I read that having a heavy / light chain (HLC) pair suppression is considered a risk factor for progression to multiple myeloma. I am having trouble getting my head around what a suppressed HLC-pair is. I tried googling, which confused me even more.
Anyone have any knowledge of this?
These are my out-of-range blood results:
Suppressed Beta 2 Globulin (1.6 g/L) reference range is 1.8 - 4.8 g/L. My Alpha 1, Alpha 2, and Beta 1 Globulins are all low - albeit still just inside the reference range.
M-spike is 9.5 g/L (0.95 g/dL). This bounces around every 3 months, from just under 9 to 11 g/L (0.9-1.1 g/dL). Whenever this test comes back, they add: Polyclonal immunoglobulins are suppressed.
WBC 3.2 x 10^9/L (reference range is 4.0-11.0)
Platelet count 135 x 10^9/L (reference range is 150-400)
Neutrophils 1.7 x 10^9/L (reference range 2.0-8.0)
Lymphocytes 0.8 x 10^9/L (reference range 1.2 - 3.5)
My free light chain ratio is low-ish but in reference range at 0.39 (range 0.26-1.65).
Any help would be appreciated. I see a hematologist/oncologist for a consult next month so I wanted to know whether I should be requesting a BMB.
Thanks!
Helen
Forums
Re: Suppression of uninvolved immunoglobulins / HLC pairs?
Hello Hellen,
Thank you for posting your questions. Note that unless an actual physician replies to your message, we're all basically lay people doing the best we can to help answer questions
I am also MGUS with an M-spike between 0.85 and 1.1 g/dL. I was diagnosed about a year ago.
First, your M-spike seems to be stable. How long ago were you diagnosed? From what I"ve read, they don't get too concerned about your M-spike unless it's higher than 3.0 g/dL or if there's a significant jump in its level (50% I believe is what I've heard), and they always look for trends, not just one measurement.
Second, the kappa-lambda free light chain ratio is what they look at for a possible risk factor for MGUS. Yours is still within range, so that's good.
Third, I may be wrong, but are you talking about suppression of your non-involved immunoglobulins? Which of yours is cloned? For example, the preponderance of MGUS patients have IgG kappa light chain MGUS. So suppression would be your IgA or IgM. If I understand your questions correctly, then suppression of the non-involved immunoglobulin is also called immunoparesis. If I am correctly understanding you, then do you have the results of your Immunoglobulin A, Immunoglobulin G and Immunoglobulin M?
It is important to know this because because there is a formula to figure out if it is significant.
Fourth, I would be concerned about your other numbers as well. I would want to know why your platelets are low. Have you been ill lately? Have you had to take any antibiotics, or are there other diseases / conditions you have that could impact these?
Lastly, I was very much encouraged here on the Myeloma Beacon to have a BMB. I am very glad I did. The only reason why I didn't want to is because I had heard it was very painful. With the right pain medication, it can be just fine, and the information it provides is infinitely useful.
As some on this board pointed out, there's really no way to know if you are MGUS or SMM unless you have a BMB done.
In my case, it confirmed MGUS as a diagnosis. It also confirmed that there were no chromosomal abnormalities.
I have had suppression of IgM and a history of frequent infections (URIs most commonly) which has caused me to need antibiotics 3 times a year minimally.
My first oncologist was very casual about observing MGUS. He felt you didn't need to have much follow up. And that's fine for many people, but I just wasn't comfortable with it, particularly because I'm sick so often.
I switched to a different oncologist who is following me more closely. Now I feel healthy, but from what I've read, there are issues that patients with a monoclonal gammopathy can be prone too, although they are rare. So it's prudent to find out as much as you can, especially in the beginning.
One more question, did you have a bone density and full body x-ray to see if there's any bone involvement?
I haven't been on this board in some time, so if you've already posted a lot, I am sorry for asking so many questions, but I think it's important to understand better what other issues you might be dealing with.
Be well
Thank you for posting your questions. Note that unless an actual physician replies to your message, we're all basically lay people doing the best we can to help answer questions
I am also MGUS with an M-spike between 0.85 and 1.1 g/dL. I was diagnosed about a year ago.
