Hello,
I am 37 and recently diagnosed with smoldering multiple myeloma. I am confused, though, because labs seem more like MGUS? It is totally possible that the error is with me. These things are kind of hard to read.
My bone marrow biopsy showed 7% monoclonal plasma, my M-spike is at 0.9 g/dL (9 g/L), and my free light chain ratio is 0.03 and I am IgG lambda. The lambda is showing 228.
My question is I thought you had to be at 10% plasma or more and over 1% for a smoldering multiple myeloma diagnosis.
Can someone please help me understand, what am I missing?
Forums
Re: Lab results - smoldering multiple myeloma or MGUS?
Priesta,
With a 7% plasma cell level (less than 10%) and an M-Spike of 0.9 g/dL (less than 3g/dL) I would tend to agree that your diagnosis sounds like MGUS. Are you perhaps looking at a written diagnosis that preceded your bone marrow biopsy test? Your doc might have given you an initial diagnosis of smoldering before all the tests were in? I was originally diagnosed as having MGUS and then it was switched to smoldering when I got my bone marrow biopsy results.
Also, are you working with a doctor that specializes specifically in multiple myeloma?
With a 7% plasma cell level (less than 10%) and an M-Spike of 0.9 g/dL (less than 3g/dL) I would tend to agree that your diagnosis sounds like MGUS. Are you perhaps looking at a written diagnosis that preceded your bone marrow biopsy test? Your doc might have given you an initial diagnosis of smoldering before all the tests were in? I was originally diagnosed as having MGUS and then it was switched to smoldering when I got my bone marrow biopsy results.
Also, are you working with a doctor that specializes specifically in multiple myeloma?
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Lab results - smoldering multiple myeloma or MGUS?
Well that is the confusing part. I was all convinced I had MGUS because I had already done some research about the m-spike. The doctor told me it was smoldering after he had completed all my labs. I said I don't understand because you said it was 7% and I thought it had to be 10% or more for the BMB? He just said that it's all just a numbers situation. He didn't go into detail.
I see him again in December and plan to ask him more questions. He said myeloma is his passion, but I don't know if he is a specialist or not in myeloma.
Should I be concerned about the FLC ratio? I read if it's above or below the recommended level, your chance of switching over to full blown increases significantly. I don't think I have had any FISH studies done.
I see him again in December and plan to ask him more questions. He said myeloma is his passion, but I don't know if he is a specialist or not in myeloma.
Should I be concerned about the FLC ratio? I read if it's above or below the recommended level, your chance of switching over to full blown increases significantly. I don't think I have had any FISH studies done.
Re: Lab results - smoldering multiple myeloma or MGUS?
An FLC ratio of 0.03 = an involved to uninvolved ratio of 33. The ratio is not low, but it also isn't high. One starts to worry when the FLC ratio hits 100 and is accompanied by an involved free light chain (in your case, lambda) value over 100 mg/L.
I'm not sure that your doc saying that multiple myeloma is his passion qualifies him as specialist. If you let us know which city you live in, folks on this forum can recommend some specific centers and/or docs in your area.
If you had a BMB, it would be pretty peculiar if they didn't also do the FISH and cytogenetic studies at that time. But, having said that, those specific lab tests are really hard for a layman to interpret. You really need a doc to summarize the key results from those tests.
I'm not sure that your doc saying that multiple myeloma is his passion qualifies him as specialist. If you let us know which city you live in, folks on this forum can recommend some specific centers and/or docs in your area.
If you had a BMB, it would be pretty peculiar if they didn't also do the FISH and cytogenetic studies at that time. But, having said that, those specific lab tests are really hard for a layman to interpret. You really need a doc to summarize the key results from those tests.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Lab results - smoldering multiple myeloma or MGUS?
This is not necessarily going to answer your question, but I try to make sure patients do not put too much emphasis on text book definitions of MGUS or smoldering myeloma. The key is to know what the M-protein assessments are doing over time and to ensure that regular follow up occurs with disease assessment labs (blood and urine) and imaging (usually x-rays). This is to ensure that, if symptomatic disease develops, it is detected as early as possible and treatment initiated.
Now, to answer your question. With an M-protein of 0.9 and bone marrow plasma cells 7%, I would define this as MGUS.
Now, to answer your question. With an M-protein of 0.9 and bone marrow plasma cells 7%, I would define this as MGUS.
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Dr. Jason Valent - Name: Jason Valent, M.D.
Beacon Medical Advisor
Re: Lab results - smoldering multiple myeloma or MGUS?
Thank you both for your quick responses. I had cytogenetics testing, which I saw a copy of, but it said at the bottom further testing (FISH) may be done upon your request. I am going to ask about that too.
I live in Arkansas, so I'm sure that Little Rock would be where the closest specialist would be for me. I haven't had any x-rays done. It doesn't sound like I need them at this point though. This was all found by accident after suffering from multiple herniated discs and neuropathy.
I appreciate your help. This is a wonderful site to help people make sense of what is going on with their health. Knowledge is power.
I live in Arkansas, so I'm sure that Little Rock would be where the closest specialist would be for me. I haven't had any x-rays done. It doesn't sound like I need them at this point though. This was all found by accident after suffering from multiple herniated discs and neuropathy.
I appreciate your help. This is a wonderful site to help people make sense of what is going on with their health. Knowledge is power.
Re: Lab results - smoldering multiple myeloma or MGUS?
Hi Priesta,
Last year when I had my annual MGUS assessment, my regular oncologist wasn't there and one of her associates read my results. He is in his 50-60's and said decades ago, when he first started in hemetology, his practice referred to MGUSers as smolderers. Now,it is based on specific guidelines.
