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IgA multiple myeloma - best way to monitor?

by blair77 on Fri Jan 24, 2014 9:30 am

I have read that measuring the M spike is not the best way to monitor IgA myeloma. If so then what is the best way? QIG testing? Would normal IgA levels of 128 which had been 2252 at diagnosis indicate a good response?

blair77
Who do you know with myeloma?: My husband
When were you/they diagnosed?: April 2013
Age at diagnosis: 43

Re: IgA multiple myeloma - best way to monitor?

by Multibilly on Fri Jan 24, 2014 12:02 pm

I've read about the lab measurement issues before with IgA type myeloma. As I recall, one of the complicating issues is that IgA molecules are very similar in size and weight to other proteins in your blood and this can throw off the lab measurements and instead provide false readings of the IgA and M-Spike levels.

You may have heard of the new Hevylite(R) assay (by the same folks that bring you the patented Freelite(R) chain assay)? http://www.thebindingsite.com/hevylite. It strikes me that this new assay might be the better way to track monoclonal protein levels in IgA patients.

This is just speculation on my part. I'm not speaking from experience here, so you might want to discuss this with your doc. I also have no idea how widely available this new test is.

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

Re: IgA multiple myeloma - best way to monitor?

by Multibilly on Fri Jan 24, 2014 5:30 pm

Ah, and this link talks about Hevylite in the context of IgA measurements in particular.

http://www.thebindingsite.com/hevylite

Limitations of Immunoglobulin Measurements

Typical analytical tests for monoclonal gammopathies are serum protein electrophoresis (SPE or SPEP) with scanning densitometry and/or immunofixation electrophoresis (IFE) together with serum free light chain immunoassays. While SPE is a simple, low cost test, it is not very sensitive and quantification of proteins at low concentrations (1-3g/L) is inaccurate.

This is particularly apparent for monoclonal IgA since its anodal electrophoretic migration positions it over other bands such as transferrin. Improved sensitivity is achieved with IFE but IFE is a non-quantitative assay. Nephelometry is also used for immunoglobulin measurements and is analytically accurate down to low concentrations. However, patients' samples also contain non-tumor polyclonal immunoglobulins of both κ and λ types that are included in the analysis. This means results are clinically inaccurate at normal serum concentrations.

Furthermore, assessments of monoclonal IgG are unreliable because of variable catabolism as FcRn recycling receptors that bind albumin and IgG become saturated or reduced by chemotherapy.

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

Re: IgA multiple myeloma - best way to monitor?

by blair77 on Fri Jan 24, 2014 5:55 pm

Thanks Multibilly!!

blair77
Who do you know with myeloma?: My husband
When were you/they diagnosed?: April 2013
Age at diagnosis: 43

Re: IgA multiple myeloma - best way to monitor?

by wesley on Sat Jan 25, 2014 12:07 am

I have IgA myeloma. ASCT starts next week. My doc said that m-spike was not much help in monitoring my disease, and that she would be watching IgA levels primarily. The OP [original poster] seems to me to have gotten a very good response based on IgA reduction.

Wesley

wesley
Who do you know with myeloma?: me
When were you/they diagnosed?: July, 2013
Age at diagnosis: 60

Re: IgA multiple myeloma - best way to monitor?

by Multibilly on Sat Jan 25, 2014 9:17 am

As a follow up to the Hevylite discussion, note that a fairly important (at least what I considered to be important) point that came out of ASH 2013 was that one may be able to use the Hevlylite assay in combination with the Freelite assay to predict both the rapidity of treatment response as well as the likelihood of attaining a deep response. Seems like there are several potential benefits to considering this new test in the multiple myeloma lab testing arsenal, depending on your particular situation.

http://www.myelomabeacon.com/docs/ash2013/762.pdf

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


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