This is Mort with new blood results for November 17, 2016 – as a follow-up to prior blood work reported on August 23, 2016 and PET/CT scan on October 12, 2016.
Once again, I am asymptomatic without any CRAB criteria, supplemented by the “clean” PET/CT scan indicating no bone lesions, (and thus dismissing B in CRAB), as well as absence of FDG avid disease. Supporting the finding of an absence of CRAB symptoms are normal results for creatinine, BUN, C-reactive protein and calcium.
One blood component, however, is above normal: beta-2-microglobulin (B2M) at 2.59 mg/L, which exhibits a small progressive increase over the two prior determinations (2.16, previously, and 2.03, still earlier). Given Multibilly’s comment to me (Aug. 23, 2016) that his oncologist “doesn’t put a lot of stock in using B2M to track multiple myeloma,” I am inclined to disregard this blood component at this time.
My M-spike, which for several years has been at around 2.0 g/dL, has increased to 2.11 from a prior value of 1.97 and a still earlier 2.05. I am inclined to the view that this small increase is within the normal variation I have been experiencing since first diagnosed with MGUS back in July 2008. Thus, for example, I had an M-spike of 2.12 on July 30, 2014.
The kappa / lambda free light chain ratio dropped to 64.81 from the prior values of 78.69 (Aug. 13, 2016) and 72.29 (Mar. 16, 2016). Mindful that a free light chain ratio of 100 or higher signifies a “myeloma-defining event”, I am nevertheless of the view that I am still in MGUS.
I have given some thought to discussions in the Myeloma Beacon Forum on the subject of bone-marrow aspirations, with and without sedation. I have put off having such a course because I would prefer having it with sedation, and my onc does not recommend that, since it means going to a different facility (a hospital or similar clinic). He claims to have performed thousands of biopsies without much pain, but I am not convinced.
My general physician, who has in many years of practice had patients with MGUS, smoldering myeloma, and multiple myeloma, feels that my lab results, PET/CT scan, and absence of symptoms lead him to believe that – in the absence of any needed treatment – I could safely postpone bone-marrow biopsy until such time I might exhibit more definite indications of any progress towards multiple myeloma.
One thing I do not understand from the discussions here in this thread, and the threads it links to, is the M-spike results Multibilly has shared with the forum. Multibilly's M-spike has usually been no higher than 2.6 g/dL (26 g/l), according to graphs such as this one, and Multibilly has said that his current diagnosis is smoldering myeloma. I do not understand why the diagnosis is not MGUS, rather than smoldering, given that the accepted threshold for being in smoldering myeloma is to have an M-spike of 3.0 g/dL (30 g/l) or higher.
Forums
Re: Risk of progression from MGUS to multiple myeloma
Hi Mort,
It looks like your lab results are basically holding steady, which is great.
In regard to your question about why Multibilly is considered to have smoldering myeloma, your assumption about the 3.0 g/dl M-spike threshold isn't really correct. The criteria for a smoldering diagnosis are that both of the following must be true:
1. There are no "myeloma defining events" present (no CRAB, not FLC ratio above 100, etc.)
2. Either
a. A serum M-spike of 3.0 g/dL or higher, OR
b. A urinary monoclonal protein level of 500 mg or more per 24 hours, OR
c. A clonal bone marrow plasma cell percentage of 10 to 60 percent.
If I recall correctly, in Multibilly's case, his bone marrow plasma cell percentage was slightly above 10 percent at diagnosis, which is why he is considered to have smoldering multiple myeloma.
My personal impression is that most people with smoldering myeloma have M-spikes under 3.0 g/dL, and its their bone marrow plasma cell percentage that puts them into the smoldering category – as it was in Multibilly's case.
There is a Beacon poll that was done a few years ago of M-spikes of smoldering patients. The results are here:
https://myelomabeacon.org/forum/weekly-poll-smoldering-myeloma-m-spike-t2286.html
Good luck!
