20 days ago my mom was diagnosed with a L1 compression fracture and sent for an MRI. The impression was:
Diffuse hypointensity within the visualized bone marrow with multiple T1 and T2 hypointense lesions throughout the visualized bone marrow is concerning for a infiltrative bone marrow process such as multiple myeloma.
My mom has now had full testing including a bone biopsy, full body x-ray, and lab. Most of the results are complete, but we cannot see her oncologist for 3 weeks with the holidays. Can you please help me understand these results:
Biopsy:
Diffuse patchy lucencies within the bone marrow and punched-out cortical lesions of the sacrum and bilateral ilii on limited nondiagnostic CT. Findings are most suggestive of multiple myeloma.
Some of the labs:
Test Normal Range Her value
RBC count 4.15 - 5.55 M/uL 2.38
Hemoglobin 12.0 - 15.0 g/dL 7.4
Hematocrit 36 - 46 % 23.3
Free Light Chains Ratio 0.26 - 1.65 2.33
Kappa Light Chains 3.3 - 19.4 mg/L 22.6
Lambda Light Chains 5.7 - 26.3 mg/L 9.7
Full body x-ray:
Lytic areas within the skull vault consistent with myeloma. Pathologic fracture through L1 consistent with myeloma. Some patchy lucencies within both femoral shafts. Moderate endosteal scalloping within the left femur. These findings are consistent with multiple myeloma. No impending pathologic fracture.
My mom is 74 and has advanced dementia. She still know us but has no short term memory. Yesterday, I reviewed all the medical results with her for 2 hours and discussed the process we are going through, and 30 minutes later she had no memory of the discussion or her medical condition. The pain meds (narco) are making her memory issues worse.
Please someone tell me if she has multiple myeloma, I am really lost
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Re: Waiting for Mom's diagnosis
Hello Sarah,
I'm sorry about the difficult time your mother and your family are facing right now. I realize it's all very scary and threatening, and I hope those of us here in the forum can help a bit.
Unfortunately, several of the test results that you've shared indicate that your mother may have myeloma. She has bone damage that looks like it could be caused by multiple myeloma. She also has anemia (low RBC count and hemoglobin). These are two classic symptoms of multiple myeloma.
She also has an elevated kappa free light chain level which is leading to a high ratio of the kappa-to-lambda free light chain levels. This is also suggestive of multiple myeloma, although many myeloma patients are diagnosed with kappa (or lambda) light chain levels that are much higher than what your mother has.
There are two sets of test results, however, that will be particularly important to determining whether your mother has myeloma.
First, she almost certainly had a set of tests done to measure and characterise the proteins in her blood (or perhaps her urine). Specifically, she probably had testing done that looked at her total IgG, IgA, and other immunoglobulin levels. Also, she likely had serum protein electrophoresis (SPEP) and immunofixation electrophoresis (IFE) tests done.
If you have the results of these tests, please share them with us. They will show whether your mother has any signs of monoclonal proteins in her blood. Myeloma cells produce monoclonal proteins. Normally, the body produces polyclonal proteins.
Second, if your mother had a bone marrow biopsy, as you say she did, she should have gotten a report saying what percent of her bone marrow was monoclonal plasma cells.
Once again, if you have that report, it would be helpful if you shared the results with us.
Finally, it would be interesting to know if your mother had measurements done of the calcium level in her blood and of her kidney function (usually measured by creatinine levels in the blood). Those tests were probably done as part of a standard blood panel, and their results also would be interesting to know.
In general, when doctors determine whether someone has multiple myeloma, they look first to see if they have what are known as the "CRAB" symptoms -- elevated Calcium levels, kidney (Renal) damage, Anemia, or Bone damage.
If there are any of these symptoms, doctors then look to see if there is firm evidence that myeloma is the source of these symptoms. That is determined by the protein studies I mentioned above, the serum (blood) free light chain testing (which usually is a reflection of blood protein levels), and by the plasma cell percentage from the bone marrow biopsy.
