I'm wondering what monitoring Immunoglobulin levels adds to the analysis if IFE, light chains, and SPEP are already being run once a month to monitor for relapse?
When the other test are all normal or negative, would the immunoglobulins reveal something different?
Forums
-
blair77 - Who do you know with myeloma?: My husband
- When were you/they diagnosed?: April 2013
- Age at diagnosis: 43
Re: What's the added value of immunoglobulin results?
That's a great question.
Your healthy immuonoglobulin level is important to know since it is critical for how your immune system functions (they are your front line immune defense, after all). It's also important to know which of your immunoglobulins is involved in your disease. Measuring the various immunoglobulin levels tells you these things.
Take the simple case of someone with IgG type multiple myeloma.
The quantitative IgG lab measures both the healthy and unhealthy versions of your IgG.
You can therefore figure out your healthy IgG level by doing simple subtraction:
Healthy IgG = Measured IgG level - Paraprotein
You also can run into a situation called immunoparesis where your "uninvolved" immunoglobulins (IgA, etc in this example) might get suppressed by the multiple myeloma disease. This also has implications for one's prognosis and immune function.
So, tracking one's quantitative immunoglobulins is pretty important.
Hope this helps.
Your healthy immuonoglobulin level is important to know since it is critical for how your immune system functions (they are your front line immune defense, after all). It's also important to know which of your immunoglobulins is involved in your disease. Measuring the various immunoglobulin levels tells you these things.
Take the simple case of someone with IgG type multiple myeloma.
The quantitative IgG lab measures both the healthy and unhealthy versions of your IgG.
You can therefore figure out your healthy IgG level by doing simple subtraction:
Healthy IgG = Measured IgG level - Paraprotein
You also can run into a situation called immunoparesis where your "uninvolved" immunoglobulins (IgA, etc in this example) might get suppressed by the multiple myeloma disease. This also has implications for one's prognosis and immune function.
So, tracking one's quantitative immunoglobulins is pretty important.
Hope this helps.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: What's the added value of immunoglobulin results?
Are you saying a high immuoglobin is good ?? Mine 1616 which is a bit high
Re: What's the added value of immunoglobulin results?
No, I'm saying that a "normal" level for the HEALTHY part of your immunoglobulin is important and you also want to make sure that your uninvolved immunglobulin levels stay in a normal range too. But, in order to find out what the healthy part of your involved immunogloublin reading is, you must first subtract out your paraprotein (aka M-spike) number from your involved immunoglobulin reading.
Your immunoglobulin lab reading is "high" because it is reporting BOTH the healthy and unhealthy (monoclonal) parts of your immunoglobulin level. If you subtract out the paraprotein number (using the same units of measure), you can figure this out.
If this doesn't make sense, just post your high immunoglobulin level and your paraprotein level (including the units of measure), and we can show you what we mean.
Your immunoglobulin lab reading is "high" because it is reporting BOTH the healthy and unhealthy (monoclonal) parts of your immunoglobulin level. If you subtract out the paraprotein number (using the same units of measure), you can figure this out.
If this doesn't make sense, just post your high immunoglobulin level and your paraprotein level (including the units of measure), and we can show you what we mean.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: What's the added value of immunoglobulin results?
Ok. The immunoglobin is 1610 g / dL.
If by paraprotein you mean the M- spike, I have two: 0.5 and 0.3 g / dL.
Plus a third, 0.1 g/dL, which they believe is a polyclonal.
If by paraprotein you mean the M- spike, I have two: 0.5 and 0.3 g / dL.
Plus a third, 0.1 g/dL, which they believe is a polyclonal.
Re: What's the added value of immunoglobulin results?
Ginny,
I know these lab results are hard to read and the numbers get very confusing.
You say your "immunoglobulin" is 1610 g/dL. I'm pretty sure that the report actually says 1610 mg/dL. You also need to tell me which "immunoglobulin" this is (IgG, IgA, etc). I'm guessing it is the IgG?
Having multiple M-Spikes complicates things a little, since I don't know if they are all tied to the same immunoglobulin or not. Let's just assume for now that they are all tied to your IgG immunoglobulin.
First, you need to convert the M-Spikes into the same units of measure that is used for your IgG.
0.5g/dL = 500 mg/dL
0.3g/dL = 300 mg/dL
0.1g/dL = 100 mg/dL
Assuming all three M-Spikes are tied to the IgG immunoglobulin, they would total 900 mg/dL.
Therefore, your healthy IgG level is 1610 mg/dL - 900 mg/dL = 710 mg/dL. The normal range for IgG is 700-1500 mg/dl, so you are in range.