It looks like your lab results are basically holding steady, which is great.
In regard to your question about why Multibilly is considered to have smoldering myeloma, your assumption about the 3.0 g/dl M-spike threshold isn't really correct. The criteria for a smoldering diagnosis are that both of the following must be true:
1. There are no "myeloma defining events" present (no CRAB, not FLC ratio above 100, etc.)
2. Either
a. A serum M-spike of 3.0 g/dL or higher, OR
b. A urinary monoclonal protein level of 500 mg or more per 24 hours, OR
c. A clonal bone marrow plasma cell percentage of 10 to 60 percent.
If I recall correctly, in Multibilly's case, his bone marrow plasma cell percentage was slightly above 10 percent at diagnosis, which is why he is considered to have smoldering multiple myeloma.
My personal impression is that most people with smoldering myeloma have M-spikes under 3.0 g/dL, and its their bone marrow plasma cell percentage that puts them into the smoldering category – as it was in Multibilly's case.
There is a Beacon poll that was done a few years ago of M-spikes of smoldering patients. The results are here:
https://myelomabeacon.org/forum/weekly-poll-smoldering-myeloma-m-spike-t2286.html
Good luck!
Re: Risk of progression from MGUS to multiple myeloma
Thank you very much, TerryH, for your crucial remarks concerning one diagnostic criterion that distinguishes MGUS from smoldering multiple myeloma, namely, the presence of a clonal bone marrow plasma cell percentage of 10 to 60 percent for smoldering myeloma, as opposed to a plasma cell percentage below 10 percent for MGUS.
I must admit I was aware of that distinction, but did not realize that patients with smoldering myeloma can have M-spikes below 3.0 g/dL. I had overlooked the diagnostic criteria for smoldering myeloma, which includes an M-spike greater than 3.0 g/dL, and/or a monoclonal bone marrow plasma cell percentage between 10 and 60%. As you have pointed out, the latter marker may become the deciding criterion for smoldering multiple myeloma instead of MGUS.
Your contribution, TerryH, tells me that I should not put off having a bone marrow aspiration and biopsy since, even without CRAB criteria, an M-spike of 2.11 g/dL and with a clear PET/CT scan, I might be closer to being smoldering than my current view of still being in MGUS.
So, many thanks again for your contribution to this thread, TerryH.
I must admit I was aware of that distinction, but did not realize that patients with smoldering myeloma can have M-spikes below 3.0 g/dL. I had overlooked the diagnostic criteria for smoldering myeloma, which includes an M-spike greater than 3.0 g/dL, and/or a monoclonal bone marrow plasma cell percentage between 10 and 60%. As you have pointed out, the latter marker may become the deciding criterion for smoldering multiple myeloma instead of MGUS.
Your contribution, TerryH, tells me that I should not put off having a bone marrow aspiration and biopsy since, even without CRAB criteria, an M-spike of 2.11 g/dL and with a clear PET/CT scan, I might be closer to being smoldering than my current view of still being in MGUS.
So, many thanks again for your contribution to this thread, TerryH.
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Mort - Name: Morton Golub
- When were you/they diagnosed?: MGUS - July 2008
- Age at diagnosis: 83
Re: Risk of progression from MGUS to multiple myeloma
Glad I could be of help, Mort.
Best of luck with the bone marrow biopsy. If you have the biopsy done at a larger cancer center, you're likely to get someone doing it who does a lot of them. So it shouldn't be too bad an experience.
This link will call up forum threads about bone marrow biopsies. The search isn't perfect, as some of the threads are related to other "biopsy" or "marrow" topics. But a lot of them should be helpful:
https://myelomabeacon.org/forum/search.php?keywords=bmb+biopsy+biopsies+marrow+bmbs&terms=any&author=&sc=1&sf=titleonly&sr=topics&sk=t&sd=d&st=0&ch=300&t=0&submit=Search
Good luck, and best wishes for the New Year!