First, your M-spike seems to be stable. How long ago were you diagnosed? From what I"ve read, they don't get too concerned about your M-spike unless it's higher than 3.0 g/dL or if there's a significant jump in its level (50% I believe is what I've heard), and they always look for trends, not just one measurement.
Second, the kappa-lambda free light chain ratio is what they look at for a possible risk factor for MGUS. Yours is still within range, so that's good.
Third, I may be wrong, but are you talking about suppression of your non-involved immunoglobulins? Which of yours is cloned? For example, the preponderance of MGUS patients have IgG kappa light chain MGUS. So suppression would be your IgA or IgM. If I understand your questions correctly, then suppression of the non-involved immunoglobulin is also called immunoparesis. If I am correctly understanding you, then do you have the results of your Immunoglobulin A, Immunoglobulin G and Immunoglobulin M?
It is important to know this because because there is a formula to figure out if it is significant.
Fourth, I would be concerned about your other numbers as well. I would want to know why your platelets are low. Have you been ill lately? Have you had to take any antibiotics, or are there other diseases / conditions you have that could impact these?
Lastly, I was very much encouraged here on the Myeloma Beacon to have a BMB. I am very glad I did. The only reason why I didn't want to is because I had heard it was very painful. With the right pain medication, it can be just fine, and the information it provides is infinitely useful.
As some on this board pointed out, there's really no way to know if you are MGUS or SMM unless you have a BMB done.
In my case, it confirmed MGUS as a diagnosis. It also confirmed that there were no chromosomal abnormalities.
I have had suppression of IgM and a history of frequent infections (URIs most commonly) which has caused me to need antibiotics 3 times a year minimally.
My first oncologist was very casual about observing MGUS. He felt you didn't need to have much follow up. And that's fine for many people, but I just wasn't comfortable with it, particularly because I'm sick so often.
I switched to a different oncologist who is following me more closely. Now I feel healthy, but from what I've read, there are issues that patients with a monoclonal gammopathy can be prone too, although they are rare. So it's prudent to find out as much as you can, especially in the beginning.
One more question, did you have a bone density and full body x-ray to see if there's any bone involvement?
I haven't been on this board in some time, so if you've already posted a lot, I am sorry for asking so many questions, but I think it's important to understand better what other issues you might be dealing with.
Be well
-
Toni - Name: Toni
- Who do you know with myeloma?: self - MGUS
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 51
Re: Suppression of uninvolved immunoglobulins / HLC pairs?
Hi Helen,
As Toni has explained, the "M-spike" (paraprotein, M-protein, etc.) that most MGUS, smoldering myeloma, and multiple myeloma patients have is caused by high levels of a specific immunoglobulin. This is the "involved" immunoglobulin, and it is elevated because the disease is creating lots of monoclonal versions of the same immunoglobulin. If you didn't have MGUS or myeloma, you would only have polyclonal immunoglobulins.
The involved immunoglobulin is identified through the serum immunofixation electrophoresis (IFE) test and is generally described in terms like "IgG lambda" or "IgA kappa". The results of this test are what lead doctors to tell patients, for example, that you have "IgG kappa multiple myeloma."
Immunoglobulins are composed of both heavy chains and light chains. When someone talks about an "IgA lambda" immunoglobulin, the "IgA" part identifies the heavy chain part of the immunoglobulin, and the "lambda" part identifies the light chain part of the immunoglobulin.
Recently, a test was introduced (the "Hevylite assay") that makes it possible to measure how much of each of six different types of immunoglobulins are in a sample of a patient's blood: IgG kappa, IgG lambda, IgA kappa, IgA lambda, IgM kappa, and IgM lambda. Each of these immunoglobulins is called a heavy / light chain (HLC).
Someone who has MGUS or untreated myeloma will have an elevated level of one of those six HLCs (unless they have a rare IgD or IgE MGUS or myeloma). That will be their "involved" HLC. The other five HLCs will be their "uninvolved" HLCs.