If it turns out that only one of the M-Spikes is involved with your IgG and the others are tied to other immunoglobulins, then your healthy IgG number would be bigger. Assuming only the 0.5 g/dl spike is involved with your IgG, your IgG level would be 1610 mg/dL - 500 mg/dL =1,010 mg/dL (which is also in range).
So, remember, I'm making some assumptions here on which of your quantitative immunoglobulin levels you are posting (IgG, IgA, etc) and also I'm not clear if all the M-Spikes are tied to the same immunoglobulin or to different immunoglobulin types. You should really therefore discuss this all with your doc to get this right.
The bottom line is that you first asked why it's important to track immunoglobulins levels. Like I said before, you want to make sure that their normal, healthy components stay in a normal range (a high level of the normal component can indicate infection, or you can get into the immunoparesis situation, etc.)
Hope this helps and doesn't confuse ya.
I know these lab results are hard to read and the numbers get very confusing.
You say your "immunoglobulin" is 1610 g/dL. I'm pretty sure that the report actually says 1610 mg/dL. You also need to tell me which "immunoglobulin" this is (IgG, IgA, etc). I'm guessing it is the IgG?
Having multiple M-Spikes complicates things a little, since I don't know if they are all tied to the same immunoglobulin or not. Let's just assume for now that they are all tied to your IgG immunoglobulin.
First, you need to convert the M-Spikes into the same units of measure that is used for your IgG.
0.5g/dL = 500 mg/dL
0.3g/dL = 300 mg/dL
0.1g/dL = 100 mg/dL
Assuming all three M-Spikes are tied to the IgG immunoglobulin, they would total 900 mg/dL.
Therefore, your healthy IgG level is 1610 mg/dL - 900 mg/dL = 710 mg/dL. The normal range for IgG is 700-1500 mg/dl, so you are in range.
If it turns out that only one of the M-Spikes is involved with your IgG and the others are tied to other immunoglobulins, then your healthy IgG number would be bigger. Assuming only the 0.5 g/dl spike is involved with your IgG, your IgG level would be 1610 mg/dL - 500 mg/dL =1,010 mg/dL (which is also in range).
So, remember, I'm making some assumptions here on which of your quantitative immunoglobulin levels you are posting (IgG, IgA, etc) and also I'm not clear if all the M-Spikes are tied to the same immunoglobulin or to different immunoglobulin types. You should really therefore discuss this all with your doc to get this right.
The bottom line is that you first asked why it's important to track immunoglobulins levels. Like I said before, you want to make sure that their normal, healthy components stay in a normal range (a high level of the normal component can indicate infection, or you can get into the immunoparesis situation, etc.)
Hope this helps and doesn't confuse ya.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: What's the added value of immunoglobulin results?
Only MGUS here, but I remembered this post and have a question about it:
If the calculation indicates you have a low immunoglobulin, what are the implications?
Can anything be done about it?
My history: I have an IgG M-spike 1.1; Immunoglobulin G 1600. So the "good" immunoglobulin G is probably around 500 (right?). This is lower than the normal threshold of 700-1600.
Also, the immunoglobulin M is a little suppressed at 35, normal range is 40-230.
Anyway, if you are not in a disease state, then what are the implications?
Yesterday when I met with a new oncologist for a second opinion (they were wonderful by the way!), he had assured me that based on my paraprotein IgG kappa (m-spike) of 1.1, I was at the lowest risk for developing myeloma, so maybe it wouldn't be necessary to do a bone marrow biopsy.
I was finally convinced that was ok. Then, as we were done with the conversation, he casually asked if there were a history of sinus problems ..."Well, um, I do get a lot of sinus infections". In fact, I'm on antibiotics 3-4 times a year and I have frequent middle ear infections. Started about 3 years ago. So that piqued his interest and he insisted we have a BMB. I've just come to accept that I get sick frequently. Sinus, bronchitis, pneumonia and middle ear infections, esp. fungal infections.
So here's what I just found out this morning as I was writing this post:
"The most frequent clinical problems in any type of IgG deficiency are repeated episodes of otitis and recurrent or chronic infections of the upper and lower respiratory tracts. Many cases of specific IgG antibody deficiency are diagnosed in seemingly healthy individuals who have recurrent or chronic sinusitis and whose initial presentations may include headache, cough, and intermittent or low-grade fever, with or without other constitutional symptoms. These patients may frequently have perforated, scarred or bulging, cloudy, immobile tympanic membranes and chronic effusions of the middle ear."
http://emedicine.medscape.com/article/136897-clinical
I guess I just answered my own question. But if any of you have any knowledge please pipe up. I'd appreciate it. Thanks!
If the calculation indicates you have a low immunoglobulin, what are the implications?
Can anything be done about it?
