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Bone marrow biopsy results...help me understand them?

by dianaiad on Mon Mar 04, 2013 7:58 pm

I have already griped about the way my doctor doesn't communicate well....I dropped by the clinic and got the results of the bone marrow biopsy from last Tuesday.

It says...."The marrow is 70% cellular. There are sheets of plasma cells. The plasma cells are about 75% of marrow cells. The plasma cells display monoclonal lambda light chain restriction. There are some normal hematopoietic elements. Amyloid is not apparent. The bony spicules are unremarkable."

In another section it states:
1. Plasma cell myeloma, moderately differentiated (about 75% of marrow cells are myeloma cells)
2. Plasma cells with monoclonal lambda light chain restriction
3. Flow Data: No B Cell surface immunoglobulin monoclonality demonstrable
(wait. Is that good news or bad news?)

My bones don't show any lytic lesions through X-rays, I haven't had an MRI or CT scan.
Gamma globulin is 3.59 gm/dl
Beta globulin is .62 gm/dl
total protein is 9.1 gm/dl
Albumin electrophoresis is 3.69 gm/dl

Beta-2-microglobulin = 4.0 mg/l
Calcium = 9.0 mg/dl
haptoglobin = 203 mg/dl
HGB - 10.6
Creatinine = 1.1

Kappa/lambda light chains, free with ration, serum...all well within normal range

The doctor CLAIMED, in the paperwork, that he had 'carefully explained" the bit about the IGG, IGA and IGM, that the IGG was rather high (4390) and the other two were low (IGA = 33, IGM = <20, all mg/dl) and that 'all the patient's questions were answered.

What a crock. THIS is the guy who, when I asked about it, told me to stop obsessing over one test, and who took over a week even to let me know what the NAME of the test was, never mind what the results were, He never did tell me those; I had to go in and get them from the medical records department.

So...what do the above things mean, exactly? I have a feeling that if I wait for this guy, he might forget to talk to me altogether--especially if I don't turn out to be interesting (read 'sick') enough.

sorry, a bit frustrated over here. :roll:
Learned in church today: 1. study consistently, because you never know when the Bishop is going to give you ten minutes notice to give a talk on how to study. 2. Pray often. See #1.

dianaiad
Who do you know with myeloma?: Me
When were you/they diagnosed?: Officially...March 2013
Age at diagnosis: 63

Re: Bone marrow biopsy results...help me understand them?

by TheRealDeal2013 on Mon Mar 04, 2013 9:36 pm

Your marrow has way too many cells to begin with (70%), when the norm is usually around 30% I understand. And the vast majority (75%) are plasma cells, which normally should be less than 5%. So I would suggest switching providers given your issues regarding competency and communication.

My doctor is young and without a doubt, smart - but I am switching, because he has no long-term plan. Instead he wants me to pump myself with the maximum dose of drugs - I am responding well - until presumably it no longer works. Then I think he (and the prestigious medical center he works for) will gleefully shove a transplant down my throat..... that it is the only plan as far as I can tell.

TheRealDeal2013

Re: Bone marrow biopsy results...help me understand them?

by Multibilly on Mon Mar 04, 2013 10:08 pm

Hi Dianaiad,

I believe you said in one of your earlier threads that you were anemic. Your hemaglobin (HGB) is low (normal range is 14.3 -18.1 g/dL)

Your IgG is also pretty high. Normal range is 700-1600 mg/dL

Your total protein is high, which is also not a surprise given your high IgG.

Do your lab results not indicate whether you are out of range of accepted values, or not?

Technically, you meet the CRAB criteria by virtue of being anemic. And you definitely have quite a fair amount of myeloma involvement (75%) in your bone marrow. Since you meet one of the CRAB criteria, I believe my primary doc would classify you as being symptomatic multiple myeloma.

You can plug your HGB, albumin, beta-2 microglobulin and calcium data for into the following and make the initial determination yourself as to what stage you are: http://www.cancer.org/cancer/multiplemyeloma/detailedguide/multiple-myeloma-staging. But really, a doc should make this final call.