Best of luck with the bone marrow biopsy. If you have the biopsy done at a larger cancer center, you're likely to get someone doing it who does a lot of them. So it shouldn't be too bad an experience.
This link will call up forum threads about bone marrow biopsies. The search isn't perfect, as some of the threads are related to other "biopsy" or "marrow" topics. But a lot of them should be helpful:
https://myelomabeacon.org/forum/search.php?keywords=bmb+biopsy+biopsies+marrow+bmbs&terms=any&author=&sc=1&sf=titleonly&sr=topics&sk=t&sd=d&st=0&ch=300&t=0&submit=Search
Good luck, and best wishes for the New Year!
Re: Risk of progression from MGUS to multiple myeloma
At long last, I submitted to a bone marrow biopsy that was administered by my oncologist with minimal pain and no post-biopsy discomfort. The biopsy was requested when new blood work of March 31 showed a big drop in hemoglobin from 12.3 to 10.0 g/dL and a jump in my free light chain (FLC) ratio from 64.8 to 93.7. Both these new values are at or near thresholds for myeloma-defining events (MDE's).
In preparation for the bone marrow biopsy on April 21, new CBC values were obtained, and my hemoglobin rose to 11.6 g/dL. Though still low, the latter value lies in the range of 11.0-12.3 g/dL over the last six years, so I feel that the anemia factor or 'A' in CRAB criteria remains unchanged as not being an MDE. Also, disappointing in the March 31 blood results was an increase in M-spike from 2.11 to 2.40 g/dL. New blood work will be done in a few weeks, including a serum protein electrophoresis (SPEP), where it is hoped that the M-spike will return to the level around 2.0 where it has been for the past four years.
As requested by my oncologist, I had a repeat PET/CT scan on April 12 following one of six months earlier. The scan presented both good and problematic news. On the one hand, it reconfirmed the absence of any lytic bone lesions, while on the other, it presented a new pulmonary hypermetabolic lesion, suggesting the possibility of a plasmacytoma. The radiologist report recommended a CT-guided biopsy of that area. The prospect of undergoing a biopsy of the lung is worrisome, but I plan to have it done in a week or so.
Meanwhile, I am taking the supplements curcumin, resveratrol, and green tea extract in the hope of minimizing the chances of my progressing to active multiple myeloma myeloma. At the same time, I am consuming sunflower seeds and nuts and a lot of fruit to increase my iron intake and hence raise my hemoglobin. I certainly wish to remain in MGUS, as I have been for nearly nine years.
In preparation for the bone marrow biopsy on April 21, new CBC values were obtained, and my hemoglobin rose to 11.6 g/dL. Though still low, the latter value lies in the range of 11.0-12.3 g/dL over the last six years, so I feel that the anemia factor or 'A' in CRAB criteria remains unchanged as not being an MDE. Also, disappointing in the March 31 blood results was an increase in M-spike from 2.11 to 2.40 g/dL. New blood work will be done in a few weeks, including a serum protein electrophoresis (SPEP), where it is hoped that the M-spike will return to the level around 2.0 where it has been for the past four years.
As requested by my oncologist, I had a repeat PET/CT scan on April 12 following one of six months earlier. The scan presented both good and problematic news. On the one hand, it reconfirmed the absence of any lytic bone lesions, while on the other, it presented a new pulmonary hypermetabolic lesion, suggesting the possibility of a plasmacytoma. The radiologist report recommended a CT-guided biopsy of that area. The prospect of undergoing a biopsy of the lung is worrisome, but I plan to have it done in a week or so.
Meanwhile, I am taking the supplements curcumin, resveratrol, and green tea extract in the hope of minimizing the chances of my progressing to active multiple myeloma myeloma. At the same time, I am consuming sunflower seeds and nuts and a lot of fruit to increase my iron intake and hence raise my hemoglobin. I certainly wish to remain in MGUS, as I have been for nearly nine years.
