Hi all,
I have been reading many comments and wondering if someone can tell me what kind of myeloma my husband has:
50 y.o
Only B in crab
Pre induction labs...cbc normal... electrolyes, calcium, kidney labs normal
beta 2 normal
15-20% neoplasm cells in bone marrow--unable to do cytogenetics--inadequate sample
Blood-- free kappa light 16.80 H (0.33-1.94)
free lambda normal
free kap/lam ratio 40.98 H (0.25-1.65)
M spike 0.0
IgA, IgG, IgM normal
24-hour urine positive for Bence Jones (monoclonal free kappa light chain)
Had 6 rounds RVD
Labs have been normal since end of 2nd round.
2 months since end of induction.
Meeting with oncologist today to discuss maintenance with Revlimid.
Could someone tell me exactly what kind of myeloma he has?
Is kappa restricted myeloma terminology correct and if so is it common, because I don't hear
that term often on forum.
Thanks so much, Kerri
Forums
9 posts
• Page 1 of 1
Re: What kind of multiple myeloma is this?
It sounds like he has "light chain myeloma", where the malignant plasma cells (those previously identified neoplasm cells in the bone marrow) are only producing the light chain components of the antibody and are not producing any monoclonal immunoglobulins (monoclonal IgG, IgA, etc).
You would therefore primarily track the progression of the myeloma through free light chain assays, 24 hour UPEPs and not the M-spike or immunoglobuin levels.
You would therefore primarily track the progression of the myeloma through free light chain assays, 24 hour UPEPs and not the M-spike or immunoglobuin levels.
Last edited by Multibilly on Tue Nov 03, 2015 2:32 pm, edited 1 time in total.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: What kind of multiple myeloma is this?
I am sure he had an immunofixation electrophoresis test (IE). That test identifies the immunoglobulin that is being overproduced. It is normally run in conjunction with the serum protein electrophoresis (SPEP), which measures the "M spike".
Even if he did not have an M spike, the IE would generally indicate an overproduction of monoclonal antibodies. For example, the two most common types are IgG and IgA. It is more rare to have an overproduction of IgM.
The light chain test indicates that he has has an overproduction of the kappa light chain that is spilling into the blood stream. So he likely has either IgG Kappa or IgA kappa multiple myeloma.
Hope this helps.
Even if he did not have an M spike, the IE would generally indicate an overproduction of monoclonal antibodies. For example, the two most common types are IgG and IgA. It is more rare to have an overproduction of IgM.
The light chain test indicates that he has has an overproduction of the kappa light chain that is spilling into the blood stream. So he likely has either IgG Kappa or IgA kappa multiple myeloma.
Hope this helps.
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Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
Re: What kind of multiple myeloma is this?
Ron,
I agree that an immunofixation test (IFE) was almost certainly run. But I'm not sure that an IFE would yield the presence of a monoclonal immunoglobulin if this is truly light chain disease (as suggested by the lack of an M-spike via the SPEP and normal immuonglobulin levels). I suppose there could be some small amount of monoclonal immunoglubulin present (after all, the various versions of multiple myeloma seem to present on a continuum), but I don't think that this is necessarily a given? But I will be the first to admit that I may be wrong on this point.
Kerri,
In any case, it would be easy to verify Ron's point regarding the "isotype" (IgG-kappa, IgA-kappa, etc) of the disease by simply looking at the comments on the immunofixation test.
I agree that an immunofixation test (IFE) was almost certainly run. But I'm not sure that an IFE would yield the presence of a monoclonal immunoglobulin if this is truly light chain disease (as suggested by the lack of an M-spike via the SPEP and normal immuonglobulin levels). I suppose there could be some small amount of monoclonal immunoglubulin present (after all, the various versions of multiple myeloma seem to present on a continuum), but I don't think that this is necessarily a given? But I will be the first to admit that I may be wrong on this point.
Kerri,
In any case, it would be easy to verify Ron's point regarding the "isotype" (IgG-kappa, IgA-kappa, etc) of the disease by simply looking at the comments on the immunofixation test.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: What kind of multiple myeloma is this?
Multibilly,
When I was originally diagonsed I had a normal total protein test and the IgA, IgG and IgM were mostly normal (my IgA was low). I had excess kappa light chains with an abnormal ratio and my SPEP showed no M spike. However, the IFE test showed excess protein IgG. Thus I was diagnosed with IgG kappa multiple myeloma. The test that is used to track my disease is primarily the sFLC assay.
Since my original diagnosis the SPEP has now grown a .3 level M spike.
That is why I suggested that the IFE test be looked at.
At this point Kerri's husband is similar to where I was originally, focusing on the sFLC Assay.
Ron
When I was originally diagonsed I had a normal total protein test and the IgA, IgG and IgM were mostly normal (my IgA was low). I had excess kappa light chains with an abnormal ratio and my SPEP showed no M spike. However, the IFE test showed excess protein IgG. Thus I was diagnosed with IgG kappa multiple myeloma. The test that is used to track my disease is primarily the sFLC assay.