The Wikipedia article on multiple myeloma has a good section on how the disease has classically been diagnosed:
http://en.wikipedia.org/wiki/Multiple_myeloma#Diagnostic_criteria
In addition, there recently has been an update to these criteria, which you can read about in this article:
S Vincent Rajkumar, "New Criteria For The Diagnosis Of Multiple Myeloma And Related Disorders," The Myeloma Beacon, Oct 26, 2014.
Hopefully, the symptoms that your mother has that suggest she has multiple myeloma will be explained, in the end, by some other condition that is less serious.
If, however, the correct diagnosis turns out to be multiple myeloma, please know that there are many, many treatments for the disease that should make it possible for your mother to live many more years. In addition, new treatments are being developed and are likely to become widely available in the next several years.
Finally, you have come to a great place for support and information about the disease. We are happy to help, provide additional feedback, and answer additional questions you may have.
Good luck!
I'm sorry about the difficult time your mother and your family are facing right now. I realize it's all very scary and threatening, and I hope those of us here in the forum can help a bit.
Unfortunately, several of the test results that you've shared indicate that your mother may have myeloma. She has bone damage that looks like it could be caused by multiple myeloma. She also has anemia (low RBC count and hemoglobin). These are two classic symptoms of multiple myeloma.
She also has an elevated kappa free light chain level which is leading to a high ratio of the kappa-to-lambda free light chain levels. This is also suggestive of multiple myeloma, although many myeloma patients are diagnosed with kappa (or lambda) light chain levels that are much higher than what your mother has.
There are two sets of test results, however, that will be particularly important to determining whether your mother has myeloma.
First, she almost certainly had a set of tests done to measure and characterise the proteins in her blood (or perhaps her urine). Specifically, she probably had testing done that looked at her total IgG, IgA, and other immunoglobulin levels. Also, she likely had serum protein electrophoresis (SPEP) and immunofixation electrophoresis (IFE) tests done.
If you have the results of these tests, please share them with us. They will show whether your mother has any signs of monoclonal proteins in her blood. Myeloma cells produce monoclonal proteins. Normally, the body produces polyclonal proteins.
Second, if your mother had a bone marrow biopsy, as you say she did, she should have gotten a report saying what percent of her bone marrow was monoclonal plasma cells.
Once again, if you have that report, it would be helpful if you shared the results with us.
Finally, it would be interesting to know if your mother had measurements done of the calcium level in her blood and of her kidney function (usually measured by creatinine levels in the blood). Those tests were probably done as part of a standard blood panel, and their results also would be interesting to know.
In general, when doctors determine whether someone has multiple myeloma, they look first to see if they have what are known as the "CRAB" symptoms -- elevated Calcium levels, kidney (Renal) damage, Anemia, or Bone damage.
If there are any of these symptoms, doctors then look to see if there is firm evidence that myeloma is the source of these symptoms. That is determined by the protein studies I mentioned above, the serum (blood) free light chain testing (which usually is a reflection of blood protein levels), and by the plasma cell percentage from the bone marrow biopsy.
The Wikipedia article on multiple myeloma has a good section on how the disease has classically been diagnosed:
http://en.wikipedia.org/wiki/Multiple_myeloma#Diagnostic_criteria
In addition, there recently has been an update to these criteria, which you can read about in this article:
S Vincent Rajkumar, "New Criteria For The Diagnosis Of Multiple Myeloma And Related Disorders," The Myeloma Beacon, Oct 26, 2014.
Hopefully, the symptoms that your mother has that suggest she has multiple myeloma will be explained, in the end, by some other condition that is less serious.
If, however, the correct diagnosis turns out to be multiple myeloma, please know that there are many, many treatments for the disease that should make it possible for your mother to live many more years. In addition, new treatments are being developed and are likely to become widely available in the next several years.
Finally, you have come to a great place for support and information about the disease. We are happy to help, provide additional feedback, and answer additional questions you may have.
Good luck!
