I was diagnosed with MGUS last year and will go for my next 6 month blood work next week. I have done all testing except the dreaded bone marrow biopsy and hope I don't have to go down that road. My "CRAB" results are all good.
My doctor says I'm good right now and we just need to monitor it, which I'm very happy about, but I'm the kind of person that doesn't like surprises and I prefer to be up on my knowledge prior to going for results.
At my last visit, my doctor said I have a slightly higher chance of developing multiple myeloma because of my blood results, but I wanted others' opinions on what my blood results look like to them and possibly some questions I might need to ask the doctor at my next visit. I have asked him every question under the sun that I could think of, but I'm sure I haven't thought about some possibilities.
At my first appointment, my blood work showed I have 2 M spikes, both IgA kappa light chain type.
I can't find much information about what my results 'mean' and its possible they don't really mean anything significant, but
My igG was low in April (620) - Normal Range for lab is 635 - 1741 mg/dL, (the last two times its been normal),
My IgA is high and has been from the beginning (875) - Normal Range for lab is 66 - 422 mg/dL (at the beginning of this it was 997 so it's getting better I guess), and
My IgM is low (38) - Normal Range for lab is 45-281 mg/dL, it has been low from the start but is getting lower.
Do these results indicate anything possible on the horizon?
Because my M protein is location in Alpha-2, an accurate quantitation by routine protein electrophoresis cannot be reliably determined, but mine was high (1.67) - Normal Lab range is 0.48 - 1.05 g/dL. This hasn't changed from my first appointment 18 months ago.
Kappa quantitative free light chain is high - 13.73,
Lambda quantitative free light chain is low - 0.017
Ratio is 80.76.
Sorry for the long post but I do thank you in advance for reading and responding.
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Re: What is my risk of progressing to multiple myeloma?
Hi Shechild,
Welcome to the forum.
The fact you have IgA-type MGUS (as opposed to IgG MGUS) puts you at a slightly higher risk of progression to multiple myeloma. See this link to better understand this.
Kyle, RA., et al, "Monoclonal gammopathy of undetermined significance (MGUS) and smoldering (asymptomatic) multiple myeloma: IMWG consensus perspectives risk factors for progression and guidelines for monitoring and management," Leukemia, April 2010 (full text of article)
Excerpt:
"Patients with IgM or IgA monoclonal protein had an increased risk of progression as compared with patients who had an IgG monoclonal protein in the 1384 patient cohort. Blade et al. also reported that patients with an IgA MGUS had a greater probability for progression to multiple myeloma."
In addition, you should note this statement in the above article:
"Rajkumar et al.developed a risk-stratification model for progression of MGUS. Patients with risk factors consisting of a serum M protein greater than or equal to15 g/l (1.5 g/dL), IgA or IgM MGUS and an abnormal serum FLC ratio had a risk of progression at 20 years of 58%; compared with 37% when two risk factors were present; 21% when one risk factor was present; and only 5% when none of the risk factors were present"
Also, the fact that your IgG and IgM levels (your "uninvolved" immunoglobulins) are somewhat suppressed suggests that you have mild immunoparesis. There are some preliminary studies which have suggested that immunoparesis may increase the risk of progression to multiple myeloma in MGUS patients. You can easily google "immunoparesis MGUS" to find articles on that topic.
I'm guessing that the above reasons are why your doctor said you have a slightly higher chance of developing multiple myeloma.
By the way, it can be confusing understanding risk of progression stats. So, you may want to also review this forum thread:
"Risk of progression in smoldering multiple myeloma" (started Sep 13, 2014)
Lastly, tracking IgA M-spikes can be tricky (as you mentioned in your post). The next time you see your oncologist, you might want to discuss including the new Hevylite assay (availalbe through Labcorp in the USA) as part of your routine testing. The Hevylite assay gets around many of the problems that IgA-type patients have with monitoring their M-spike levels.
Welcome to the forum.
The fact you have IgA-type MGUS (as opposed to IgG MGUS) puts you at a slightly higher risk of progression to multiple myeloma. See this link to better understand this.