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Mort - Name: Morton Golub
- When were you/they diagnosed?: MGUS - July 2008
- Age at diagnosis: 83
Re: Risk of progression from MGUS to multiple myeloma
In my previous post (directly above), I neglected to mention an important result from my bone marrow biopsy of April 21. The bone marrow plasma cell percentage was reported to be 5-10%, which presumably puts me in the MGUS category. Genetic studies are forthcoming. Meanwhile, I feel heartened by this news despite an apparently high free light chain ratio and a somewhat low hemoglobin. I am otherwise asymptomatic.
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Mort - Name: Morton Golub
- When were you/they diagnosed?: MGUS - July 2008
- Age at diagnosis: 83
Re: Risk of progression from MGUS to multiple myeloma
In my post of April 30 (directly above), I indicated that a PET/CT scan of April 12 confirmed the absence of any lytic bone lesions noted in an earlier scan, but presented a new pulmonary hypermetabolic lesion, suggesting the possibility of a plasmacytoma. Today, I visited the
recommended interventional radiologist to carry out a CT-guided biopsy of the problematic mass.
As a preliminary to the actual biopsy, a new CT scan was obtained, and the mass found to be smaller than it was less than a month ago. Given my age, the location of the mass within the lung and not on the surface, thereby increasing the risk of a biopsy, plus the apparent shrinking
of the mass, the radiologist opted to pass up the biopsy at this time, with the proposal to have a new CT scan done in 2 or 3 months, and then see if any further action is warranted.
I am tempted to ascribe the apparent improvement in today's CT scan over the the prior PET/CT scan, as well as the improvement in hemoglobin from March 31 to April 21, to my recent adoption of an anti-myeloma nutrition and supplementation protocol reported in my post of April 30.
recommended interventional radiologist to carry out a CT-guided biopsy of the problematic mass.
As a preliminary to the actual biopsy, a new CT scan was obtained, and the mass found to be smaller than it was less than a month ago. Given my age, the location of the mass within the lung and not on the surface, thereby increasing the risk of a biopsy, plus the apparent shrinking
of the mass, the radiologist opted to pass up the biopsy at this time, with the proposal to have a new CT scan done in 2 or 3 months, and then see if any further action is warranted.
I am tempted to ascribe the apparent improvement in today's CT scan over the the prior PET/CT scan, as well as the improvement in hemoglobin from March 31 to April 21, to my recent adoption of an anti-myeloma nutrition and supplementation protocol reported in my post of April 30.
-
Mort - Name: Morton Golub
- When were you/they diagnosed?: MGUS - July 2008
- Age at diagnosis: 83
Re: Risk of progression from MGUS to multiple myeloma
As a follow-up to three posts on April 30 (directly above), I am pleased to report new blood results of May 17, 2017, which again support my view of still being in MGUS. To see the trend, the data are given for the last four determinations, Aug. 13, 2016, Nov. 11, March 31, 2017 and, May 17, 2017
Year 2016 2016 2017 2017
Month & Day Aug 13 Nov 11 Mar 31 May 17
M-spike 1.97 2.11 2.40 1.98 g/dL
Kappa FLC 801.04 773.18 1263.22 726.92 mg/L
Lambda FLC 10.18 11.93 13.48 13.93 mg/L
Kappa/lambda 78.7 64.8 93.7 52.18
IgA serum 27 27 33 36 mg/dL
IgG 2411 2524 2894 2430 mg/dL
IgM 32 35 41 35 mg/dL
There is absence of CRAB criteria, although the hemoglobin and red blood cells have for nine years been at or below normal values, despite adequate levels of iron and ferritin in the blood. I have recently changed my Mediterranean diet to include some red meat once a week to potentially increase the iron content in the blood and hence the hemoglobin and red blood cells, which were 10.9 g/dL and 3.5 10^6/uL, respectively on May 17.
