[C.J.]

Should we get a bone marrow biopsy?

by C.J. on Thu Aug 07, 2014 3:25 pm

To BMB or not to BMB, that is the question?

Hello all and thank you for providing such a helpful resource! Apologies in advance for the length and detail of this post.

My 65 year-old husband has just received a diagnosis of MGUS. He is 10-years post-prostatectomy for a stage IIB cancer, thankfully he remains with no detectable PSA. History of type II diabetes, hypertension, hyperlipedemia (well controlled with meds & diet.)

Based on my reading here and elsewhere, his test numbers are indeed abnormal, but still quite low for a definitive diagnosis:

Serum M-spike 0.1, Urine M-spike not observed (UPEP 24hr);
S Free Kappa 27.8,
U Free Kappa 1.89 (within lab's normal range),
S K:L ratio 2.07,
U K:L ratio 11.87 (high, but only 1.44 above lab's upper boundary),
S IFEGK shows IgG monoclonal protein with Kappa Light specificity
U IFE shows apparent normal immunofixation pattern
S Beta-2 macroglobulin is 2.5 (or only .1 above lab's normal range)
all his serum Immunoglobulins (G,A, M) proteins were within normal range, although IgG was at the upper normal boundary
Calcium 10.1 (at upper boundary of 10.2)
BUN/Creatinine Ratio: 26 (High)
Platelet count slightly elevated at 386 (379 lab's upper boundary)
Radiographic skeletal survey was negative for "obvious" lesions, but shows generalized osteopenia of spine with stenosis.

He is asymptomatic and other than a series of unusual infections this past year (i.e., sinus, gastrointestinal, multiple UTIs) with intermittent low-grade fevers, he is generally in good health. A scan discovered two "suspected cysts" in his left kidney, and a thyroid cyst but no changes observed on most recent scans (about 9 months ago).

Hematologist / oncologist reviewed his test results/history and said: "not to worry, see you in 3 months" So, it's MGUS with watchful waiting. But watchful waiting in a cancer survivor just doesn't seem like a good idea.

There was no bone marrow biopsy (BMB), nor even a mention of one. Since it appears to us that BMB is the gold-standard diagnostic tool for MGUS, is it unreasonable to have one early in the process?

We are worried about progression to multiple myeloma or that this could be another form of cancer since his B2M is elevated.

If not a BMB should we check for other tumor markers to possibly exclude this as an early presentation of lympohoma, amyloidosis, CLL, or distant metastasis?

We have many more questions than answers at this point and greatly appreciate any insight forum members can share.

Thanks again,

C.J.

[Toni]

Re: Should we get a bone marrow biopsy?

by Toni on Thu Aug 07, 2014 6:34 pm

Hi C.J.,

It sounds like your husband is a real fighter!

I have a few questions for you but first, the one thing everyone on this forum will recommend is that you see a hem/onc who specializes in myeloma. It just makes sense to do so. And although there are wonderful oncologists out there, a physician who specializes in myeloma will have a far better eye to look out for very subtle signs.

That being said, here's my first question. Is that M-spike really only 0.1? or is it 1.0? Can you look at and respond with the actual unit of measure so we can understand it better? It would like like "g/dl"

When I first posted after they detected an M-spike, the doctor told me I had MGUS and I didn't need a bone marrow biopsy (BMB). I asked about it on this forum and many people, including a myeloma doctor recommended it simply to differentiate between MGUS and SMM - monoclonal gammopathy of unspecified significance and smoldering multiple myeloma. SMM does not necessarily mean myeloma but it does require closer watching.

I am having a BMB tomorrow morning. I'm not looking forward to it, but if it falls in the MGUS category, I will be much happier only checking every year or so.

I went to a second doctor who specializes in myeloma and at first he concurred with my first doctor about not needing a BMB, but when I told him I am sick frequently (requiring antibiotics, etc) then he said, oh no, that's different, let's get a BMB.

I would also think that with some of your husband's test results being borderline or even over/under normal it would be prudent to get the bone test.

All the best to you and your husband and please stay close to these forums. There is so much knowledge and encouragement here!

[C.J.]

Re: Should we get a bone marrow biopsy?

by C.J. on Thu Aug 07, 2014 8:42 pm

Hi, Toni. Thanks so much for taking the time to respond to my post. I wish you all the best on your BMB tomorrow and with your continued lack of progression (that sounds a bit strange, but I hope you know what I mean

We are indeed going to see another hematologist who specializes in multiple myeloma and perhaps he can confirm this MGUS diagnosis. The M-spike was truly only 0.1 g/dl, nearly immeasurable, which makes us wonder if MGUS is really what we're seeing.

I am so happy to have found The Beacon site, so much great information and a great community of contributors.

Thanks again for sharing your insights and experience.

Kind regards,

CJ