Standard test for multiple myeloma provides clues of a rare, more deadly type (Simple reinterpretation of normal protein electrophoresis test identifies IgD myeloma variant early for better treatment)

Medical Xpress / Med. College of Georgia / International Journal of Pathology and Clinical Research ^ | May 19, 2022 | Singh Gurmukh

[ConservativeMind]

A test for the common blood cancer multiple myeloma also holds clear clues that the patient has one of the most uncommon and deadly forms of this cancer, investigators say.

While there is a specific test for this rare IgD multiple myeloma, the clues from standard testing are sufficient to rapidly initiate aggressive treatment to reduce or prevent kidney destruction by the excessive number of circulating proteins called light chains it produces, says Dr. Gurmukh Singh.

Specific testing for IgD myeloma is available at a handful of reference labs across the country, but takes extra time and expense that may not be necessary and likely will delay the start of treatment, Singh says.

IgD myeloma accounts for about 1% of multiple myelomas and has a worse prognosis, says Singh.

With multiple myeloma, the plasma cells that normally produce a wide range of antibodies to help us fight infection instead produce a single dysfunctional antibody, called an M spike, which leaves us vulnerable to infection and can even attack our bones.

… For example, one test commonly used in these patients is protein electrophoresis, which enables Singh to look in detail at what plasma cells are making based on their unique electrical charge. In all four patients with IgD myeloma, Singh found multiple bands that reflect both those dysfunctional antibodies and the excessive light chains characteristic of this type of multiple myeloma, rather than just the single, solid band of color that depicts the M spike. They also consistently indicated more of a specific type of light chain, called lambda, Singh says.

Singh reported that patients who produce these excessive levels of free light chains could benefit most from plasmapheresis to remove some of the circulating light chains from the blood, and dialysis to help the kidneys filter them.

[ConservativeMind]

This fix just takes asking to lab tech to look at the sample for a visual characteristic they’ve been ignoring.

[ConservativeMind]

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[EternalHope]

VERY interesting.

My wife is a long term multiple myeloma survivor.

She was diagnosed very late, but survived because of TWO autologous stem cell transplants. Since then she’s had pretty much every new treatment for multiple myeloma. It relapses, she gets a new treatment, it is brought under control, rinse and repeat.

HOWEVER, her most recent labs show what we and her oncologist suspect is two separate myeloma clones (a second clone is rare, but happens with myeloma patients that have been treated heavily, and survived as long as she has). I had not heard of this particular variant, but her recent labs are consistent with what is described here.

Regardless, it appears treatment for the new variant described in this article would be the same as she is currently getting to bring her most recent relapse under control.

So, in a practical sense, this is worthwhile information but not something that will change what we are currently doing.

Thanks for posting!