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Reading Lab Results

by orangeroses on Tue Jul 10, 2012 9:28 am

Hi everyone!
My dad was diagnosed with stage III Multiple Myeloma in February. Needless to say, he's very upset about the results. The combination of that and the hypercalcemia has made him not want to look into his results or anything. My mom gets a brief explanation at the doctor's but I'm not sure she completely understands as she's unable to fully explain it to me. I can't go to the dr with her as I live out of state. Thus, I'm left with a sheet of test results I can't understand either and no idea how my father is doing or how I can help.

There's a reference for the "normal" amount of some of these proteins, but since multiple myeloma isn't normal, I'm unable to gauge how severe his symptoms are.

So I guess what I'm asking is if anyone knows a good reference for beginning to tackle the numbers. Or any tips on key numbers I should be looking at. I'm guessing B2 MICROGLOBULIN, LDH,.. what else?

The labs show 7695 IU/L for LDH, which I'm guessing is ridiculously high? What might be causing that?

Thanks in advance for your help.
C

orangeroses
Name: Cara
Who do you know with myeloma?: Father
When were you/they diagnosed?: 2/2012
Age at diagnosis: 61

Re: Reading Lab Results

by Cindylou on Tue Jul 10, 2012 11:38 am

M-spike is the one you'll want to pay the most attention to.
Others to keep tabs on are Ig values, free light chain ratio, blood counts, b2-microglobulin, LDH, calcium, creatinine.
I'm probably forgetting a few.

Cindylou

Re: Reading Lab Results

by Louise777 on Tue Jul 10, 2012 1:27 pm

Where would one get these numbers from? We get a finger stick twice a week and I get a copy of the resulting bloodwork counts but they have only the following:
WBC
RBC
HGB
HCT
MCV
MCH
MCHC
RDW
PLT
NEUT#
LYMPH#
MONO#
ESO#
BASO#
NEUT%
LYMPH%
MONO%
ESO%
BASO%

and then there is a referance range these should fall into. We are high in som and low in others but I, like "Orangeroses", have no idea which of these is more important. Any advice would, as always, be much appreciated.

Louise

Louise777

Re: Reading Lab Results

by kdboca on Tue Jul 10, 2012 2:06 pm

Louise777, those numbers are standard CBC (Complete Blood Count) and are done for everyone, not just multiple myeloma patients. They may point to the need for further testing but are not usually used to evaluate the progression of multiple myeloma. Cindylou had the right counts to monitor for multiple myeloma, but these are obtained by much more expensive tests such as SPEP, UPEP, 24-hour urine, Serum Free Light Chain Assay. A bone marrow biopsy is often performed on patients beyond MGUS stage and can provide genetic analysis predicting risk of development. All of the tests can be referenced on the web as to what they mean, but to know how they apply to the patient you need to ask the doctor at the time you receive the results.

kdboca

Re: Reading Lab Results

by Cindylou on Tue Jul 10, 2012 2:35 pm

M-protein: is determined by SPEP (serum) and UPEP (urine protein electrophoresis)

IgA, IgD, IgE, and IgG as well as Kappa versus Lambda type: are determined by serum or urine IFE (immunofixation). Each myeloma patient typically has one predominant Ig type, either IgA, IgD, IgE, and IgG. As well as either kappa or lambda light chains.

Free light chain ratio (ratio of kappa to lambda): is determined by serum FLC assay. The ratio of kappa to lambda is more important than the exact amount of each.

Calcium and creatinine: are determined by a metabolic panel

Blood cell counts: are determined by CBC (complete blood count) as kdbocca already said.

Percent of myeloma cells: is determined with a bone marrow biopsy.

Cindylou

Re: Reading Lab Results

by Christa's Mom on Tue Jul 10, 2012 2:52 pm

How frustrating to be away from your family, and not have a good idea of what is going on. I feel for you.