I believe there was an earlier thread from you that discussed the possibility that you can indeed have multiple myeloma with no FLC involvement.

If what I say is accurate (I am just a layman, and not a doc), I would suggest discussing treatment options ASAP, while also seeing another multiple myeloma specialist to interpret your data and to also discuss his/her views on treatment options. I would also talk to them about your skeletal xrays and see if they would still recommend getting a PET/CT scan or MRI to rule out any bone lesions.

This has got to be a tough crossroads for you. Best of luck to you. Folks here are happy to help.

Multibilly
Name: Multibilly
Who do you know with myeloma?: Me
When were you/they diagnosed?: Nov, 2012

Re: Bone marrow biopsy results...help me understand them?

by Nancy Shamanna on Tue Mar 05, 2013 8:27 am

Hi Dianalad, I am sorry to hear that you do have myeloma, according to your bone marrow/aspirate biopsy. I was in the the same spot in 2009, with those dreaded 'sheets' of plasma cells filling my marrow. What ensued was induction chemo, a stem cell transplant and a year of further low dose chemo. So you may need to prepare for a long session of chemotherapy treatments!
I hope that you can find a medical team that you are comfortable with, but that you don't have to do a lot of long distance driving while undergoing treatments either. Maybe a familly member or friend could come with you to app'ts to help figure things out. I never went by myself to any app'ts for probably 18 months....for I needed that second set of 'ears' to comprehend stuff!
Oh, and did they do the FISH test too? That is important for determining your cytogenetic risk, and is taken from the bone marrow biopsy.
Please keep us posted. I hope you can get into appropriate treatment very soon!

Nancy Shamanna
Name: Nancy Shamanna
Who do you know with myeloma?: Self and others too
When were you/they diagnosed?: July 2009

Re: Bone marrow biopsy results...help me understand them?

by Dr. Edward Libby on Tue Mar 05, 2013 3:25 pm

Greetings from Seattle,
It does sound like you have symptomatic myeloma because you have more than 10% plasma cells in the marrow and your hemoglobin has fallen by more than 2gm/dL from the normal range. Unless there is an alternative explanation for the anemia you should probably be treated for symptomatic myeloma.

Your FISH results on the bone marrow are important to determine your prognosis.

The lack of b-cell surface monoclonality does not relate to the myeloma and is neither a positive nor a negative for you.

It is important that you hav a good working relationship with your oncologist so hopefully you can patch things up with the person you have been seeing or can trannsfer your care to an hematologist/oncologist you trust and can talk with comfortably. Getting a second opinion at a major center can ease some of your doubts about whether or not you are on the right track. In addition becoming informed about myeloma is a powerful way to gain more control over the disease.

I wish you good luck and a long life with this difficult but treatable disease.
Dr. Edward Libby
University of Washington & Fred Hutchinson Cancer Research Center

Any advice provided in these postings is based on a very limited amount of information. There is no substitute for the care of your oncologist/hematologist. Therefore, all suggestions should be discussed with your treating physician. None of the comments presented here are meant to replace the evaluation of a patient by a knowledgeable physician.


Dr. Edward Libby
Name: Edward Libby, M.D.
Beacon Medical Advisor

Re: Bone marrow biopsy results...help me understand them?

by KathyCA on Sat Mar 09, 2013 1:48 pm

Based on the information given, as a layperson fighting this disease over 5years, i would highly recommend a direct talk about how you are feeling with your current oncologist or as for a second opinion referral.

This is your life and you must be your advocate. If your doctor feels that he has answered all your questions yet you leave not feeling so, then there is a communication issue. That said, do you own research, there are excellent websites out there to help you with lab and test results not to mention the Beason site. Never go to your doctor without your list of questions made, his time is valuable and it is good to respect it by being prepared.

My observation is that your myeloma in the bone marrow is high as areyour protein numbers. These would be indications of needing treatment. If you can, get and MRI to check for lesions, there have been articles here that it is the most effective to analyze for them.

KathyCA


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