Because the Hevylite test only recently became available, researchers are just starting to assess whether suppression of HLCs matters in terms of the likelihood of an MGUS or smoldering myeloma patient progressing to multiple myeloma.
One study that has been done for MGUS is one that I've referenced at the end of this posting. It found that suppression of HLCs is, in fact, a signal that a patient's MGUS is more likely to progress to myeloma.
The researchers focused in particular on what they called "HLC pair suppression", which is I think what you really wanted to understand. Here is what it is.
If an MGUS patient had IgG kappa MGUS, then they were classified as having HLC pair suppression if their IgG LAMBDA HLC was below the lower limit of the normal range for IgG lambda.
In other words, a patient has HLC pair suppression when their HLC that has the same heavy chain, but different light chain, as their involved HLC is below the normal range.
I hope that, with this background information, the paper I mentioned above will make more sense to you.
I should add that the paper will only be helpful to you if your doctor is able to have a Hevylite test done with a sample of your blood.
Good luck!
Reference:
JA Katzmann et al, "Suppression of uninvolved immunoglobulins defined by heavy/light chain pair suppression is a risk factor for progression of MGUS," Leukemia, Jan 2013 (link to abstract; link to full text at PubMed)
Abstract:
We hypothesized that the suppression of uninvolved immunoglobulin in monoclonal gammopathy of undetermined significance (MGUS) as detected by suppression of the isotype-specific heavy and light chain (HLC-pair suppression) increases the risk of progression to malignancy. This approach required quantitation of individual heavy/light chains (for example, IgGλ in IgGκ MGUS patients).
Of 1384 MGUS patients from Southeastern Minnesota seen at the Mayo Clinic from 1960 to 1994, baseline serum samples obtained within 30 days of diagnosis were available in 999 persons. We identified HLC-pair suppression in 27% of MGUS patient samples compared with 11% of patients with suppression of uninvolved IgG, IgA or IgM.
HLC-pair suppression was a significant risk factor for progression (hazard ratio (HR), 2.3; 95% confidence interval (CI) 1.5–3.7; P<0.001). On multivariate analysis, HLC-pair suppression was an independent risk factor for progression to malignancy in combination with serum M-spike size, heavy chain isotype and free light chain ratio (HR, 1.8; 95% CI, 1.1–3.00; P=0.018).
The finding that HLC-pair suppression predicts progression in MGUS and occurs several years before malignant transformation has implications for myeloma biology.
As Toni has explained, the "M-spike" (paraprotein, M-protein, etc.) that most MGUS, smoldering myeloma, and multiple myeloma patients have is caused by high levels of a specific immunoglobulin. This is the "involved" immunoglobulin, and it is elevated because the disease is creating lots of monoclonal versions of the same immunoglobulin. If you didn't have MGUS or myeloma, you would only have polyclonal immunoglobulins.
The involved immunoglobulin is identified through the serum immunofixation electrophoresis (IFE) test and is generally described in terms like "IgG lambda" or "IgA kappa". The results of this test are what lead doctors to tell patients, for example, that you have "IgG kappa multiple myeloma."
Immunoglobulins are composed of both heavy chains and light chains. When someone talks about an "IgA lambda" immunoglobulin, the "IgA" part identifies the heavy chain part of the immunoglobulin, and the "lambda" part identifies the light chain part of the immunoglobulin.
Recently, a test was introduced (the "Hevylite assay") that makes it possible to measure how much of each of six different types of immunoglobulins are in a sample of a patient's blood: IgG kappa, IgG lambda, IgA kappa, IgA lambda, IgM kappa, and IgM lambda. Each of these immunoglobulins is called a heavy / light chain (HLC).
Someone who has MGUS or untreated myeloma will have an elevated level of one of those six HLCs (unless they have a rare IgD or IgE MGUS or myeloma). That will be their "involved" HLC. The other five HLCs will be their "uninvolved" HLCs.
Because the Hevylite test only recently became available, researchers are just starting to assess whether suppression of HLCs matters in terms of the likelihood of an MGUS or smoldering myeloma patient progressing to multiple myeloma.
