[Pootren]

Symptomatic with low plasma cell percent - how possible?

by Pootren on Mon Aug 18, 2014 11:02 am

I'm really having trouble understanding how my father can have 4 lesions, elevated protein but only have 3 percent plasma cells. How can this be?

I'm reading that in order to have symptomatic multiple myeloma plasma cells must be greater than 10 percent. We are trying to stage this thing or see where he is at, but it's so complicated. He is starting chemo etc., so it's definitely 'symptomatic'.

Would this mean he would have a mild form? How could so many tumours develop and his bones become so brittle?

I've been reading and researching but can't find another case like this.Just want an idea where he is at so we know what to expect.

[Ladyaero]

Re: Symptomatic with low plasma cell percent - how possible?

by Ladyaero on Mon Aug 18, 2014 12:00 pm

Unfortunately, myeloma often does not follow a "typical" presentation. My husband's blood work (and plasma percentage and PET scans of his bones) would tell you that his cancer has not been "active" since his stem cell transplant, but the many, many tumors (which have been biopsied, so we know they are myeloma) say differently. Although not common, it is possible to have lesions and tumors without your marrow showing a high volume of myeloma cells.

[Pootren]

Re: Symptomatic with low plasma cell percent - how possible?

by Pootren on Mon Aug 18, 2014 12:30 pm

Thanks so much for your response.

Was your husband's multiple myeloma able to be staged at all? How do you know how 'serious' it is?

We are clueless at this point as the way it is staged is based on all of these factors (plasma cell percentage, protein etc..). Would this mean they have a better prognosis?

[Multibilly]

Re: Symptomatic with low plasma cell percent - how possible?

by Multibilly on Mon Aug 18, 2014 3:44 pm

Pootren,

I'm including the link to your earlier post so that folks understand the background to your question. There were a couple of points that were made in the earlier thread regarding this topic (you may find that the next time you do a bone marrow biopsy that the results will show an abnormal amount of plasma cells).

https://myelomabeacon.org/forum/bone-marrow-biopsy-blood-test-results-t3876.html

Multibilly:

Note also that the plasma percentage reading from a bone marrow biopsy can vary quite a bit, depending on whether the biopsy needle hits a pocket of disease or not (the disease is not uniformly spread throughout one's bone marrow.

Dr. Jason Valent:

Your father's case is only a bit odd. I have several patients where the random bone marrow biopsy looks quite normal but lytic lesions are present in multiple areas. I do biopsy one of the lesions just to make sure that it is myeloma and not something else causing the lytic lesions. There are benign and other malignant causes of lytic lesions.

Again though, it is not unheard of for the marrow to look normal and the bones to be involved with myeloma lesions

Now, having said this, I can see how you might be puzzled if your Dad truly has a completely normal bone marrow plasma % reading (based on multiple bone marrow biopsy results), but also has lytic lesions...I don't know how to explain that corner case other than to say "it happens". Maybe somebody else can explain it?

As far as the definition of symptomatic multiple myeloma is concerned, please see the IMWG's definiton here:

http://myeloma.org/ArticlePage.action?articleId=2970

Diagnostic Criteria: All Three Required

Symptomatic multiple myeloma:

#1 Monoclonal plasma cells in the bone marrow >/=10% and/or presence of a biopsy-proven plasmacytoma
#2 Monoclonal protein present in the serum and/or urine*
#3 Myeloma-related organ dysfunction (>/=1)c

[C] Calcium elevation in the blood (serum calcium >10.5 mg/l or upper limit of normal
[R] Renal insufficiency (serum creatinine >2mg per 100 ml)
[A] Anemia (hemoglobin <10 g per 100 ml or 2 g <normal)
[B] Lytic bone lesions or osteoporosis

*If no monoclonal protein is detected (non-secretory disease), then >/= 30% monoclonal bone marrow plasma cells and/or a biopsy-proven plasmacytoma required.

In your dad's case, the presence of biopsy-proven lytic lesions (lytic lesions are one of the possible manifestations of a plasmacytoma) are sufficient to qualify him as "symptomatic" (that fulfills #1, #2 and #3 above).

[Rneb]

Re: Symptomatic with low plasma cell percent - how possible?

by Rneb on Tue Aug 19, 2014 3:53 pm

I'm sorry your father is going thru this rough patch.

Unfortunately, not all myeloma presents in the same fashion, with the same lab values.

Some Myeloma is "Ultra-low secretory" and some is "ultra-high".

This disease is very VARIED in it's presentation(s).

Good luck.

[Ladyaero]

Re: Symptomatic with low plasma cell percent - how possible?

by Ladyaero on Tue Aug 19, 2014 4:53 pm

In response to your questions, when my husband was diagnosed he had tumors, a high m-spike, and he had high activity in his marrow, so he fell at the top of the standard stages at that time. It has only been since his transplant that his myeloma has switched gears, so to speak, to this other "presentation" (no m-spike, no/low marrow activity, but multiple tumors).

As far as whether this is a positive or negative indicator for your father, I'm afraid I really don't know. I wouldn't even want to speculate based on published papers, etc, because there are so many variables.

Just remember that your father is not a statistic (plus much of the data out there is older than 5 years), so a positive focus on his treatment may help you all more than being able to label exactly what stage he is.

Best wishes to you and your family.