Kyle, RA., et al, "Monoclonal gammopathy of undetermined significance (MGUS) and smoldering (asymptomatic) multiple myeloma: IMWG consensus perspectives risk factors for progression and guidelines for monitoring and management," Leukemia, April 2010 (full text of article)
Excerpt:
"Patients with IgM or IgA monoclonal protein had an increased risk of progression as compared with patients who had an IgG monoclonal protein in the 1384 patient cohort. Blade et al. also reported that patients with an IgA MGUS had a greater probability for progression to multiple myeloma."
In addition, you should note this statement in the above article:
"Rajkumar et al.developed a risk-stratification model for progression of MGUS. Patients with risk factors consisting of a serum M protein greater than or equal to15 g/l (1.5 g/dL), IgA or IgM MGUS and an abnormal serum FLC ratio had a risk of progression at 20 years of 58%; compared with 37% when two risk factors were present; 21% when one risk factor was present; and only 5% when none of the risk factors were present"
Also, the fact that your IgG and IgM levels (your "uninvolved" immunoglobulins) are somewhat suppressed suggests that you have mild immunoparesis. There are some preliminary studies which have suggested that immunoparesis may increase the risk of progression to multiple myeloma in MGUS patients. You can easily google "immunoparesis MGUS" to find articles on that topic.
I'm guessing that the above reasons are why your doctor said you have a slightly higher chance of developing multiple myeloma.
By the way, it can be confusing understanding risk of progression stats. So, you may want to also review this forum thread:
"Risk of progression in smoldering multiple myeloma" (started Sep 13, 2014)
Lastly, tracking IgA M-spikes can be tricky (as you mentioned in your post). The next time you see your oncologist, you might want to discuss including the new Hevylite assay (availalbe through Labcorp in the USA) as part of your routine testing. The Hevylite assay gets around many of the problems that IgA-type patients have with monitoring their M-spike levels.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: What is my risk of progressing to multiple myeloma?
Hi Shechild,
Multibilly has given you some great feedback (as he always does). In case you're looking for more information on some of the points he makes, I thought I would mention that this forum posting by Alex nicely summarizes the three factors frequently mentioned as risk factors for progression from MGUS to multiple myeloma.
Also, this posting by Cheryl is a nice introduction to the Hevylite testing that Multibilly mentioned. Cheryl's post also describes research that has been done looking at whether the results of Hevylite testing can help predict risk of progression.
I know you say you do not have any of the "CRAB" criteria, but I just want to make sure you've checked your serum calcium, creatinine, and hemoglobin levels to confirm they are well within the normal range
Also, when I first read your post, I wondered if you should, in fact, get a bone marrow biopsy to determine your plasma cell percentage. It would help establish for certain whether your diagnosis is, in fact, MGUS, or if it is smoldering multiple myeloma.
Multibilly didn't mention anything about this in his post, however, so perhaps it's not that important.
Good luck!
Multibilly has given you some great feedback (as he always does). In case you're looking for more information on some of the points he makes, I thought I would mention that this forum posting by Alex nicely summarizes the three factors frequently mentioned as risk factors for progression from MGUS to multiple myeloma.
Also, this posting by Cheryl is a nice introduction to the Hevylite testing that Multibilly mentioned. Cheryl's post also describes research that has been done looking at whether the results of Hevylite testing can help predict risk of progression.
I know you say you do not have any of the "CRAB" criteria, but I just want to make sure you've checked your serum calcium, creatinine, and hemoglobin levels to confirm they are well within the normal range
Also, when I first read your post, I wondered if you should, in fact, get a bone marrow biopsy to determine your plasma cell percentage. It would help establish for certain whether your diagnosis is, in fact, MGUS, or if it is smoldering multiple myeloma.
Multibilly didn't mention anything about this in his post, however, so perhaps it's not that important.
Good luck!
Re: What is my risk of progressing to multiple myeloma?
Wow! I had thought I researched everything to know about MGUS! Thank you both for your responses. I will be reading the articles recommended.
As far as my CRAB criteria, my results have been well within normal range, I think that is why he hasn't moved on to doing a bone marrow biopsy.
Again, thank you both for your answers. I do greatly appreciate it.
As far as my CRAB criteria, my results have been well within normal range, I think that is why he hasn't moved on to doing a bone marrow biopsy.
