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lab results

by mrsv118 on Thu Aug 23, 2012 7:58 pm

Can you guys help me interpret my lab results?

I was diagnosed with SMM.

Here are my labs:
Bone Marrow: Cellular Marrow involved by plasma cell neoplasm (30% of overall cellularity)
Flow cytometry: Kappa restricted plasma cell population 4%.
FISH: cancelled as no cells were observed.
----So does this mean that my "genetics" are normal but I have 30% plasma cells in my bone marrow?

B2 microglobulin 2.29 mg/L

Urine Immunofixation: Monoclonal Kappa free light chains seen on IFE

24hr urine all normal but has a comment : Monoclonal spike seen in gamma region 43%.
---What does that mean?---

PEP: Monoclonal spike seen in the gamma region 0.2 g/dl
IgG,A,M all low.
Immunofixation pattern comment: monoclonal IgG Kappa seen on IFE

Kappa free light chain 309 mg/l
Lamda free light chain 5.0 mg/L
Kappa Lambda ratio 61.8

So this is what I'm getting from all this info?
My M protein is 0.2g/dl.
My genetics are normal.
My M protein is secreting Kappa free light chains.
My Kappa Lambda ration is 61.8 (that seems high for only a 0.2 M spike. but I have no idea)

Thoughts?

mrsv118
Name: Kate
Who do you know with myeloma?: ME
When were you/they diagnosed?: 7/19/12
Age at diagnosis: 48

Re: lab results

by Dr. Peter Voorhees on Thu Aug 23, 2012 9:00 pm

The plasma cells in your bone marrow are making a small amount of IgG kappa antibodies (which is being picked up on your serum protein electrophoresis and immunofixation -- the 0.2 g/dL number), but are making a lot of free kappa light chains in addition to intact antibodies. That is why the serum free kappa light chain concentration and ratio are high. The 30% involvement of the marrow would indicate either smoldering myeloma or symptomatic myeloma -- not MGUS. Do you have anemia? Kidney problems? A high calcium level on your blood work? Bone lesions on x-rays? Lastly, the cytogenetic tests are not evaluable. It would seem as though they did not have any cells to run the test. As such, you cannot draw any conclusions in that regard.

Let me know about the questions above and we will go from there.

Thanks and hang in there!

Pete V.
Dr. Peter Voorhees
University of North Carolina at Chapel Hill

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. Peter Voorhees
Name: Peter Voorhees, M.D.
Beacon Medical Advisor

Re: lab results

by mrsv118 on Thu Aug 23, 2012 9:23 pm

Thanks Dr V,
I am not anemic, MRI and bone xrays were good. Serum protein/urine protein are normal.
I did have a bone marrow and I have the result but there is so much information I'm not sure what is relevant info.

Bone marrow differential count all normal except for Plasma cell at 28%.
Cytogenics:
Karyotype 46XX (im still a girl) ;)
Analysis:
Metaphases counted 20
metaphases analyzed 20
metaphases karyotyped 20
GTG band level 400-500
interpretation:
within the limits of the technology utilized in this study, no consistent numerical and structural chromosome abnormality was identified in twenty metaphases analyzed. Correlation with other clinical and laboratory results is suggested.

mrsv118
Name: Kate
Who do you know with myeloma?: ME
When were you/they diagnosed?: 7/19/12
Age at diagnosis: 48

Re: lab results

by Dr. Peter Voorhees on Thu Aug 23, 2012 9:28 pm

So it looks like conventional cytogenetics were obtained and normal. This is good. I guess they were unable to do the FISH testing for technical reasons. What region of your body did you have MRIed? Kidney function and calcium normal?

Pete V.
Dr. Peter Voorhees
University of North Carolina at Chapel Hill

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. Peter Voorhees
Name: Peter Voorhees, M.D.
Beacon Medical Advisor

Re: lab results

by mrsv118 on Thu Aug 23, 2012 9:58 pm

I had MRI's of my entire spine and bilateral hips with and without contrast. No lytic lesions seen and the only statement was that my marrow appears abnormal. On the hips he calls it "diffuse abnormal appearance of the marrow consistent with a marrow packing disorder (ie myeloma). No osseous dominant lesion is present.
And on the spine the impression states: Heterogeneous marrow without any focal lesions/enhancement..

Kidney function is normal, no calcium issues.

mrsv118
Name: Kate
Who do you know with myeloma?: ME
When were you/they diagnosed?: 7/19/12
Age at diagnosis: 48

Re: lab results

by Dr. Peter Voorhees on Fri Aug 24, 2012 6:40 am

So smoldering myeloma it is. There are no red flags for symptomatic myeloma. Continue to follow-up with your oncologist regularly (for example, every 3 months), to ensure that your light chain levels are not rising and there are no evolving signs of symptomatic myeloma.

Thanks, good luck and smolder on indefinitely without any problems!

Pete V.
Dr. Peter Voorhees
University of North Carolina at Chapel Hill

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. Peter Voorhees
Name: Peter Voorhees, M.D.
Beacon Medical Advisor

Re: lab results

by mrsv118 on Fri Aug 24, 2012 8:10 am

Thanks Dr V,

Last question.
What makes a smolderer "high risk"? Is it the genetics?

mrsv118
Name: Kate
Who do you know with myeloma?: ME
When were you/they diagnosed?: 7/19/12
Age at diagnosis: 48

Re: lab results

by Beacon Staff on Fri Aug 24, 2012 9:38 am

Hi Kate,

There are various definitions of what characteristics make a smoldering myeloma patient have a "high risk" of progressing to symptomatic multiple myeloma. In fact, there are studies currently ongoing looking into what characteristics are the most important.

Currently, if a patient has any one of the following criteria, they are considered to have a high risk of progressing to symptomatic myeloma.

1. Bone marrow plasma cells ≥10%
2. M-spike ≥ 3 g/dl
3. 95% or greater aberrant plasma cells (aPC) immunophenotyping, or
4. Abnormal immunoglobulin free light chain (FLC) ratio

Beacon Staff


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