One study that has been done for MGUS is one that I've referenced at the end of this posting. It found that suppression of HLCs is, in fact, a signal that a patient's MGUS is more likely to progress to myeloma.
The researchers focused in particular on what they called "HLC pair suppression", which is I think what you really wanted to understand. Here is what it is.
If an MGUS patient had IgG kappa MGUS, then they were classified as having HLC pair suppression if their IgG LAMBDA HLC was below the lower limit of the normal range for IgG lambda.
In other words, a patient has HLC pair suppression when their HLC that has the same heavy chain, but different light chain, as their involved HLC is below the normal range.
I hope that, with this background information, the paper I mentioned above will make more sense to you.
I should add that the paper will only be helpful to you if your doctor is able to have a Hevylite test done with a sample of your blood.
Good luck!
Reference:
JA Katzmann et al, "Suppression of uninvolved immunoglobulins defined by heavy/light chain pair suppression is a risk factor for progression of MGUS," Leukemia, Jan 2013 (link to abstract; link to full text at PubMed)
Abstract:
We hypothesized that the suppression of uninvolved immunoglobulin in monoclonal gammopathy of undetermined significance (MGUS) as detected by suppression of the isotype-specific heavy and light chain (HLC-pair suppression) increases the risk of progression to malignancy. This approach required quantitation of individual heavy/light chains (for example, IgGλ in IgGκ MGUS patients).
Of 1384 MGUS patients from Southeastern Minnesota seen at the Mayo Clinic from 1960 to 1994, baseline serum samples obtained within 30 days of diagnosis were available in 999 persons. We identified HLC-pair suppression in 27% of MGUS patient samples compared with 11% of patients with suppression of uninvolved IgG, IgA or IgM.
HLC-pair suppression was a significant risk factor for progression (hazard ratio (HR), 2.3; 95% confidence interval (CI) 1.5–3.7; P<0.001). On multivariate analysis, HLC-pair suppression was an independent risk factor for progression to malignancy in combination with serum M-spike size, heavy chain isotype and free light chain ratio (HR, 1.8; 95% CI, 1.1–3.00; P=0.018).
The finding that HLC-pair suppression predicts progression in MGUS and occurs several years before malignant transformation has implications for myeloma biology.
Last edited by Cheryl G on Sat Mar 21, 2015 7:30 pm, edited 1 time in total.
Re: Suppression of uninvolved immunoglobulins / HLC pairs?
Thanks so much Toni and Cheryl!
You have given me a lot of excellent information that I will need to process. I am still a bit slow learning about all this stuff.
I should have added that my monoclonal band is in the gamma region (IgG).
Also, I have known about the M-spike for just over a year - I was tested because of arthritis "flare-ups" that cause painful, swollen, hot, and red joints. Plus, I have chest pain when I breath and I cough a lot. I did eventually get a chest MRI, which showed nothing - amazing, considering how much it hurts to take deep breaths (especially with exercise).
For some reason, my platelets and WBC seem to be low with every test. I actually feel okay (and try to avoid being around sick people).
I'll take a look more thoroughly at the information you have given me. I am scared of BMB because of the possibility of pain (like you were, Toni). I think I remember hearing of a few scary experiences from the forums here.
Thanks again,
Helen
You have given me a lot of excellent information that I will need to process. I am still a bit slow learning about all this stuff.
I should have added that my monoclonal band is in the gamma region (IgG).
Also, I have known about the M-spike for just over a year - I was tested because of arthritis "flare-ups" that cause painful, swollen, hot, and red joints. Plus, I have chest pain when I breath and I cough a lot. I did eventually get a chest MRI, which showed nothing - amazing, considering how much it hurts to take deep breaths (especially with exercise).
For some reason, my platelets and WBC seem to be low with every test. I actually feel okay (and try to avoid being around sick people).
I'll take a look more thoroughly at the information you have given me. I am scared of BMB because of the possibility of pain (like you were, Toni). I think I remember hearing of a few scary experiences from the forums here.
