Recently I went to what I thought was a routine follow up appointment with my new rheumatologist. I was diagnosed about 10 years ago with Lupus. He told me that all of my labs regarding Lupus were negative and he didn't know why I was diagnosed with it.
He then said I did have some abnormal labs however and I needed to see a hematologist because it could be in his words"lymphoma". My SPEP was Beta 1.64 and Gamma 0.46 with a monoclonal pattern. The only other really abnormal lab I had was a very low Vitamin D which was 13.34.
I saw the hematologist who stated this could and probably is nothing but he couldn't ignore it and needed to run some more tests. Well I have received some but not all values back and my IgA is 838 while my IgG is 575. The IgM is normal. Platelets are a little low at 370. I am waiting for the results of the 24 hr urine for BJP and Light Chains now. Oh yeah my Beta 2 micro was 2.
What is the significance of all of this? I was convinced it was nothing until the IgA came back so high. Now I am not sure. I should mention I am on chronic steroids for what I thought were symptoms related to Lupus and have been for years. I recently decided to wean myself off of them and have been decreasing the steroids by 1mg per month for the last 5 months. Started at 20mg per day which I had been on for years and now am down to 15mg per day. Could these steroids affect the results? I am a nurse practitioner and from what I know the steroids would have actually suppressed all of this and they could actually be higher. Am I wrong?
Please help?
Angie
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angiebaldy - Name: angiebaldy
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Sept 2012 MGUS Jan. 2014 SMM
- Age at diagnosis: 47
Re: SPEP Monoclonal Pattern
Hi Angie - Feel bad you are going thru this. I'm clearly not as educated or informed as many of this forum are, but you don't really know what is going on until all the tests come back. The waiting is the worst.
However, I do know what you are feeling. In Oct during a routine blood test, I had an M spike of 1 and was referred to a hemo-oncologist. It took a month to see her and I couldn't stop thinking/reading/obsessing about the M spike. When I finally saw her, she ran another blood test and the M spike increased to 1.5 - by then I was convinced I had at least Smoldering multiple myeloma. For another month, I waited for results from the 24 hr urine, total bone x-rays, and finally a BMA. My diagnosis is Ig G MGUS with trisomic 7. Soon I will have my first 6 month blood test since diagnosed and am trying not to obsess on the M spike.
Like you, I started questioning the drug I take (synthyroid) and having years of chronic insomnia, but my doctor said there was no assoc. Take care, Diane
However, I do know what you are feeling. In Oct during a routine blood test, I had an M spike of 1 and was referred to a hemo-oncologist. It took a month to see her and I couldn't stop thinking/reading/obsessing about the M spike. When I finally saw her, she ran another blood test and the M spike increased to 1.5 - by then I was convinced I had at least Smoldering multiple myeloma. For another month, I waited for results from the 24 hr urine, total bone x-rays, and finally a BMA. My diagnosis is Ig G MGUS with trisomic 7. Soon I will have my first 6 month blood test since diagnosed and am trying not to obsess on the M spike.
Like you, I started questioning the drug I take (synthyroid) and having years of chronic insomnia, but my doctor said there was no assoc. Take care, Diane
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dianem
Re: SPEP Monoclonal Pattern
Angie,
From what you've described, it does sound like you have an IgA monoclonal gammopathy, but you need more information to determine if this is MGUS (monoclonal gammopathy of unknown significance), smoldering myeloma, or active multiple myeloma. The first 2 are characterized by the presence of a monoclonal protein in serum and/or urine plus abnormal plasma cells in the bone marrow, but no end-organ damage (i.e. no CRAB criteria - no elevated Calcium, no Renal (kidney) failure, no significant Anemia, no Bone lesions). In these cases, no treatment is required other than close observation. If there is evidence for 1 or more CRAB criteria, then the diagnosis is active myeloma and treatment is generally required.
The work-up to differentiate these diagnoses generally includes blood and urine tests, xrays of the bones (called a skeletal survey), and a bone marrow biopsy. Sometimes other imaging tests (like MRI or PET scans) are performed as well. Once you have all of these results, your hematologist should be able to tell you the diagnosis. It is possible that the chronic prednisone use has kept this in check somewhat and suppressed the IgA level, but it shouldn't preclude the ability to make a diagnosis.
From what you've described, it does sound like you have an IgA monoclonal gammopathy, but you need more information to determine if this is MGUS (monoclonal gammopathy of unknown significance), smoldering myeloma, or active multiple myeloma. The first 2 are characterized by the presence of a monoclonal protein in serum and/or urine plus abnormal plasma cells in the bone marrow, but no end-organ damage (i.e. no CRAB criteria - no elevated Calcium, no Renal (kidney) failure, no significant Anemia, no Bone lesions). In these cases, no treatment is required other than close observation. If there is evidence for 1 or more CRAB criteria, then the diagnosis is active myeloma and treatment is generally required.
The work-up to differentiate these diagnoses generally includes blood and urine tests, xrays of the bones (called a skeletal survey), and a bone marrow biopsy. Sometimes other imaging tests (like MRI or PET scans) are performed as well. Once you have all of these results, your hematologist should be able to tell you the diagnosis. It is possible that the chronic prednisone use has kept this in check somewhat and suppressed the IgA level, but it shouldn't preclude the ability to make a diagnosis.
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Dr. Adam Cohen - Name: Adam D. Cohen, M.D.
Beacon Medical Advisor
Re: SPEP Monoclonal Pattern
Thank you both so much! I have a follow up appointment on the 19th and the rest of my labs and the 24 hr urine should be back then. As you can probably tell I am a worrier!
My husband has already told me to settle down and wait for all of the information to come in before I worry about all the "what ifs". He is right but that is easier said than done. I wil try to put it in the back of my mind if I can though!
My husband has already told me to settle down and wait for all of the information to come in before I worry about all the "what ifs". He is right but that is easier said than done. I wil try to put it in the back of my mind if I can though!
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angiebaldy - Name: angiebaldy
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Sept 2012 MGUS Jan. 2014 SMM
- Age at diagnosis: 47
4 posts
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