Hi,
I'm IGG kappa with 10 to 20% plasma cells in bone marrow and also FLC ratio fluctuating between 5 and ll. I have no crab features.
My chromosome analysis indicated normal, female karyotype with no abnormalities detected.
Should a FISH have been ordered or was it not called for. Following this I was put on 6 month checks instead of 3. Until I started wondering about FISH I felt assured I was not in danger of progressing soon. Any insight will be appreciated. Marti
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smarty - Name: Marti
- Who do you know with myeloma?: myself Smoldering Myeloma
- When were you/they diagnosed?: May 1, 2015
- Age at diagnosis: 76
Re: Should I have had FISH testing done?
Marti,
chromosome analysis looks at the high-level grouping of all of one's chromosomes to yield the karyotype (a single overall snapshot of all of one's chromosomes). Standard chromosome analysis can detect gross aberrations like the existence of extra chromosomes such as a trisomy. Depending on the level of microscopic inspection/resolution that was performed, chromosome analysis can also pick up on some structural abnormalities like deletions and translocations via what is known as banding analysis. But it may not be that accurate in being able to exactly characterize these abnormalities. So, it's important to understand what level of chromosome analysis was done when looking at a chromosome analysis report. In any case, chromosome analysis is not a bad starting point when understanding what is going on genetically with one's disease.
One of the big downsides to chromosome analysis is that it can only look at a very small cell population (this analysis is laboriously done by a person growing the cells from a bone marrow biopsy in a culture and then looking at each of the chromosomes under a microscope. Typically, the pathologist is only looking at a small colony of 20 cells or so). On the other hand, iFISH can look at a large number of non-cultured cells and can accurately detect any abnormalities for which the instrumentation was set up to look for.
In any case, I think it's unusual that a iFISH analysis was not run as part of your overall bone marrow biopsy test routine, especially if one went through all the expense and effort of doing a bone marrow biopsy. Are you sure you didn't have a iFISH study performed? You may simply not have a copy of the report and your doctor may have it. I'm also guessing that you are being seen at the Cleveland Clinic since you are in Cleveland? I would be especially surprised if the Cleveland Clinic didn't run an iFISH study.
But even if they didn't initially run an iFISH study, they may still have the biopsy sample in the lab and can still run the iFISH study. If they can't run an iFISH study, I doubt that a doctor would order another BMB under the circumstances and would instead wait until your markers warranted a new BMB study. At least, that is what I think my doctor might do under the circumstances.
If you are worried that you aren't being tested frequently enough, you could always ask to be checked more regularly or split the difference and ask to be checked every 18 weeks or so?
chromosome analysis looks at the high-level grouping of all of one's chromosomes to yield the karyotype (a single overall snapshot of all of one's chromosomes). Standard chromosome analysis can detect gross aberrations like the existence of extra chromosomes such as a trisomy. Depending on the level of microscopic inspection/resolution that was performed, chromosome analysis can also pick up on some structural abnormalities like deletions and translocations via what is known as banding analysis. But it may not be that accurate in being able to exactly characterize these abnormalities. So, it's important to understand what level of chromosome analysis was done when looking at a chromosome analysis report. In any case, chromosome analysis is not a bad starting point when understanding what is going on genetically with one's disease.
One of the big downsides to chromosome analysis is that it can only look at a very small cell population (this analysis is laboriously done by a person growing the cells from a bone marrow biopsy in a culture and then looking at each of the chromosomes under a microscope. Typically, the pathologist is only looking at a small colony of 20 cells or so). On the other hand, iFISH can look at a large number of non-cultured cells and can accurately detect any abnormalities for which the instrumentation was set up to look for.
In any case, I think it's unusual that a iFISH analysis was not run as part of your overall bone marrow biopsy test routine, especially if one went through all the expense and effort of doing a bone marrow biopsy. Are you sure you didn't have a iFISH study performed? You may simply not have a copy of the report and your doctor may have it. I'm also guessing that you are being seen at the Cleveland Clinic since you are in Cleveland? I would be especially surprised if the Cleveland Clinic didn't run an iFISH study.
But even if they didn't initially run an iFISH study, they may still have the biopsy sample in the lab and can still run the iFISH study. If they can't run an iFISH study, I doubt that a doctor would order another BMB under the circumstances and would instead wait until your markers warranted a new BMB study. At least, that is what I think my doctor might do under the circumstances.
If you are worried that you aren't being tested frequently enough, you could always ask to be checked more regularly or split the difference and ask to be checked every 18 weeks or so?
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Should I have had FISH testing done?
Hi Multibility,
Thank you so much for your response. I thought that I received all my reports on line and I did get one that was negative for Lukemia. I will e-mail my oncologist to ask if fish was run and if not why not. When I get reply I will post it. Thanks again. Marti
Thank you so much for your response. I thought that I received all my reports on line and I did get one that was negative for Lukemia. I will e-mail my oncologist to ask if fish was run and if not why not. When I get reply I will post it. Thanks again. Marti
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smarty - Name: Marti
- Who do you know with myeloma?: myself Smoldering Myeloma
- When were you/they diagnosed?: May 1, 2015
- Age at diagnosis: 76
Re: Should I have had FISH testing done?
My hemo-oncologist replied that "we only run fish if diagnosis of multiple myeloma and he is still referring to my condition as mgus although I believe it is smoldering myeloma. I will see him in January and see what happens with my blood work. I will also discuss with him why he is insisting on mgus. Maybe at my age 77 it doesn't matter much. I thankfully feel very well. Again I apreciate your response and input Multibility and always read your comments. Thanks again. Marti
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smarty - Name: Marti
- Who do you know with myeloma?: myself Smoldering Myeloma
- When were you/they diagnosed?: May 1, 2015
- Age at diagnosis: 76
Re: Should I have had FISH testing done?
Interesting follow-up Marti.
I never heard of that kind of policy regarding FISH testing before, but maybe I'm just not aware that some doctors take this approach with MGUS patients (that is, order a BMB but no iFISH test). Technically, I agree that it sounds like you must be smoldering if you have 10-20% bone marrow plasma cells.
If you don't mind me asking, what institution provided you with that FISH test policy?
I never heard of that kind of policy regarding FISH testing before, but maybe I'm just not aware that some doctors take this approach with MGUS patients (that is, order a BMB but no iFISH test). Technically, I agree that it sounds like you must be smoldering if you have 10-20% bone marrow plasma cells.
If you don't mind me asking, what institution provided you with that FISH test policy?
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Should I have had FISH testing done?
The Cleveland Clinic and my doctor is listed as hemo oncology and lists multiple myeloma as one of his specialties. I will make an attempt to check on this if possible. I wish I had something to offer in opposition to that theory and he is very cooperative when I have suggested articles to read. Depending on new lab results I will probably have bone marrow after one year at which time I would insist on fish. Marti
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smarty - Name: Marti
- Who do you know with myeloma?: myself Smoldering Myeloma
- When were you/they diagnosed?: May 1, 2015
- Age at diagnosis: 76
6 posts
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