Again, thank you both for your answers. I do greatly appreciate it.
Re: What is my risk of progressing to multiple myeloma?
Hi SheChild,
My MGUS was first discovered over ten years ago. Like you, I have IgA kappa light chain monoclonal proteins. Over those ten years, the concentration of my M proteins drifted slowly upward until late last year, at which time they began to rapidly increase. A bone marrow biopsy showed that my marrow was 50% abnormal plasma cells and I was subsequently diagnosed with active myeloma with the t(4;14) cytogenetic abnormality. I am currently receiving treatment with cyclophosphamide, Velcade (bortezomib), and dexamethasone (CyBorD) in an attempt to tame my myeloma.
Both my IgG and IgM drifted downward during the time my M proteins drifted upward. My IgG level reached its lowest point (210 mg/L) shortly before my first round of treatment began. After two rounds of treatment, my IgG have risen to 300 mg/L. My IgM remains stuck at < 20 mg/L.
Looking back at my experience, I can say that I often wondered whether my MGUS would switch over to something more active. Early on I decided to keep track of almost all my blood test results in a spreadsheet program. When seen as a graph, I was able to discern the fluctuations from the drift. In this way I could keep my anxiety down until the end when it became apparent that my MGUS was getting out of hand.
I’m attaching one of my graphs so you can see for yourself how a drifting MGUS switched over to a rampant gammopathy. The recent drop in M proteins is due to treatment. Note that I use units of grams per litre; 1 g/L = 0.1 g /dl = 100 mg/dL.
Good luck to you,
Joe
My MGUS was first discovered over ten years ago. Like you, I have IgA kappa light chain monoclonal proteins. Over those ten years, the concentration of my M proteins drifted slowly upward until late last year, at which time they began to rapidly increase. A bone marrow biopsy showed that my marrow was 50% abnormal plasma cells and I was subsequently diagnosed with active myeloma with the t(4;14) cytogenetic abnormality. I am currently receiving treatment with cyclophosphamide, Velcade (bortezomib), and dexamethasone (CyBorD) in an attempt to tame my myeloma.
Both my IgG and IgM drifted downward during the time my M proteins drifted upward. My IgG level reached its lowest point (210 mg/L) shortly before my first round of treatment began. After two rounds of treatment, my IgG have risen to 300 mg/L. My IgM remains stuck at < 20 mg/L.
Looking back at my experience, I can say that I often wondered whether my MGUS would switch over to something more active. Early on I decided to keep track of almost all my blood test results in a spreadsheet program. When seen as a graph, I was able to discern the fluctuations from the drift. In this way I could keep my anxiety down until the end when it became apparent that my MGUS was getting out of hand.
I’m attaching one of my graphs so you can see for yourself how a drifting MGUS switched over to a rampant gammopathy. The recent drop in M proteins is due to treatment. Note that I use units of grams per litre; 1 g/L = 0.1 g /dl = 100 mg/dL.
Good luck to you,
Joe
- Joe's M Protein versus time
- Joe's MGUS Graph.png (11.04 KiB) Viewed 1768 times
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Wobbles - Name: Joe
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: June 2016
- Age at diagnosis: 67
Re: What is my risk of progressing to multiple myeloma?
Joe,
Thank you for your reply. I'm sorry to hear you have progressed, but hope you are and will continue to respond favorably to treatment.
I haven't thought about doing a chart of my results, which is a great idea. However, my results I receive from my doctor do have the previous three results side by side, so I can see how I'm doing over time.
My IgA has been going down from the beginning, but so have my others, which seems concerning since they were in the normal ranges.
I wish you the best. I have an aunt that has been battling multiple myeloma for 20 years and so far is winning.
Again, thank you for your reply.
Thank you for your reply. I'm sorry to hear you have progressed, but hope you are and will continue to respond favorably to treatment.
I haven't thought about doing a chart of my results, which is a great idea. However, my results I receive from my doctor do have the previous three results side by side, so I can see how I'm doing over time.
My IgA has been going down from the beginning, but so have my others, which seems concerning since they were in the normal ranges.
I wish you the best. I have an aunt that has been battling multiple myeloma for 20 years and so far is winning.
Again, thank you for your reply.
6 posts
• Page 1 of 1