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Re: Suppression of uninvolved immunoglobulins / HLC pairs?
Hi Helen, i am just right next door to you in Calgary! I did have an initial dx of myeloma, and before I had a BMB to determine that I did have the blood test SPEP (to determine the monoclonal protein by gel electrophoresis), and other tests for the CRAB symptoms. Those are anemia, renal function, calcium levels in the blood and bone damage. (Six years ago I do not think that the serum free light chain test was available here yet) The SPEP test was abnormal, which is why I needed also a BMB, before I could start treatment. I haven't had the Hevylite test, but have heard it described at talks I have been to at myeloma conferences. I wouldn't have had a BMB, unless my blood tests showed myeloma I think! Good luck!
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: Suppression of uninvolved immunoglobulins / HLC pairs?
Hi Nancy,
Another Canadian, eh? You live in beautiful Calgary...just next door to me but over a massive mountain range! We are certainly blessed in Canada (in some ways) with our health care system as I have read some in the US have to battle with their insurance company for every test. We do have our own issues here, however (at least in Vancouver).
I am sorry to hear you have to deal with multiple myeloma. I hope things remain stable for you for many, many years to come.
We newbies really appreciate all the advice and knowledge that you share with us. Those conferences sound intriguing. I hope that I do not bury my head in the sand if my MGUS progresses.
All the best to you,
Helen
Another Canadian, eh? You live in beautiful Calgary...just next door to me but over a massive mountain range! We are certainly blessed in Canada (in some ways) with our health care system as I have read some in the US have to battle with their insurance company for every test. We do have our own issues here, however (at least in Vancouver).
I am sorry to hear you have to deal with multiple myeloma. I hope things remain stable for you for many, many years to come.
We newbies really appreciate all the advice and knowledge that you share with us. Those conferences sound intriguing. I hope that I do not bury my head in the sand if my MGUS progresses.
All the best to you,
Helen
Re: Suppression of uninvolved immunoglobulins / HLC pairs?
Thanks Helen, Hope that if you do have MGUS, it just stays that way and doesn't progress further! We are blessed here to have universal health care, but like any other system, there is always room for improvement too. I like to study myeloma and also issues of advocacy as to how it pertains to that. Since I have now been involved with this for about six years, that has given me the opportunity to learn more and hopefully be of some help in 'citizen participation ' of our health care system, if you know what I mean! Through the Beacon in particular, I have been able to compare and contrast between our system and others too. I thank my good fortune so far that I have had the time and energy to do that also, for certainly many others have not been so lucky.
Enjoy the early spring on the west coast, I have seen a lot of pictures of flowering spring bulbs, trees in blossom and more! Take good care of yourself!
Enjoy the early spring on the west coast, I have seen a lot of pictures of flowering spring bulbs, trees in blossom and more! Take good care of yourself!
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: Suppression of uninvolved immunoglobulins / HLC pairs?
Hi Multibilly,
Thanks again for your reply earlier.
I went to see my oncologist/hematologist yesterday. She said that I can't compare these two numbers (my IgG M-spike and my IgG immunoglobulin numbers) because it is like comparing apples and oranges. She said the test is performed differently. It could also be that you mention the heavy chain immunoglobulin and I think that just my regular immunoglobulin was tested.
She still wants me to do the blood work-up every three months for another year. She was very thorough in checking me over physically (checking my lymph nodes and liver).
Take care and thanks again for your input. Your replies are always encouraging and informative.
Helen
Thanks again for your reply earlier.
I went to see my oncologist/hematologist yesterday. She said that I can't compare these two numbers (my IgG M-spike and my IgG immunoglobulin numbers) because it is like comparing apples and oranges. She said the test is performed differently. It could also be that you mention the heavy chain immunoglobulin and I think that just my regular immunoglobulin was tested.
She still wants me to do the blood work-up every three months for another year. She was very thorough in checking me over physically (checking my lymph nodes and liver).
Take care and thanks again for your input. Your replies are always encouraging and informative.
Helen
Re: Suppression of uninvolved immunoglobulins / HLC pairs?
Hi, Helen,
My specialist seems to be of the same view as yours. She told me the same thing practically using the same words.
However, there are several posts by volunteer doctors here in the Forum who take the view that Multibilly described, i.e., that you normally subtract the M-spike value from the total immunoglobulin value. I am sure that the the whole issue must be quite complex. For example, in the case of IgA myeloma, one definitely cannot rely on the normal formula indicated by the doctors and Multibilly. Whether this is true for IgG, I just do not know.
My doctor never explained what she meant by "apples and oranges." I wish she had.
My specialist seems to be of the same view as yours. She told me the same thing practically using the same words.