Thanks again,
Helen
Re: Suppression of uninvolved immunoglobulins / HLC pairs?
Have either of you, Cheryl or Toni (or anyone else reading), had this Hevylite assay? I don't think I have had this blood work-up performed; since it is fairly new, most people are probably in the same boat.
I do have something on my report called Serum Proteins: Immunoglobulins. These are not broken down into HLC but, since they are not suppressed, I am thinking that is good.
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)
BTW My monoclonal band (9.5 g/L = 0.95 g/dL) is in the mid gamma region and has been identified as IgG lambda (not kappa).
Cheers,
Helen
I do have something on my report called Serum Proteins: Immunoglobulins. These are not broken down into HLC but, since they are not suppressed, I am thinking that is good.
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)
BTW My monoclonal band (9.5 g/L = 0.95 g/dL) is in the mid gamma region and has been identified as IgG lambda (not kappa).
Cheers,
Helen
Re: Suppression of uninvolved immunoglobulins / HLC pairs?
Hi Helen,
You've received some great comments from Toni and Cheryl.
First off, I'm not a doc, so please take whatever I say with a grain of salt and check all this with your doc.
You said you have IgG kappa type multiple myeloma. This means that your M-spike is made up of monoclonal versions of your the IgG heavy chain immunoglobluin (that is, your "involved" immunoglobulin).
The IgG level you reported (IgG = 12.2 g/L (reference 6.7-15.2 g/L)) measures both the monoclonal version of IgG (that is, the M-spike), plus the normal, healthy version of your IgG. Roughly speaking, your healthy IgG level is the measured IgG level minus the M-spike (12.2 g/L - 9.5 g/L = 2.7 g/L).
If you compare a healthy, normal level of IgG (6.7-15.2 g/L), to your level of 2.7 g/L, you would appear to have some sort of IgG deficiency going on. One cause of this can be a condition known as hypogammaglobulinemia. It could also be that the multiple myeloma is just suppressing the normal IgG, but only a doctor can tell by looking at everything that is going on with your blood work.
Has your doctor discussed this with you? Are these recent lab results similar to earlier lab results?
You've received some great comments from Toni and Cheryl.
First off, I'm not a doc, so please take whatever I say with a grain of salt and check all this with your doc.
You said you have IgG kappa type multiple myeloma. This means that your M-spike is made up of monoclonal versions of your the IgG heavy chain immunoglobluin (that is, your "involved" immunoglobulin).
The IgG level you reported (IgG = 12.2 g/L (reference 6.7-15.2 g/L)) measures both the monoclonal version of IgG (that is, the M-spike), plus the normal, healthy version of your IgG. Roughly speaking, your healthy IgG level is the measured IgG level minus the M-spike (12.2 g/L - 9.5 g/L = 2.7 g/L).
If you compare a healthy, normal level of IgG (6.7-15.2 g/L), to your level of 2.7 g/L, you would appear to have some sort of IgG deficiency going on. One cause of this can be a condition known as hypogammaglobulinemia. It could also be that the multiple myeloma is just suppressing the normal IgG, but only a doctor can tell by looking at everything that is going on with your blood work.
Has your doctor discussed this with you? Are these recent lab results similar to earlier lab results?
-
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?
Thank you so much for showing me that, Multibilly!
My oncologist / hematologist has not mentioned anything about that - although I have only seen her once, and that was a full year ago. I see her again in mid-April, so I'll bring definitely ask her what she thinks the significance of this is.
I looked back over my previous reports and calculated the level of normal, healthy IgG and my levels over the past year seem to move up and down:
2.7 (Jan 2015), 2.9, 2.6, 1.2, 3.9 g/L (Jan 2014)
Since the reference range is 6.7 - 15.2 g/L, this deficiency has been going on for quite a while. That 1.2 seems very low.
I looked at symptoms of hypogammaglobulinemia, also called common variable immunodeficiency (CVID). If I had this, it would explain my mild thrombocytopenia (low levels of platelets) and neutropenia (low levels of WBC). (Although multiple myeloma would as well, I suppose!) I have been told by my rheumatologist that I have some form of autoimmune disease - she is just not sure which one.