Re: Waiting for Mom's diagnosis
Thank you for the quick response. Several of the tests are not complete including the bone marrow biopsy and the SPEC, but I I do have the following:
Test Normal Range Her value
IgG, serum 700 - 1600 mg/dL 428
IgA, serum 70 - 400 mg/dL 27
IgM, Serum 40 - 230 mg/dL 56
Protein, Total,Ser 6.4 - 8.2 g/dL 6.5
Albumin 3.73 - 5.65 g/dL 4.63
Alpha-1 Globulins 0.13 - 0.45 g/dL 0.22
Alpha-2 Globulins 0.37 - 0.93 g/dL 0.65
Beta Globulins, Ser 0.69 - 1.29 g/dL 0.62
Gamma Globulins 0.58 - 1.50 g/dL 0.38
Interpretation: SPE and IFIX reveals
Moderate hypogammaglobulinemia
No monoclonal protein seen on immunofixation.
Suggest urine free light chain analysis if myeloma is in
the differential diagnosis.
Decreased Beta Globulins
Mild decrease in polyclonal IgG
Mild polyclonal decrease in IgA.
Creatinine, Ser <1.03 mg/dL 1.22
This test does list no monoclonal protein, is it possible that she does not have myeloma even with the x-rays and MRI?
Test Normal Range Her value
IgG, serum 700 - 1600 mg/dL 428
IgA, serum 70 - 400 mg/dL 27
IgM, Serum 40 - 230 mg/dL 56
Protein, Total,Ser 6.4 - 8.2 g/dL 6.5
Albumin 3.73 - 5.65 g/dL 4.63
Alpha-1 Globulins 0.13 - 0.45 g/dL 0.22
Alpha-2 Globulins 0.37 - 0.93 g/dL 0.65
Beta Globulins, Ser 0.69 - 1.29 g/dL 0.62
Gamma Globulins 0.58 - 1.50 g/dL 0.38
Interpretation: SPE and IFIX reveals
Moderate hypogammaglobulinemia
No monoclonal protein seen on immunofixation.
Suggest urine free light chain analysis if myeloma is in
the differential diagnosis.
Decreased Beta Globulins
Mild decrease in polyclonal IgG
Mild polyclonal decrease in IgA.
Creatinine, Ser <1.03 mg/dL 1.22
This test does list no monoclonal protein, is it possible that she does not have myeloma even with the x-rays and MRI?
Re: Waiting for Mom's diagnosis
The new results you've posted paint a somewhat conflicted story.
Your mother's creatinine level is high, although not dramatically so. Still, it suggests that she's experienced some kidney damage, which is another symptom of myeloma.
The big "HOWEVER", on the other hand, is that her immunofixation did not find any signs of a monoclonal protein, and her three main immunoglobulin levels (IgG, IgA, and IgM) are low rather than high. Normally with multiple myeloma, you would expect one of those immunoglobulin levels to be high. There are two other types of immunoglobulin that were not measured in your mother's test, IgD and IgE, but if monoclonal IgD or IgE were present to any significant extent, I believe the immunofixation would have picked it up.
At this point, the bone marrow biopsy result is probably going to be the key to your mother's diagnosis. The main question is whether or not it will show a higher than normal percentage of plasma cells in the marrow.
If it does, then the other results your mother has are probably the result of multiple myeloma, albeit a rare form of myeloma known as nonsecretory multiple myeloma. It's a form of the disease that doesn't "secrete" monoclonal protein to any significant extent.
(Actually, since your mother does have a slightly elevated serum kappa free light chain level, and also some kidney damage, the diagnosis would probably be oligosecretory myeloma, meaning myeloma that secretes just a little bit of monoclonal protein.)
Given your mother's bone damage, anemia, and kidney damage, if the bone marrow doesn't reveal a higher than normal percentage of plasma cells in the marrow, then your mother's doctors still may want to run a PET scan to see if it picks up signs of myeloma in her bones (or somewhere else).