The tests Kdboka references were done at the time of diagnosis, but they are not repeated every time he sees the onc. The CBCs are repeated frequently to make sure whatever treatment protocol he is following is not having too much of an adverse affect on him. If his blood counts get too low, they could skip a cycle of treatment to let him recover a bit.

I'm assuming your dad has been undergoing treatment since February or March. So I'm assuming (big assumption) he's had about four rounds of treatment? I would guess that they would redo some of his initial tests -- SPEP, UPEP and perhaps bone marrow biopsy to see how he is responding. Do you know if he is planning on having a stem cell transplant?

Checkout the International Myeloma Foundation's website (www.myeloma.org), they have lots of good publicatons that explain the tests, drugs, etc.

Lyn

Christa's Mom
Name: Christa's Mom
Who do you know with myeloma?: Husband
When were you/they diagnosed?: September, 2010
Age at diagnosis: 53

Re: Reading Lab Results

by orangeroses on Wed Jul 11, 2012 2:21 pm

Thanks for all of the replies!!!

@CindyLou I'm not seeing an M-Spike on these reports. Might it have another name? Also, I believe the type he has is Kappa Light Chain, minimally secretive.

@Christa's Mom - As for stem cell, I wish. He is pretty against the idea and I'm not sure his kidneys are up for it.

Dad was on Velcade and Dex for four months and he wasn't responding well and ended up back in the hospital in the beginning of June. Our doctor said he couldn't help us any more and we switched to MD Anderson and they have him on a Velcade, Dex and cytoxan cocktail.

MD Anderson is great because they post all of their tests online so I can look at them. :)

I 'm looking at is COMPLETE BLOOD CNT/DIF/PLT from 7/2 and a 24 hr Urine Analysis from 6/18.

Mom just called me and said that MD Anderson told them to be prepared to be admitted to the Hospital after their appointment today. We don't know any more than that and I'm assuming it's because of these ridiculously high numbers.

The numbers that seem to be alarmingly out of proportion for me are the LDH at 7695 IU/L and the B2 MICROGLOBULIN, SERUM at 8.8 mg/L as well as the CREATININE SERUM at 2.60 mg/dL .

I'm assuming FREE KAPPA LIGHT CHAIN at 9400.00 mg/L with a FREE KAPPA/LAMBDA RATIO of 1380.32 is quite bad. :(

orangeroses
Name: Cara
Who do you know with myeloma?: Father
When were you/they diagnosed?: 2/2012
Age at diagnosis: 61

Re: Reading Lab Results

by Morank on Wed Jul 11, 2012 5:04 pm

I know my husband's doctor is really only concerned with the m-spike. It is not listed on the regular CBC and is done once a month. We have to call the Doctor's office (we have Kaiser) and talk to the advice nurse to get the latest results of these tests. Maybe you could have your mom or dad let the Doctor's office know that you will be calling and that it's ok to give you the results of whichever tests results you are asking about.

Morank
Name: Kim and Jeff
Who do you know with myeloma?: Spouse- Jeff
When were you/they diagnosed?: Dec. 2011
Age at diagnosis: 47

Re: Reading Lab Results

by Cindylou on Wed Jul 11, 2012 5:30 pm

It might also be labeled as monoclonal protein or paraprotein.

Cindylou

Re: Reading Lab Results

by Eric Hofacket on Wed Jul 11, 2012 10:02 pm

Orangeroses,
That is a tough spot you are in. I have a bit of an engineering and science background so I have been able to educate myself a bit on my lab results since being diagnosed with multiple myeloma enough to understand the basics. By no means am I confident enough I feel I do not needed to talk with my doctors about what these results mean for me. I believe it is really important a patient’s physician explain what the lab results mean and it can be misleading to interpret them without a doctor. Maybe you can contact your father’s doctor and explain who you are and the situation and ask to seek the information you are looking for from him over the phone. There may be patient privacy laws you would have to deal with but I think as a family member you should be able to be privy to this information with your fathers consistent.

Eric Hofacket
Name: Eric H
When were you/they diagnosed?: 01 April 2011
Age at diagnosis: 44

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