These are some results from my complement proteins (which fight bacteria).
Complement C3 is 0.72 (reference range is 0.80-1.80 g/L)
CH50 classical is <10 (reference range 63-145 CAE units)
CH50 alternative is 30 (reference range 92-152 X 10 3/L)
Those low CH50 levels really threw me for a loop - but no one has mentioned anything about them (to me anyway). My rheumatologist just said it was interesting ...
Thanks again for working those figures out for me. That gives me something to ask about and it helps me make a decision about the BMB. If the hematologist recommends a BMB, then I will go ahead and hope I have as good an experience as Toni did.
All the best,
Helen
(P,S. - I want to add that everyone on this forum is so supportive and helpful! You are all a real blessing to others.)
My oncologist / hematologist has not mentioned anything about that - although I have only seen her once, and that was a full year ago. I see her again in mid-April, so I'll bring definitely ask her what she thinks the significance of this is.
I looked back over my previous reports and calculated the level of normal, healthy IgG and my levels over the past year seem to move up and down:
2.7 (Jan 2015), 2.9, 2.6, 1.2, 3.9 g/L (Jan 2014)
Since the reference range is 6.7 - 15.2 g/L, this deficiency has been going on for quite a while. That 1.2 seems very low.
I looked at symptoms of hypogammaglobulinemia, also called common variable immunodeficiency (CVID). If I had this, it would explain my mild thrombocytopenia (low levels of platelets) and neutropenia (low levels of WBC). (Although multiple myeloma would as well, I suppose!) I have been told by my rheumatologist that I have some form of autoimmune disease - she is just not sure which one.
These are some results from my complement proteins (which fight bacteria).
Complement C3 is 0.72 (reference range is 0.80-1.80 g/L)
CH50 classical is <10 (reference range 63-145 CAE units)
CH50 alternative is 30 (reference range 92-152 X 10 3/L)
Those low CH50 levels really threw me for a loop - but no one has mentioned anything about them (to me anyway). My rheumatologist just said it was interesting ...
Thanks again for working those figures out for me. That gives me something to ask about and it helps me make a decision about the BMB. If the hematologist recommends a BMB, then I will go ahead and hope I have as good an experience as Toni did.
All the best,
Helen
(P,S. - I want to add that everyone on this forum is so supportive and helpful! You are all a real blessing to others.)
Re: Suppression of uninvolved immunoglobulins / HLC pairs?
Hi Helen, I hope that you can find out what the problems are with your immune system, and find out what treatments to take, if any.
I was curious when you mentioned the Hevylite assay as to if you had also had the serum free light chain ("Freelite") assay, a blood test from the same company, the Binding Site.
The antibodies being tested for consist of both 'light' and 'heavy' chains. The light chains are produced in excess by all of our antibodies and thus there is a low level of them in the blood normally. However, if there are a lot of mutant myeloma type cells present, the amount of light chains increases to a higher level than usual. The serum free light chain test is used along with testing for monoclonal antibodies (M protein). But, from what I understand, the heavier chains of the antibodies do not float in excess so much. The newer test for Heavy chains, which is approved for use in the US, seems to be used more for the 'nonsecretory' sort of myeloma. The test can be done in other countries too, and sent in to a clinic such as the Mayo for analysis.
Good luck with your medical tests!
I was curious when you mentioned the Hevylite assay as to if you had also had the serum free light chain ("Freelite") assay, a blood test from the same company, the Binding Site.
The antibodies being tested for consist of both 'light' and 'heavy' chains. The light chains are produced in excess by all of our antibodies and thus there is a low level of them in the blood normally. However, if there are a lot of mutant myeloma type cells present, the amount of light chains increases to a higher level than usual. The serum free light chain test is used along with testing for monoclonal antibodies (M protein). But, from what I understand, the heavier chains of the antibodies do not float in excess so much. The newer test for Heavy chains, which is approved for use in the US, seems to be used more for the 'nonsecretory' sort of myeloma. The test can be done in other countries too, and sent in to a clinic such as the Mayo for analysis.
