.1-0.4 g/dL, 1-4 g/L). However, on my latest blood test, the M-spike jumped to 900, but is still IgG kappa.
My doctor said that he has never seen a secondary MGUS M-spike higher than 500. None of the studies that I have seen quantify the level of the secondary MGUS M-spikes that were studied.
I am wondering if anyone here has ever experienced or seen a confirmed secondary MGUS M-spike of that level.
Forums
Re: Secondary MGUS M-spike levels
The latest results show an increase in the M-spike to 1100 mg/dl. On the other hand, IgG has declined into the normal range, 1546 g/dl (was 1709 last month).
Other markers are good. Cret., cl is normal, hemoglobin just below normal at 12.3 g/dl.
Other markers are good. Cret., cl is normal, hemoglobin just below normal at 12.3 g/dl.
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goldmine848 - Name: Andrew
- When were you/they diagnosed?: June 2013
- Age at diagnosis: 60
Re: Secondary MGUS M-spike levels
Andrew:
I feel I have entered "Alice in Wonderland" with your situation. I have no clues to offer.
This disease is baffling, sometimes.
Regards,
I feel I have entered "Alice in Wonderland" with your situation. I have no clues to offer.
This disease is baffling, sometimes.
Regards,
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Rneb
Re: Secondary MGUS M-spike levels
Rneb,
Yes I am similarly baffled. I suppose it could have switched types. Trying to avoid a bone marrow biopsy but that might be the only way to tell for sure at this point.
Yes I am similarly baffled. I suppose it could have switched types. Trying to avoid a bone marrow biopsy but that might be the only way to tell for sure at this point.
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goldmine848 - Name: Andrew
- When were you/they diagnosed?: June 2013
- Age at diagnosis: 60
Re: Secondary MGUS M-spike levels
Hi Andrew,
This has got to be driving you crazy.
As I look at your numbers and units of measure, I think you meant to say that your IgG is at 1546 mg/dL with an M-spike of 1100 mg/dL. So, this makes your "healthy" IgG level ~ 446 mg/dL (1546 -1100). I'm guessing that 446 mg/dL is likely below your normal IgG reference range. So, it seems like you've got a touch of immunoparesis, where your healthy IgG is now being suppressed.
Are your free light chain values changing too?
This has got to be driving you crazy.
As I look at your numbers and units of measure, I think you meant to say that your IgG is at 1546 mg/dL with an M-spike of 1100 mg/dL. So, this makes your "healthy" IgG level ~ 446 mg/dL (1546 -1100). I'm guessing that 446 mg/dL is likely below your normal IgG reference range. So, it seems like you've got a touch of immunoparesis, where your healthy IgG is now being suppressed.
Are your free light chain values changing too?
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Secondary MGUS M-spike levels
You are right: IgG is 1546 mg/dl and M-spike is 1100 mg/dl.
Of course, the question is whether the M-spike is good (secondary MGUS) or bad (relapse).
Free light chains are:
Kappa - 2.30 mg/dl
Lambda - 1.52 mg/dl
Kappa / lambda ratio - 1.51
They have been fairly stable.
Of course, the question is whether the M-spike is good (secondary MGUS) or bad (relapse).
Free light chains are:
Kappa - 2.30 mg/dl
Lambda - 1.52 mg/dl
Kappa / lambda ratio - 1.51
They have been fairly stable.
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goldmine848 - Name: Andrew
- When were you/they diagnosed?: June 2013
- Age at diagnosis: 60
Re: Secondary MGUS M-spike levels
So is your doc saying that a "benign" secondary M-spike isn't accompanied by a rise in one's bone marrow plasma cell percentage, but a "malignant" secondary spike would be? Is that why a bone marrow biopsy may be the definitive test to sort this out?
Last edited by Multibilly on Tue Sep 29, 2015 10:12 pm, edited 1 time in total.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Secondary MGUS M-spike levels
Yes. Ultimately the only way to tell is by determining if there are malignant cells in the marrow. In the studies examining secondary MGUS, biopsies were used to confirm. It generally has been assumed that a new M-spike of a different type is secondary MGUS, but there are instances in which the new type is malignant.
What has us concerned here is that the new M-spike is rising and is at a relatively high level.
What has us concerned here is that the new M-spike is rising and is at a relatively high level.
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goldmine848 - Name: Andrew
- When were you/they diagnosed?: June 2013
- Age at diagnosis: 60
Re: Secondary MGUS M-spike levels
An update here.
I had a bone marrow biopsy. My doctor called when he got the report and told me the biopsy was clean, so what I have is certainly a secondary MGUS M-spike.
But ...
I got the report. One of the conclusions was : No morphologic or immunophenotypic evidence of plasma cell dyscrasia. Sounds good to me.
In another part of the report it says: Abnormal cells by flow cytometry: No.
However, in the section labelled "Marrow Aspirate Differential Count," there is an entry that reads:
Plasma Cells: 2.5% with a reference range of 0-1.2%.
This despite the finding under microscopic peripheral blood review: No circulating plasma cells are identified.
So are there malignant plasma cells in my marrow? I realize that 2.5% is pretty low, but isn't zero better? Or am I misreading the report?
We will see what the doctor says but insights are welcome.
I had a bone marrow biopsy. My doctor called when he got the report and told me the biopsy was clean, so what I have is certainly a secondary MGUS M-spike.
But ...
I got the report. One of the conclusions was : No morphologic or immunophenotypic evidence of plasma cell dyscrasia. Sounds good to me.
In another part of the report it says: Abnormal cells by flow cytometry: No.
However, in the section labelled "Marrow Aspirate Differential Count," there is an entry that reads:
Plasma Cells: 2.5% with a reference range of 0-1.2%.
This despite the finding under microscopic peripheral blood review: No circulating plasma cells are identified.
So are there malignant plasma cells in my marrow? I realize that 2.5% is pretty low, but isn't zero better? Or am I misreading the report?
We will see what the doctor says but insights are welcome.
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goldmine848 - Name: Andrew
- When were you/they diagnosed?: June 2013
- Age at diagnosis: 60
Re: Secondary MGUS M-spike levels
I may have figured this out. The report says: The plasma cells are CD 19+ and CD 56-. From what I have read and only partially understand, the malignant cells would be CD 19- and CD 56+ At least I think so: See:
N Robillard et al, "A single-tube multiparameter seven-colour flow cytometry strategy for the detection of malignant plasma cells in multiple myeloma," Blood Cancer Journal, Aug 16, 2013 (full text of article).
N Robillard et al, "A single-tube multiparameter seven-colour flow cytometry strategy for the detection of malignant plasma cells in multiple myeloma," Blood Cancer Journal, Aug 16, 2013 (full text of article).
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goldmine848 - Name: Andrew
- When were you/they diagnosed?: June 2013
- Age at diagnosis: 60
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