Paraprotein Levels

Good Evening Jane;

Your answers are in the following article:

Diagnostic criteria

In 2003, the International Myeloma Working Group[1] agreed on diagnostic criteria for symptomatic myeloma, asymptomatic myeloma and MGUS (monoclonal gammopathy of undetermined significance):

• Symptomatic myeloma:
  1. Clonal plasma cells >10% on bone marrow biopsy or (in any quantity) in a biopsy from other tissues (plasmacytoma)
  2. A monoclonal protein (paraprotein) in either serum or urine
  3. Evidence of end-organ damage (related organ or tissue impairment, ROTI):
     • Hypercalcemia (corrected calcium >2.75 mmol/L)
     • Renal insufficiency attributable to myeloma
     • Anemia (hemoglobin <10 g/dL)
     • Bone lesions (lytic lesions or osteoporosis with compression fractures)
     • Frequent severe infections (>2 a year)
     • Amyloidosis of other organs
     • Hyperviscosity syndrome
• Asymptomatic myeloma:
  1. Serum paraprotein >30 g/L AND/OR
  2. Clonal plasma cells >10% on bone marrow biopsy AND
  3. NO myeloma-related organ or tissue impairment
• Monoclonal gammopathy of undetermined significance (MGUS):
  1. Serum paraprotein <30 g/L AND
  2. Clonal plasma cells <10% on bone marrow biopsy AND
  3. NO myeloma-related organ or tissue impairment

Related conditions include solitary plasmacytoma (a single tumor of plasma cells, typically treated with irradiation), plasma cell dyscrasia (where only the antibodies produce symptoms, e.g. AL amyloidosis), and POEMS syndrome (peripheral neuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder, skin changes).

The International Staging System (ISS) for myeloma was published by the International Myeloma Working Group in 2005:[4]

• Stage I: β2-microglobulin (β2M) < 3.5 mg/L, albumin >= 3.5 g/dL
• Stage II: β2M < 3.5 and albumin < 3.5; or β2M >= 3.5 and < 5.5
• Stage III: β2M >= 5.5

First published in 1975, the Durie-Salmon staging system [5] is still in use, but has largely been superseded by the simpler ISS:

• stage 1: all of
  • Hb > 10g/dL
  • normal calcium
  • Skeletal survey: normal or single plasmacytoma or osteoporosis
  • Serum paraprotein level < 5 g/dL if IgG, < 3 g/dL if IgA
  • Urinary light chain excretion < 4 g/24h
• stage 2: fulfilling the criteria of neither 1 nor 3
• stage 3: one or more of
  • Hb < 8.5g/dL
  • high calcium > 12mg/dL
  • Skeletal survey: 3 or more lytic bone lesions
  • Serum paraprotein >7g/dL if IgG, > 5 g/dL if IgA
  • Urinary light chain excretion > 12g/24h

Stages 1, 2 and 3 of the Durie-Salmon staging system can be divided into A or B depending on serum creatinine:

• A: serum creatinine < 2mg/dL (< 177 umol/L)
• B: serum creatinine > 2mg/dL (> 177 umol/L)

Take care;

Kevin

 Thanks Kevin for a complete rundown on what the tests means. Also for posting there are only 3 stages to MM. Many doctors do not seem to know this fact. There are several sites and books that give wonderful explanations. MMS

On 4/12/2008 K. C. wrote:

Good Evening Jane;

Your answers are in the following article:

Diagnostic criteria

In 2003, the International Myeloma Working Group[1] agreed on diagnostic criteria for symptomatic myeloma, asymptomatic myeloma and MGUS (monoclonal gammopathy of undetermined significance):

• Symptomatic myeloma:
  1. Clonal plasma cells >10% on bone marrow biopsy or (in any quantity) in a biopsy from other tissues (plasmacytoma)
  2. A monoclonal protein (paraprotein) in either serum or urine
  3. Evidence of end-organ damage (related organ or tissue impairment, ROTI):
     • Hypercalcemia (corrected calcium >2.75 mmol/L)
     • Renal insufficiency attributable to myeloma
     • Anemia (hemoglobin <10 g/dL)
     • Bone lesions (lytic lesions or osteoporosis with compression fractures)
     • Frequent severe infections (>2 a year)
     • Amyloidosis of other organs
     • Hyperviscosity syndrome
• Asymptomatic myeloma:
  1. Serum paraprotein >30 g/L AND/OR
  2. Clonal plasma cells >10% on bone marrow biopsy AND
  3. NO myeloma-related organ or tissue impairment
• Monoclonal gammopathy of undetermined significance (MGUS):
  1. Serum paraprotein <30 g/L AND
  2. Clonal plasma cells <10% on bone marrow biopsy AND
  3. NO myeloma-related organ or tissue impairment

Related conditions include solitary plasmacytoma (a single tumor of plasma cells, typically treated with irradiation), plasma cell dyscrasia (where only the antibodies produce symptoms, e.g. AL amyloidosis), and POEMS syndrome (peripheral neuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder, skin changes).