Good luck with your medical tests!
-
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?
Helen,
Wow, I'm really glad you posted. I did not know anything about this test, so it's quite enlightening.
I just wanted to let you know that, if you have good pain management, there's nothing to be apprehensive about with the BMB. I had conscious sedation and I had no pain to speak of. Plus, the specialist who performed the BMB does hundreds a year, so she was highly skilled. Insist on these and you will be just fine. Plus, the information it provides will truly provide a clear picture of your condition.
You are the best advocate for your health care, and I know you are doing a great job making yourself knowledgeable about your results. This will help you to insist on further testing or treatment as necessary. Be confident that you can be in partnership with your healthcare providers to solve this puzzle so that you can have optimum health.
All the best
Wow, I'm really glad you posted. I did not know anything about this test, so it's quite enlightening.
I just wanted to let you know that, if you have good pain management, there's nothing to be apprehensive about with the BMB. I had conscious sedation and I had no pain to speak of. Plus, the specialist who performed the BMB does hundreds a year, so she was highly skilled. Insist on these and you will be just fine. Plus, the information it provides will truly provide a clear picture of your condition.
You are the best advocate for your health care, and I know you are doing a great job making yourself knowledgeable about your results. This will help you to insist on further testing or treatment as necessary. Be confident that you can be in partnership with your healthcare providers to solve this puzzle so that you can have optimum health.
All the best
-
Toni - Name: Toni
- Who do you know with myeloma?: self - MGUS
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 51
Re: Suppression of uninvolved immunoglobulins / HLC pairs?
Thanks Toni!
I will definitely try to have the conscious sedation if I have the BMB. I am not proud . I will probably be having it done at St. Paul's hospital in Vancouver so I would expect the doctor to have had a lot of experience as it is a busy place. I'll ask, though, as I'd prefer that a student does not do it.
Hello Nancy!
Thanks for asking about the light chain test. I might still be a bit confused about these heavy and light chains and the types of tests. I have had the Free Light Chains test done. This was good (I think):
Light Chains Kappa Free 7.2 (reference range 3.3 - 19.4 mg/L)
Light Chains Lambda Free 18.6 (reference range 5.7 - 26.3 mg/L)
Light Chains Kappa Free/Light Chains Lambda Free 0.39 (reference range 0.26 - 1.65)
My hematologist/oncologist did order a test for Beta 2 Microglobulin in Jan 2014. I waited anxiously for that result because it determines the severity and spread (stage) of multiple myeloma. Mine came in at 1.0 (<4 mcg/mL is considered a good prognostic factor if you have multiple myeloma). Not sure why that test was ordered - or even if every MGUS patient has this test done. This is one area of life in which you don't want to be 'special'.
Cheers,
Helen
I will definitely try to have the conscious sedation if I have the BMB. I am not proud
. I will probably be having it done at St. Paul's hospital in Vancouver so I would expect the doctor to have had a lot of experience as it is a busy place. I'll ask, though, as I'd prefer that a student does not do it.Hello Nancy!
Thanks for asking about the light chain test. I might still be a bit confused about these heavy and light chains and the types of tests. I have had the Free Light Chains test done. This was good (I think):
Light Chains Kappa Free 7.2 (reference range 3.3 - 19.4 mg/L)
Light Chains Lambda Free 18.6 (reference range 5.7 - 26.3 mg/L)
Light Chains Kappa Free/Light Chains Lambda Free 0.39 (reference range 0.26 - 1.65)
My hematologist/oncologist did order a test for Beta 2 Microglobulin in Jan 2014. I waited anxiously for that result because it determines the severity and spread (stage) of multiple myeloma. Mine came in at 1.0 (<4 mcg/mL is considered a good prognostic factor if you have multiple myeloma). Not sure why that test was ordered - or even if every MGUS patient has this test done. This is one area of life in which you don't want to be 'special'.
Cheers,
Helen
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