Bone marrow biopsy showed a plasma cell concentration of 5-10% with normal cytogenetics and no aberrations detected by FISH analysis.
What is notable in the above data is a rather big drop in kappa/lambda ratio from 93.7 to 52.18, a large decrease in M-spike from 2.40 to 1.98, and some decrease in IgG over a period of just 7 weeks. I suspect these decreases are the result of my daily use of curcumin (400 mg) which commenced on April 16, or just a month prior to the latest determination. Whether curcumin is indeed responsible will be tested in several months at the next scheduled blood tests.
Year 2016 2016 2017 2017
Month & Day Aug 13 Nov 11 Mar 31 May 17
M-spike 1.97 2.11 2.40 1.98 g/dL
Kappa FLC 801.04 773.18 1263.22 726.92 mg/L
Lambda FLC 10.18 11.93 13.48 13.93 mg/L
Kappa/lambda 78.7 64.8 93.7 52.18
IgA serum 27 27 33 36 mg/dL
IgG 2411 2524 2894 2430 mg/dL
IgM 32 35 41 35 mg/dL
There is absence of CRAB criteria, although the hemoglobin and red blood cells have for nine years been at or below normal values, despite adequate levels of iron and ferritin in the blood. I have recently changed my Mediterranean diet to include some red meat once a week to potentially increase the iron content in the blood and hence the hemoglobin and red blood cells, which were 10.9 g/dL and 3.5 10^6/uL, respectively on May 17.
Bone marrow biopsy showed a plasma cell concentration of 5-10% with normal cytogenetics and no aberrations detected by FISH analysis.
What is notable in the above data is a rather big drop in kappa/lambda ratio from 93.7 to 52.18, a large decrease in M-spike from 2.40 to 1.98, and some decrease in IgG over a period of just 7 weeks. I suspect these decreases are the result of my daily use of curcumin (400 mg) which commenced on April 16, or just a month prior to the latest determination. Whether curcumin is indeed responsible will be tested in several months at the next scheduled blood tests.
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Mort - Name: Morton Golub
- When were you/they diagnosed?: MGUS - July 2008
- Age at diagnosis: 83
Re: Risk of progression from MGUS to multiple myeloma
As a follow-up to my post of June 6, I submit new results from blood drawn on August 15, 2017.
Of particular interest is the M-spike (1.64 g/dL, or 16.4 g/l), which reveals a continued decrease from values of 2.40 and 1.96 g/dL for blood drawn on March 31 and May 17, respectively. Through an oversight, the serum free light chain kappa-lambda ratio was not reported, and my oncologist indicated that I could submit a new blood sample in a month or so to fill that void. I had hoped to see a further diminution in that ratio, consistent with the decrease in M-spike, to provide support for a decrease in myeloma cells in my body as a result of a daily consumption of 400 mg of curcumin. Based on nearly linear plots of the three M-spikes and the two kappa-lambda ratios (93.7 and 52.18 for March 31 and May 17, respectively) as a function of passage of time, I arrive at a possible estimated FLC ratio of about 30, a substantial drop from the previous high value of 93.7.
The prior post showed that accompanying the decrease in M-spike from March 31 to May 17, the value of serum IgG decreased from 2894 to 2430 mg/dL, respectively. While a comparable drop in IgG for August 15 – consistent with the drop in M-spike – was expected, this proved not to be the case, the value (2484 mg/dL) being, instead, virtually the same as that (2430) for May 17. This possibly throws into doubt the accuracy of the reported M-spike of 1.64 g/dL. It may be noted that back in August 2011 when I had an M-spike of 1.65 g/dL, the IgG value was 2101 mg/dL.
Another conundrum relates to values of beta-2-microglobulin, which show a steady, slow increase from 2.42 to 2.78 to 3.24 mg/L for March 31, May 17 and August 15 ,respectively. This runs counter to what we would expect for a decrease in myeloma threat. I am aware, of course, of the analyst's note that "Results cannot be interpreted as absolute evidence of the presence or absence of malignant disease."