However, there are several posts by volunteer doctors here in the Forum who take the view that Multibilly described, i.e., that you normally subtract the M-spike value from the total immunoglobulin value. I am sure that the the whole issue must be quite complex. For example, in the case of IgA myeloma, one definitely cannot rely on the normal formula indicated by the doctors and Multibilly. Whether this is true for IgG, I just do not know.
My doctor never explained what she meant by "apples and oranges." I wish she had.
Re: Suppression of uninvolved immunoglobulins / HLC pairs?
Hi all,
Unless there was some miscommunication, I'm really baffled why a hematologist / oncologist or myeloma specialist would use the phrase "apples to oranges" to describe the statements that have been made in this thread about the relationship between a patient's total level of a specific immunoglobulin, how much "normal" immunoglobulin the patient has of that type, and a patient's M-spike.
It's true that there can be errors in the measurement of both the total level of a particular immunoglobulin (such as IgA) and of M-spikes (particularly IgA M-spikes). However, I think it's basically true by definition that if someone, for example, has IgG myeloma, then they have two types of IgG immunoglobulin in their blood: healthy (polyclonal) IgG, and unhealthy (monoclonal) IgG.
So, sure, all sorts of measurement errors will cause the equation
Total IgG = Healthy IgG + IgG M-spike
to not be exactly true for a given set of test results. But "apples and oranges"? That seems an extreme statement.
As I said, maybe this is a communication issue. SPEP reports, for example, list your "gamma globulin". That is NOT your IgG level. Your (total) IgG, IgA, and IgM levels are reported in the serum immunoglobulins lab report. If you have IgG myeloma, for example, it is the IgG level from the serum immunoglobulins lab report that can be thought of as being the sum of your healthy IgG levels and your M-spike.
Also, just to be clear, it's not just a few isolated people here in the forum who have brought up this way of splitting a given total immunoglobulin level into "healthy" and "unhealthy" components. It took me only a few quick searches to find at least four myeloma specialists who have made postings explaining this way of looking at immunoglobulin levels.
Dr. Craig Hofmeister of Ohio State, for example, uses the approach in this forum thread:
"IgA immunoglobulin vs. M-spike" (started Jan 25, 2011)
And Dr. Peter Voorhees of UNC-Chapel Hill uses it in this thread:
"Remission, what does it mean?" (started Dec 10, 2013)
Dr. Shain (Moffitt) and Dr. Kaufman (Emory) also mention it in other threads.
Maybe all these respected myeloma specialists and researchers have got it wrong, but somehow I doubt that.
Unless there was some miscommunication, I'm really baffled why a hematologist / oncologist or myeloma specialist would use the phrase "apples to oranges" to describe the statements that have been made in this thread about the relationship between a patient's total level of a specific immunoglobulin, how much "normal" immunoglobulin the patient has of that type, and a patient's M-spike.
It's true that there can be errors in the measurement of both the total level of a particular immunoglobulin (such as IgA) and of M-spikes (particularly IgA M-spikes). However, I think it's basically true by definition that if someone, for example, has IgG myeloma, then they have two types of IgG immunoglobulin in their blood: healthy (polyclonal) IgG, and unhealthy (monoclonal) IgG.
So, sure, all sorts of measurement errors will cause the equation
Total IgG = Healthy IgG + IgG M-spike
to not be exactly true for a given set of test results. But "apples and oranges"? That seems an extreme statement.
As I said, maybe this is a communication issue. SPEP reports, for example, list your "gamma globulin". That is NOT your IgG level. Your (total) IgG, IgA, and IgM levels are reported in the serum immunoglobulins lab report. If you have IgG myeloma, for example, it is the IgG level from the serum immunoglobulins lab report that can be thought of as being the sum of your healthy IgG levels and your M-spike.
Also, just to be clear, it's not just a few isolated people here in the forum who have brought up this way of splitting a given total immunoglobulin level into "healthy" and "unhealthy" components. It took me only a few quick searches to find at least four myeloma specialists who have made postings explaining this way of looking at immunoglobulin levels.
Dr. Craig Hofmeister of Ohio State, for example, uses the approach in this forum thread:
"IgA immunoglobulin vs. M-spike" (started Jan 25, 2011)
And Dr. Peter Voorhees of UNC-Chapel Hill uses it in this thread:
"Remission, what does it mean?" (started Dec 10, 2013)
Dr. Shain (Moffitt) and Dr. Kaufman (Emory) also mention it in other threads.
Maybe all these respected myeloma specialists and researchers have got it wrong, but somehow I doubt that.
Re: Suppression of uninvolved immunoglobulins / HLC pairs?
Thanks Terry & mrozdav,
Very interesting that mrozdav received exactly the same reply to the same question.
My lab reports definitely called the test results Serum Proteins: Immunoglobulins. My results were as shown below. My M-spike was (9.5 g/L = 0.95 g/dL) IgG lambda.
