[DonWheelspi]

What does the increase in my M-spike mean?

by DonWheelspi on Sun Jun 10, 2018 2:38 pm

So, last year I presented for the first time with an "M-spike" (2000). It was confirmed to be monoclonal.

Today, June 2018, it's a little higher, 2064, and now my RDW is a little abnormal (15.7 where 15 is the upper range of normal).

So what does it mean? Is my disease progressing?

Best I can figure out, 3% of people over 50 show similar results. In my case:

• Cancer doesn't run in my family, it gallops. Maternal grandparents, all three of their daughters, and one of my generation had cancer. My father had cancer too, tho' it's not what killed him. Two on the maternal side had blood cancers, though not multiple myeloma.
• I don't know if the change over a year from 2000 M-spike to 2064 should be alarming, but the trend is the wrong direction.

My guess is this tells me what I knew: the chance I will get cancer one day is higher than for most people. I never really smoked (well, a pipe, but I quit) and I don't drink much. I'm fat, but athletic.

Any feedback would be appreciated.

[Multibilly]

Re: What does the increase in my M-spike mean?

by Multibilly on Mon Jun 11, 2018 8:32 am

Hi Don,

Are the "2000" and "2064" values really your serum M-spike values from serum protein electrophoresis tests? What are the units of measure? These values sound more like a quantitative immunoglobulin level such as your IgG level.

M-spikes are usually reported in g/dL in the USA and in g/L in Europe. So they would be on the order of 0-10 g/dL in the USA or 0-100 g/L in Europe - but not "2000".

Also, if a doctor is tracking your disease, he / she should also be tracking your serum free light chain values and not just your M-spike.

Lastly, is your current diagnosis MGUS?

[Nancy Shamanna]

Re: What does the increase in my M-spike mean?

by Nancy Shamanna on Mon Jun 11, 2018 9:15 am

Hi Don,

As Multibilly points out, there is no monoclonal value that would be as high as 2000, even though there is a difference of ten times between the American and European (and Canadian) values.

When I look at my copies of blood tests, as a myeloma patient, I am being tested for a complete look at the blood, including white blood cells, red blood cells, hemoglobin, hematocrit, platelets, neutrophils, lymphocytes, monocytes, eosinophils, basophils, granulocytes. Also chemistry being tested includes sodium, potassium,, chloride, CO2, glucose, creatinine, eGFR, calcium total protein, albumin, bilirubin, ALT, All Phos, LDH, alpha, beta and gamma globulins, kappa, lambda, and the ratio of these free light chains, and last but not least the monoclonal proteins.

So I wouldn't think that you would be able to deduce much from a single test. For a definitive diagnosis, other tests such as a marrow biopsy and scans such as X-rays, PET, CT scans can be done.

Hope that you can figure out what is being tested, and if you have a condition such as MGUS, smoldering myeloma, or active myeloma.

Good luck!

[DonWheelspi]

Re: What does the increase in my M-spike mean?

by DonWheelspi on Mon Jun 11, 2018 2:55 pm

Many thank to all who responded!

Are the "2000" and "2064" values really your serum M-spike values from serum protein electrophoresis tests?

Yes, as far as I understand any of this. That number was part of a report that included:

IgA 107
IgG 921
IgM 2068

and "POSITIVE for 18qs" which (the report says) is an aberration associated with non-Hodgkin lymphoma.

As to MGUS, I see a lot of potential labels tossed around, including "evaluate for Walden­strom's macro­globulinemia v lymphoma" (on the lab results) but, no, the doctor refuses to put any label on it. I'm here because runaway IgM abnormalities appear to be associated with multiple myeloma, and that is the main abnormality my tests (done now 3x over near a year) seem to show.

Calcium, creatinine, and protein and other things were also checked, and found within normal ranges.

I am also troubled by yeast infections (men get them, too!) and gout, if that means anything.

This may just be one of those frustrating situations where medicine announces a "bad" number but there's no diagnosis, no disease, no explanation, no treatment. Just worry more. I think it all means I am a candidate for lymphoma, multiple myeloma, non-Hodgkins lymphoma, or Walden­strom's.

Given my family history, not a shock, but also not helpful. : (

[Multibilly]

Re: What does the increase in my M-spike mean?

by Multibilly on Mon Jun 11, 2018 3:56 pm

Hi Don,

The fact that you have an IgM monoclonal disorder changes things a bit and puts you in a slightly different and rarer category than a non-IgM MGUS patient. The normal level for IgM is 20-172 mg/dL. You have an IgM level of 2068 mg/dL, so that means that you likely have an IgM M-spike some­where around 2 g/dL. But you should really refer to your serum protein electro­phoresis report to get the exact M-spike number.

I'm not sure what to make of an "18qs" abnormality? DId you mean just "18q", which can indeed be associated with lymphoma?

First, I'd suggest you read this article:

J Mikhael, "Ask the Hematologist: A Diagnostic Approach to Patients with an IgM monoclonal protein", The Hematologist, Sep 15, 2014 (full text of article)

Secondly, I would strongly suggest finding a myeloma specialist that has familiarity with IgM disorders so as to get a better handle on your diagnosis. If you let us know what city you are in, folks on this forum can make some recommendations.

[DonWheelspi]

Re: What does the increase in my M-spike mean?

by DonWheelspi on Fri Jun 15, 2018 11:00 pm

Did you mean just "18q", which can indeed be associated with lymphoma?

Yes, just 18q. The report says: "FISH analysis on specimen enriched for mature B-cells utilizing probes specific for aberrations commonly associated with non-Hodgkin's lymphoma (NHL) is performed. These studies are positive for trisomy 18q. The finding is not specific and can be seen in NHL including marginal zone lymphoma. Clinical correlation is recommended for a complete evaluation." (OCR'd from the image file, so might have a typo).

First, I'd suggest you read this article:

Right on point, thank you!

If you let us know what city you are in ...

New York City, and thanks for that too! I think my doctor's attitude is my numbers haven't changed over (nearly) a year so: crisis over. We haven't even scheduled a follow-up date for a new blood test.

But I am open to a second opinion.

- Don

[Foundry738]

Re: What does the increase in my M-spike mean?

by Foundry738 on Sat Jun 16, 2018 1:30 pm

An IgM number that high deserves to be followed at no more than 6 month intervals, in my opinion. My IgM is running 1000-1200 and we just extended to six months after several 4 month checks. A bone marrow biopsy would be a good thing to help determine if you are looking at multiple myeloma, Waldenstrom, or something else.