 

[edit] StagingInternational Staging System

The International Staging System (ISS) for myeloma was published by the International Myeloma Working Group in 2005:[4]

• Stage I: β2-microglobulin (β2M) < 3.5 mg/L, albumin >= 3.5 g/dL
• Stage II: β2M < 3.5 and albumin < 3.5; or β2M >= 3.5 and < 5.5
• Stage III: β2M >= 5.5

Durie-Salmon staging system

First published in 1975, the Durie-Salmon staging system [5] is still in use, but has largely been superseded by the simpler ISS:

• stage 1: all of
  • Hb > 10g/dL
  • normal calcium
  • Skeletal survey: normal or single plasmacytoma or osteoporosis
  • Serum paraprotein level < 5 g/dL if IgG, < 3 g/dL if IgA
  • Urinary light chain excretion < 4 g/24h
• stage 2: fulfilling the criteria of neither 1 nor 3
• stage 3: one or more of
  • Hb < 8.5g/dL
  • high calcium > 12mg/dL
  • Skeletal survey: 3 or more lytic bone lesions
  • Serum paraprotein >7g/dL if IgG, > 5 g/dL if IgA
  • Urinary light chain excretion > 12g/24h

Stages 1, 2 and 3 of the Durie-Salmon staging system can be divided into A or B depending on serum creatinine:

• A: serum creatinine < 2mg/dL (< 177 umol/L)
• B: serum creatinine > 2mg/dL (> 177 umol/L)

Take care;

Kevin

Good Evening MMS;

"Also for posting there are only 3 stages to MM."

I'm not so sure of that. My Dr. told me that there's 4.

And personally, I hope there is, cause I'm presently at stage III.

Take care;

Kevin

Surely you don't want to reach Stage IV Kevin??  Wouldn't you rather be going back to stage 1??  I would think that now that you've had the transplant that you will be heading for 'normal' readings across the board!! 

Many thanks for the staging info -- I haven't come across it in such a concise way!!  Keep getting better and better!!  Cath

Good Evening Cath;

"Surely you don't want to reach Stage IV Kevin??" 

I prefer to look at as an extra quarter in this battle. I don't feel comfortable being at Stage III, when there is no Stage IV! That means we're in the closing minutes of this competition, and I'm not ready to punt.

"Wouldn't you rather be going back to stage 1??"

Of course1 But that can't happen. Drs. tell me that your stage can never go backwards. I'll always be Stage III, even though my numbers have fallen to Stage I.

"I would think that now that you've had the transplant that you will be heading for 'normal' readings across the board!!" 

I had hoped that same feeling. However, my M-spike at last reading was 1.2. The Dr. tells my not to worry that the level will come down as I go further along in my remission. Let the transplant work he tells me. So for right now I'm placing my complete trust in the hands of a man who I never knew existed 10 months ago!  

"Keep getting better and better!!"

Thank you! I'm trying, but the fatigue is something that takes getting used to. Almost reminds me of how I felt back in May prior to my Dx.

Enough about me, how are you progressing along? You should be entering your Fall season shortly, no? Spring appears to be arriving here finally. Can't wait to get my toes in my garden's soil. Maybe this year I'll wait till its dark and get naked and roll around in that cool earth. Listen to me, it must be the chemo talking!

Take care;

Kevin

Hi Kevin --  Autumn is here and because we have had a few cold nights the deciduous trees are actually gaining colour -- red, yellow, and orange leaves -- they look lovely especially as we have been in drought conditions for so long and everything is either pale yellow or brown -- these tress are bright sparks of colour on the skyline -- absolutely beautiful!  We haven't started taking pictures, but hopefully in the next couple of days we will find some time!!

Please listen to your body!!  If you are feeling so tired -- LISTEN -- and rest!!  I have had to completely change my lifestyle in order to stay healthy by resting most of the day and being 'active' for four hours.  If I try for more then I get sick -- it has been a very hard lessen to learn!  But you are on the road to recovery, and if you are tired as a result of the transplant it is just your body trying to recouver to its normal state, so you must give it time by resting -- you are not weak, not going to waste away because you are not walking continuously around the hospital, etc!   It will only be for a short while and I'm betting that you will feel less tired as the days go by, but if you push it and try to make yourself keep active you will risk becoming ill.  My experience has shown just how suseptable I am to any bug thats going around -- especially when I try for being active for just an hour or two more.  It doesn't happen immediately so I think I'm OK, but within days I do go down.  This usually happens when my daughter comes with our youngest grandson -- I can't help picking him up, playing with him, taking them out and showing them off, the full gamut of being a loving grandparent -- but both of the last two visits have ended up with me in hospital!  Once with pneumonia and the second time with three kidney stones.  She is due to visit again in the last week of April, and though I am really looking forward to her coming, I'm also afraid of what is going to happen.  I will do everything I can do avoid going 'down', but .....!! So, please take note and get the rest that your body is asking for -- you will have plenty of time to be active when the transplant is complete and everything has settled down!! 

And as for rolling around naked in the cool earth -- Go for it!!  What a way to celebrate the start of spring!!  I may consider trying the same thing in a big pile of autumn leaves!!  Best wishes, Cath