Diane
Last year when I had my annual MGUS assessment, my regular oncologist wasn't there and one of her associates read my results. He is in his 50-60's and said decades ago, when he first started in hemetology, his practice referred to MGUSers as smolderers. Now,it is based on specific guidelines.
Diane
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DianeM
Re: Lab results - smoldering multiple myeloma or MGUS?
Hi Multibilly,
I have one more question, this may sound dumb but how did you come up with that number 33 for my FLC ratio? Since my lambda light chain is already at 228 mg/L, I want to watch the ratio going forward.
I have one more question, this may sound dumb but how did you come up with that number 33 for my FLC ratio? Since my lambda light chain is already at 228 mg/L, I want to watch the ratio going forward.
Re: Lab results - smoldering multiple myeloma or MGUS?
Priesta wrote:
Dear Priesta,
Not so dumb. Their are two kinds of immunoglobulin light chain molecules, called kappa and lambda. The serum free light chain survey measures the concentration of each one in your blood plasma. Each free light chain has a wide range of normal values, and there are many things other than myeloma that can cause them to vary and even to go outside the normal ranges. However, myeloma almost always generates too much of just one of them (the "involved" light chain), and it often suppresses production of the other ("uninvolved"). Therefore, it is the ratio of the concentrations (one divided by the other) that is a sensitive indicator of the state of the disease.
By convention, it is the kappa/lambda ratio that is normally reported by laboratories. If the involved light chain is kappa, the ratio will be above normal; if it's lambda (as in your case), it will be below normal.
The normal ranges are approximately
kappa 3 to 19 mg/L
lambda 6 to 26 mg/L
kappa/lambda ratio 0.3 to 1.7 (dimensionless)
I say "approximately" because they vary slightly from one lab to another.
You mentioned that your lambda level is 228 (and I assume that you mean 228 mg/L, but not all labs use the same units so it is very important *always* to give the units when reporting any lab result). You didn't mention your kappa level, but you gave the ratio as 0.03, so I calculate that your kappa concentration was 6.8 mg/L, which is within the normal range.
Instead of the kappa/lamba ratio, it's sometimes convenient to give the ratio of involved to uninvolved light chain concentration. If your involved protein is kappa, it's the same. If your involved protein is lambda, it's just 1 / (kappa/lambda). That's what Multibilly was doing: 1/0.03 = 33, so your involved/uninvolved ratio is 33. According to new diagnostic criteria discussed here:
http://newsnetwork.mayoclinic.org/discussion/international-research-group-publishes-updated-criteria-for-diagnosing-multiple-myeloma/ ,
a ratio above 100 with the involved protein above 100 mg/L suggests a diagnosis of active myeloma. You do not meet this criterion.
I hope this helps.
Best wishes,
Larry
I have one more question, this may sound dumb but how did you come up with that number 33 for my FLC ratio? Since my lambda light chain is already at 228 mg/L, I want to watch the ratio going forward."
Dear Priesta,
Not so dumb. Their are two kinds of immunoglobulin light chain molecules, called kappa and lambda. The serum free light chain survey measures the concentration of each one in your blood plasma. Each free light chain has a wide range of normal values, and there are many things other than myeloma that can cause them to vary and even to go outside the normal ranges. However, myeloma almost always generates too much of just one of them (the "involved" light chain), and it often suppresses production of the other ("uninvolved"). Therefore, it is the ratio of the concentrations (one divided by the other) that is a sensitive indicator of the state of the disease.
By convention, it is the kappa/lambda ratio that is normally reported by laboratories. If the involved light chain is kappa, the ratio will be above normal; if it's lambda (as in your case), it will be below normal.
The normal ranges are approximately
kappa 3 to 19 mg/L
lambda 6 to 26 mg/L
kappa/lambda ratio 0.3 to 1.7 (dimensionless)
I say "approximately" because they vary slightly from one lab to another.
You mentioned that your lambda level is 228 (and I assume that you mean 228 mg/L, but not all labs use the same units so it is very important *always* to give the units when reporting any lab result). You didn't mention your kappa level, but you gave the ratio as 0.03, so I calculate that your kappa concentration was 6.8 mg/L, which is within the normal range.
Instead of the kappa/lamba ratio, it's sometimes convenient to give the ratio of involved to uninvolved light chain concentration. If your involved protein is kappa, it's the same. If your involved protein is lambda, it's just 1 / (kappa/lambda). That's what Multibilly was doing: 1/0.03 = 33, so your involved/uninvolved ratio is 33. According to new diagnostic criteria discussed here:
http://newsnetwork.mayoclinic.org/discussion/international-research-group-publishes-updated-criteria-for-diagnosing-multiple-myeloma/ ,
a ratio above 100 with the involved protein above 100 mg/L suggests a diagnosis of active myeloma. You do not meet this criterion.
I hope this helps.
Best wishes,
Larry
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LarryD - Name: Larry D'Addario
- Who do you know with myeloma?: wife
- When were you/they diagnosed?: September 2012
- Age at diagnosis: 65
Re: Lab results - smoldering multiple myeloma or MGUS?
Since you have lambda-type multiple myeloma, you just invert your k/l FLC ratio from your lab result to get to the involved/uninvolved (l/k) FLC ratio. You said your FLC ratio was 0.03. 1/(0.03) = 33 = your l/k ratio. Or, you could just take you lambda number and divide it by your kappa number and you should also get something close to 33.
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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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