Since I am asymptomatic, with bone marrow biopsy showing a plasma cell concentration of 5-10%, PET/CT scan showing no lytic bone lesions, and no CRAB criteria, I regard myself still in MGUS. The recommended three-month repeat CT scan to assess the condition of a pulmonary hypermetabolic lesion first detected on April 12 has been carried out, with the finding that the mass in the lung has shrunk to a "scar-like configuration," implying that it represents no cause for further concern.
Of particular interest is the M-spike (1.64 g/dL, or 16.4 g/l), which reveals a continued decrease from values of 2.40 and 1.96 g/dL for blood drawn on March 31 and May 17, respectively. Through an oversight, the serum free light chain kappa-lambda ratio was not reported, and my oncologist indicated that I could submit a new blood sample in a month or so to fill that void. I had hoped to see a further diminution in that ratio, consistent with the decrease in M-spike, to provide support for a decrease in myeloma cells in my body as a result of a daily consumption of 400 mg of curcumin. Based on nearly linear plots of the three M-spikes and the two kappa-lambda ratios (93.7 and 52.18 for March 31 and May 17, respectively) as a function of passage of time, I arrive at a possible estimated FLC ratio of about 30, a substantial drop from the previous high value of 93.7.
The prior post showed that accompanying the decrease in M-spike from March 31 to May 17, the value of serum IgG decreased from 2894 to 2430 mg/dL, respectively. While a comparable drop in IgG for August 15 – consistent with the drop in M-spike – was expected, this proved not to be the case, the value (2484 mg/dL) being, instead, virtually the same as that (2430) for May 17. This possibly throws into doubt the accuracy of the reported M-spike of 1.64 g/dL. It may be noted that back in August 2011 when I had an M-spike of 1.65 g/dL, the IgG value was 2101 mg/dL.
Another conundrum relates to values of beta-2-microglobulin, which show a steady, slow increase from 2.42 to 2.78 to 3.24 mg/L for March 31, May 17 and August 15 ,respectively. This runs counter to what we would expect for a decrease in myeloma threat. I am aware, of course, of the analyst's note that "Results cannot be interpreted as absolute evidence of the presence or absence of malignant disease."
Since I am asymptomatic, with bone marrow biopsy showing a plasma cell concentration of 5-10%, PET/CT scan showing no lytic bone lesions, and no CRAB criteria, I regard myself still in MGUS. The recommended three-month repeat CT scan to assess the condition of a pulmonary hypermetabolic lesion first detected on April 12 has been carried out, with the finding that the mass in the lung has shrunk to a "scar-like configuration," implying that it represents no cause for further concern.
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Mort - Name: Morton Golub
- When were you/they diagnosed?: MGUS - July 2008
- Age at diagnosis: 83
Re: Risk of progression from MGUS to multiple myeloma
Hello Mort,
I've read your entries with interest. I'm so pleased that you are holding steady at MGUS! Thank you for sharing with us your supplement regimen: resveratrol, curcumin, and green tea extract, plus a Mediterranean diet. Perhaps drinking green tea would be similarly effective as the extract.
Keep in mind that vitamin C (ascorbic acid), when taken with plant iron, increases its absorption.
Keep us informed of your progress. I'm hoping for you!
I've read your entries with interest. I'm so pleased that you are holding steady at MGUS! Thank you for sharing with us your supplement regimen: resveratrol, curcumin, and green tea extract, plus a Mediterranean diet. Perhaps drinking green tea would be similarly effective as the extract.
Keep in mind that vitamin C (ascorbic acid), when taken with plant iron, increases its absorption.
Keep us informed of your progress. I'm hoping for you!
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Lilac - Name: Lilac
- Who do you know with myeloma?: myself (MGUS)
- When were you/they diagnosed?: 2016
- Age at diagnosis: 56
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