I'm afraid I can't say whether or not your mother's x-ray findings and lab results can be explained by something other than multiple myeloma. I'm not a doctor, so the question is beyond my expertise. Sorry I can't be more helpful on that front!
Good luck!
Your mother's creatinine level is high, although not dramatically so. Still, it suggests that she's experienced some kidney damage, which is another symptom of myeloma.
The big "HOWEVER", on the other hand, is that her immunofixation did not find any signs of a monoclonal protein, and her three main immunoglobulin levels (IgG, IgA, and IgM) are low rather than high. Normally with multiple myeloma, you would expect one of those immunoglobulin levels to be high. There are two other types of immunoglobulin that were not measured in your mother's test, IgD and IgE, but if monoclonal IgD or IgE were present to any significant extent, I believe the immunofixation would have picked it up.
At this point, the bone marrow biopsy result is probably going to be the key to your mother's diagnosis. The main question is whether or not it will show a higher than normal percentage of plasma cells in the marrow.
If it does, then the other results your mother has are probably the result of multiple myeloma, albeit a rare form of myeloma known as nonsecretory multiple myeloma. It's a form of the disease that doesn't "secrete" monoclonal protein to any significant extent.
(Actually, since your mother does have a slightly elevated serum kappa free light chain level, and also some kidney damage, the diagnosis would probably be oligosecretory myeloma, meaning myeloma that secretes just a little bit of monoclonal protein.)
Given your mother's bone damage, anemia, and kidney damage, if the bone marrow doesn't reveal a higher than normal percentage of plasma cells in the marrow, then your mother's doctors still may want to run a PET scan to see if it picks up signs of myeloma in her bones (or somewhere else).
I'm afraid I can't say whether or not your mother's x-ray findings and lab results can be explained by something other than multiple myeloma. I'm not a doctor, so the question is beyond my expertise. Sorry I can't be more helpful on that front!
Good luck!
Re: Waiting for Mom's diagnosis
Hi,
I'm sorry for all your worries about your mom's condition. I can't really offer any valuable insight regarding her potential diagnosis. But I did want to comment on her hemoglobin. 7.4 is a very low hemoglobin value and it should probably be addressed prior to her appointment in 3 weeks.
Is the oncologist now out of the office for the next 3 weeks, or is that just the soonest they could schedule her?
Personally, I would call them about this at least. If they are unavailable, I would call her primary doctor and have him address it. She could very well need a blood transfusion before she see's the oncologist.
Good luck on the next steps in her / your journey.
I'm sorry for all your worries about your mom's condition. I can't really offer any valuable insight regarding her potential diagnosis. But I did want to comment on her hemoglobin. 7.4 is a very low hemoglobin value and it should probably be addressed prior to her appointment in 3 weeks.
Is the oncologist now out of the office for the next 3 weeks, or is that just the soonest they could schedule her?
Personally, I would call them about this at least. If they are unavailable, I would call her primary doctor and have him address it. She could very well need a blood transfusion before she see's the oncologist.
Good luck on the next steps in her / your journey.
Re: Waiting for Mom's diagnosis
I would agree with all the comments above. The findings are all suspicious for myeloma, but not yet diagnostic.
The bone marrow biopsy will likely provide the answer. She should also have a 24-hour urine done for UPEP (urine protein electrophoresis) and urine immunofixation, if not done. If these tests are all negative, then a directed biopsy of one of the bone lesions would be needed to identify myeloma versus some other type of cancer that can metastasize to the bone, though this would be less likely.
I'm sorry she is going through this and hope you can get an answer soon.
The bone marrow biopsy will likely provide the answer. She should also have a 24-hour urine done for UPEP (urine protein electrophoresis) and urine immunofixation, if not done. If these tests are all negative, then a directed biopsy of one of the bone lesions would be needed to identify myeloma versus some other type of cancer that can metastasize to the bone, though this would be less likely.
I'm sorry she is going through this and hope you can get an answer soon.
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Dr. Adam Cohen - Name: Adam D. Cohen, M.D.
Beacon Medical Advisor
6 posts
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