Since my original diagnosis the SPEP has now grown a .3 level M spike.
That is why I suggested that the IFE test be looked at.
At this point Kerri's husband is similar to where I was originally, focusing on the sFLC Assay.
Ron
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Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
Re: What kind of multiple myeloma is this?
thanks so much for your replies.
The IE Immunoelectrophoresis--- the IGA, IGG, IGM were normal at diagnosis and are still
The SPEP were all normal except for Kappa light chain
immunoplobulins have been normal in blood and urine.
so i guess he has light chain myeloma...
is this a common myeloma---considered standard risk?
I know this disease can mutate--is it possible to effect his IGG,IGA,IGM in the future and thus
need to track M spike..?
This disease is complicated...
Thanks again for the clarification.. kerri
The IE Immunoelectrophoresis--- the IGA, IGG, IGM were normal at diagnosis and are still
The SPEP were all normal except for Kappa light chain
immunoplobulins have been normal in blood and urine.
so i guess he has light chain myeloma...
is this a common myeloma---considered standard risk?
I know this disease can mutate--is it possible to effect his IGG,IGA,IGM in the future and thus
need to track M spike..?
This disease is complicated...
Thanks again for the clarification.. kerri
Re: What kind of multiple myeloma is this?
Ron,
But wouldn't you simply then be classified as having light chain myeloma with a IgG-Kappa isotype?
But wouldn't you simply then be classified as having light chain myeloma with a IgG-Kappa isotype?
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: What kind of multiple myeloma is this?
Multibilly,
I considered myself to be light chain multiple myeloma since that was the only usefull test that could measure my condition.
Kerry,
You are right (as was Multibilly's original suspicion). Your husband has light chain multiple myeloma. That does not mean he is high risk. I have had this for going on 7 years. I have not had an SCT but have been on some form of continuous treatment. If you read some of my other posts you will find that I am very active physically, am an avid cyclist and have done gone over 5,000 miles this year. I work full time only taking time off when I have treatments and dr, appointments. My employer works around those.
I hope this helps. The disease effects everyone differently. Some like Multibilly have had a smoldering condition that may, if he is lucky, never develop into full blown multiple myeloma. Some like me responded well to just novel agent thearapy and others have had successful SCT that have kept them in remission for years. Then of course there are those with very aggressive disease. You husbands condition is not a duplicate of mine by any means but sounds similar.
I considered myself to be light chain multiple myeloma since that was the only usefull test that could measure my condition.
Kerry,
You are right (as was Multibilly's original suspicion). Your husband has light chain multiple myeloma. That does not mean he is high risk. I have had this for going on 7 years. I have not had an SCT but have been on some form of continuous treatment. If you read some of my other posts you will find that I am very active physically, am an avid cyclist and have done gone over 5,000 miles this year. I work full time only taking time off when I have treatments and dr, appointments. My employer works around those.
I hope this helps. The disease effects everyone differently. Some like Multibilly have had a smoldering condition that may, if he is lucky, never develop into full blown multiple myeloma. Some like me responded well to just novel agent thearapy and others have had successful SCT that have kept them in remission for years. Then of course there are those with very aggressive disease. You husbands condition is not a duplicate of mine by any means but sounds similar.
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Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
Re: What kind of multiple myeloma is this?
Thanks for closing on this Ron.
Kerri,
I'm not a doc, but I think it is probably still a good idea to still keep and eye on the M-spike and the other immunoglobulins from time to time even though your serum free light chain assay will be your primary guiding test for now.
I say this because the disease can mutate into different forms over time. As an example, the disease can sometimes switch over to a different isotype (i.e. go from IgG Kappa to IgG Lambda), or you can an develop multiple M-spikes with different isotypes (IgG Kappa + IgA Kappa), or your currently normal immunoglobulin levels can sometimes become suppressed in a process called immunoparesis. In fact, just about every combination of light chains and heavy chains with some or all of these reforming into different or multiple combinations and/or some or none of them secreting into the blood is possible over time. These kinds of changes are not that common, but they certainly happen with a fraction of multiple myeloma patients.
As my youngest kid likes to say "it's just messed up Dad"
Kerri,
I'm not a doc, but I think it is probably still a good idea to still keep and eye on the M-spike and the other immunoglobulins from time to time even though your serum free light chain assay will be your primary guiding test for now.
I say this because the disease can mutate into different forms over time. As an example, the disease can sometimes switch over to a different isotype (i.e. go from IgG Kappa to IgG Lambda), or you can an develop multiple M-spikes with different isotypes (IgG Kappa + IgA Kappa), or your currently normal immunoglobulin levels can sometimes become suppressed in a process called immunoparesis. In fact, just about every combination of light chains and heavy chains with some or all of these reforming into different or multiple combinations and/or some or none of them secreting into the blood is possible over time. These kinds of changes are not that common, but they certainly happen with a fraction of multiple myeloma patients.
As my youngest kid likes to say "it's just messed up Dad"
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
9 posts
• Page 1 of 1