My history: I have an IgG M-spike 1.1; Immunoglobulin G 1600. So the "good" immunoglobulin G is probably around 500 (right?). This is lower than the normal threshold of 700-1600.
Also, the immunoglobulin M is a little suppressed at 35, normal range is 40-230.
Anyway, if you are not in a disease state, then what are the implications?
Yesterday when I met with a new oncologist for a second opinion (they were wonderful by the way!), he had assured me that based on my paraprotein IgG kappa (m-spike) of 1.1, I was at the lowest risk for developing myeloma, so maybe it wouldn't be necessary to do a bone marrow biopsy.
I was finally convinced that was ok. Then, as we were done with the conversation, he casually asked if there were a history of sinus problems ..."Well, um, I do get a lot of sinus infections". In fact, I'm on antibiotics 3-4 times a year and I have frequent middle ear infections. Started about 3 years ago. So that piqued his interest and he insisted we have a BMB. I've just come to accept that I get sick frequently. Sinus, bronchitis, pneumonia and middle ear infections, esp. fungal infections.
So here's what I just found out this morning as I was writing this post:
"The most frequent clinical problems in any type of IgG deficiency are repeated episodes of otitis and recurrent or chronic infections of the upper and lower respiratory tracts. Many cases of specific IgG antibody deficiency are diagnosed in seemingly healthy individuals who have recurrent or chronic sinusitis and whose initial presentations may include headache, cough, and intermittent or low-grade fever, with or without other constitutional symptoms. These patients may frequently have perforated, scarred or bulging, cloudy, immobile tympanic membranes and chronic effusions of the middle ear."
http://emedicine.medscape.com/article/136897-clinical
I guess I just answered my own question. But if any of you have any knowledge please pipe up. I'd appreciate it. Thanks!
-
Toni - Name: Toni
- Who do you know with myeloma?: self - MGUS
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 51
Re: What's the added value of immunoglobulin results?
Multibilly, I'm reading your post about suppressed immunoglobulins and you wrote it gives a picture of your ability to defend against the bad guys, which I know, but you also said it can be a prognosticator of the disease. Do you have a resource I can go to learn about suppressed immnuoglobulins?
Mine are suppressed because of the medication and, when I ask the doctors all they say is "well, we hope these will stabilize eventually". I am totally healthy other than having multiple myeloma and rarely if ever get sick.
Mine are suppressed because of the medication and, when I ask the doctors all they say is "well, we hope these will stabilize eventually". I am totally healthy other than having multiple myeloma and rarely if ever get sick.
-
torimooney - Name: tori
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: apr 2012
- Age at diagnosis: 64
Re: What's the added value of immunoglobulin results?
Hi Tori,
Multibilly may have had other research in mind when he made the statement he did, but we suspect he may have been referring to research such as what is discussed in this Beacon news article from earlier this year:
"Levels Of Uninvolved Immunoglobulins Linked To Prognosis In Newly Diagnosed Multiple Myeloma," The Myeloma Beacon, March 24, 2014.
There are additional references that may be of interest in the comments to the article.
Note that this and related research refers to the normal ("uninvolved") immunoglobulins being suppressed for reasons other than as a side effect of treatment. We're not aware of any research indicating that lower-than-normal uninvolved immunoglobulin levels as a result of treatment have any prognostic value.
Also, the technical term for lower-than-normal uninvolved immunoglobulins is "immunoparesis". You may find the term useful as you (or other readers) do additional research on the topic. It's not a term that is consistently used, but it certainly is used relatively often.
Good luck!
Multibilly may have had other research in mind when he made the statement he did, but we suspect he may have been referring to research such as what is discussed in this Beacon news article from earlier this year:
"Levels Of Uninvolved Immunoglobulins Linked To Prognosis In Newly Diagnosed Multiple Myeloma," The Myeloma Beacon, March 24, 2014.
There are additional references that may be of interest in the comments to the article.
Note that this and related research refers to the normal ("uninvolved") immunoglobulins being suppressed for reasons other than as a side effect of treatment. We're not aware of any research indicating that lower-than-normal uninvolved immunoglobulin levels as a result of treatment have any prognostic value.
Also, the technical term for lower-than-normal uninvolved immunoglobulins is "immunoparesis". You may find the term useful as you (or other readers) do additional research on the topic. It's not a term that is consistently used, but it certainly is used relatively often.
Good luck!
Re: What's the added value of immunoglobulin results?
Tori,
I was indeed thinking about the article that the Beacon mentioned above. Thanks for clarifying the details Beacon!
I was indeed thinking about the article that the Beacon mentioned above. Thanks for clarifying the details Beacon!
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
14 posts
• Page 1 of 2 • 1, 2