IgG 12.2 g/L (reference 6.7-15.2)
IgA 1.32 g/L (reference 0.70-4.00)
IgM 1.11 g/L (reference 0.40-2.30)
So then my Total IgG = Healthy IgG + IgG M-spike would be 12.2 g/L = 2.7 g/L + 9.5 g/L. So my "healthy" IgG is only 2.7 g/L which is well below the reference range.
Does that mean most people (with an M-spike) have a fairly high total IgG if the healthy IgG is to fall within the reference range? I would have to have a total IgG of 16.2 g/L for my healthy IgG to be inside that reference range. Am I correct in this thinking?
Unless I have some unusual readings, my next appointment with the oncologist / hematologist is in one year ... long time to wait to ask about it again.
Very interesting that mrozdav received exactly the same reply to the same question.
My lab reports definitely called the test results Serum Proteins: Immunoglobulins. My results were as shown below. My M-spike was (9.5 g/L = 0.95 g/dL) IgG lambda.
IgG 12.2 g/L (reference 6.7-15.2)
IgA 1.32 g/L (reference 0.70-4.00)
IgM 1.11 g/L (reference 0.40-2.30)
So then my Total IgG = Healthy IgG + IgG M-spike would be 12.2 g/L = 2.7 g/L + 9.5 g/L. So my "healthy" IgG is only 2.7 g/L which is well below the reference range.
Does that mean most people (with an M-spike) have a fairly high total IgG if the healthy IgG is to fall within the reference range? I would have to have a total IgG of 16.2 g/L for my healthy IgG to be inside that reference range. Am I correct in this thinking?
Unless I have some unusual readings, my next appointment with the oncologist / hematologist is in one year ... long time to wait to ask about it again.
Re: Suppression of uninvolved immunoglobulins / HLC pairs?
Helen,
Do you have an earlier set of lab tests you can look at for comparison? Lab errors always can and do occur. As one of my specialists likes to say, "If you don't like your lab results, just repeat them ... you will like them better a second time around"
Do you have an earlier set of lab tests you can look at for comparison? Lab errors always can and do occur. As one of my specialists likes to say, "If you don't like your lab results, just repeat them ... you will like them better a second time around"
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Suppression of uninvolved immunoglobulins / HLC pairs?
Hi Multibilly,
I checked back over all my results for every test I have had. The results are always low.
Here are my "healthy" IgG results (achieved from subtracting my M-Spike from my total IgG):
4.5 g/L (two weeks ago - my M-Spike went down to 7.8 g/L and total IgG measured 12.3 g/L.)
2.7 g/L (Jan 2015)
2.9 g/L
2.6 g/L
1.2 g/L
3.9 g/L (Jan 2014)
The reference range is 6.7 - 15.2 g/L.
So, I don't think there was a mistake. Perhaps this is a sign of some autoimmune problem?
I checked back over all my results for every test I have had. The results are always low.
Here are my "healthy" IgG results (achieved from subtracting my M-Spike from my total IgG):
4.5 g/L (two weeks ago - my M-Spike went down to 7.8 g/L and total IgG measured 12.3 g/L.)
2.7 g/L (Jan 2015)
2.9 g/L
2.6 g/L
1.2 g/L
3.9 g/L (Jan 2014)
The reference range is 6.7 - 15.2 g/L.
So, I don't think there was a mistake. Perhaps this is a sign of some autoimmune problem?
Re: Suppression of uninvolved immunoglobulins / HLC pairs?
Helen, I am very glad to hear your specialist is seeing you every 3 months 
And if I remember correctly, you are having a BMB in a month or so? Good follow up!
I wonder, do you get sick frequently? That low of a immunoglobulin G often results in susceptibility to illness. I think you said you have breathing problems and arthritis?
Here is an interesting study which shows that polyclonal IgG tends to be suppressed to a greater degree than IgA and IgM:
L Wang & DC Young, "Suppression of Polyclonal Immunoglobulin Production by M-proteins Shows Isotype Specificity," Annals of Clinical & Laboratory Science, Summer 2001 (full text of article)
And if I remember correctly, you are having a BMB in a month or so? Good follow up!I wonder, do you get sick frequently? That low of a immunoglobulin G often results in susceptibility to illness. I think you said you have breathing problems and arthritis?
Here is an interesting study which shows that polyclonal IgG tends to be suppressed to a greater degree than IgA and IgM:
L Wang & DC Young, "Suppression of Polyclonal Immunoglobulin Production by M-proteins Shows Isotype Specificity," Annals of Clinical & Laboratory Science, Summer 2001 (full text of article)
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Toni - Name: Toni
- Who do you know with myeloma?: self - MGUS
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 51
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