[Dr. Edward Libby]

Re: Now have two m-spikes - IgA kappa & IgG kappa

by Dr. Edward Libby on Mon Jul 28, 2014 1:19 pm

Greetings from sunny Seattle!

Multiclonal peaks are not uncommon in multiple myeloma. There are reports of biclonal and even triclonal spikes in patients with newly diagnosed multiple myeloma. There is no definite prognostic significance to this finding. Multiple immunoglobulin (Ig) isotypes and isotype switches, which are rare in untreated patients, are reported to be more common in patients after stem cell transplanation. Oligo comes from a Greek word meaning "little" or "few". Transient oligoclonal bands detectable by serum IFE are common during the recovery of Ig production post transplant.

A large study published in BLOOD in 1998 looked at oligoclonal protein bands and Ig isotype switching in 550 multiple myeloma patients after stem cell transplanation. 10% of the patients had abnormal protein bands post transplant. Further analysis of these patients revealed that progression free survival and overall survival was improved when patients developed this type of banding post transplantation. The study authors proposed that this phenomenon is likely to be due to recovery of Ig production rather than alterations in the biology of the malignant plasma cell clone.

The 2012 ASH abstract noted in previous posts is an analysis similar to the BLOOD article. They reported on 788 patients post stem cell transplant and found that 12 percent of patients developed new M-spikes within three months post-transplant. Of these patients, 2/3 developed a single new M-spike, and 1/3 developed several new M-spikes. Significant improvements were seen in PFS and OS in patients with new banding after transplant. The ASH abstract adds strength to the previously published report in BLOOD.

I cannot tell from your post if you had a stem cell transplant but that would be a possible cause of the new banding. I sincerely hope that your disease is not returning and wish you all the best in your battle with multiple myeloma.

[WeatherNurse13]

Re: Now have two m-spikes - IgA kappa & IgG kappa

by WeatherNurse13 on Mon Jul 28, 2014 11:04 pm

Thanks Doctor Libby!

I had an ASCT in 2/2013. Been in a complete remission since before transplant. My original protein was IgA kappa and that is the one with the large amount noted in the Immunofixation/SPEP. There was a small amount of IgG kappa seen as well. Both in gamma. The only difference is that my initial diagnoses showed that my monoclonal bands were seen in beta and gamma.

My bone marrow biopsy is tomorrow and first PET scan on Thursday. I should know more over the next week.

[bad blood]

Re: Now have two m-spikes - IgA kappa & IgG kappa

by bad blood on Tue Jul 29, 2014 10:11 am

I am also looking for those answers. I thought I was out of the woods on my recent tests, BMB.
They have not got all my results back yet. I will see the doctor Aug 6 to go over all my results.

One other new findings on my labs. Besides my acquired Von Willebrand and acquired factor 8 deficiency, I now have abnormal platelet dysfunction. Very very low Von Willebrand factors too. Yes, and went from IgG lambda to IgM lambda (now CD56 positive too). Had a bone survey last week.. I don't have those results yet too.

Boy ... this disease just keeps getting more complicated!

[Ginny1]

Re: Now have two m-spikes - IgA kappa & IgG kappa

by Ginny1 on Tue Jul 29, 2014 5:10 pm

Ugh, I have MGUS and 3 M-spikes, 2 of which are IgG the other is a poly! Can't wait to hear response!