Newly Diagnosed with Smoldering Multiple Myeloma: Watch & wait

Posted by lfevold @lfevold, Oct 22, 2020

Interested in connecting with others with the same diagnosis. Looking into dietary changes that could help.
I will introduce myself to the group. This will be long so sorry in advanced.

I was a Lab Tech for 15 years so of course we ran test samples on ourselves in training. I have always had an elevated ESR - I put that down to allergies. Jump ahead to 2013 I started to have GI issues plus a couple of cycles of Diverticulitis. Local doc ran a panel for Celiacs but the was negative but the IgA was 1533 mg/dl, no follow-up even though I asked. GI symptoms went away. 2019 started having issues with GI again plus a slightly decreased Hgb not bad but put me through colonoscopy and upper GI - nothing remarkable. Blood work the IgA was now 1960 mg/do. Total Iron was slightly decreased so just put me on over the counter Iron supplements. Fast forward to June 2020, gi issues (diarrhea for 6 weeks) - local doc ignored it. At that point I requested a referral to Mayo Clinic/Rochester. Through all of the testing for GI issues which nothing found remarkable, I asked about the IgA which they ran again, came back 2350 mg/dl. Also C Reactive Protein was elevated. They referred me to a Rheumatologist who ran all of the RA type testing but included the MGUS screening. I have an M Spike of 1.6 mg/dl. Low Lambda Light Chain but Kappa was right on the top end so the Kappa/Lambda Ragio is a little over 5.0. Also re ran the Immunology levels IgG low at 326, IgM low at 10 and IgA still at 2350. So the RA doc referred me to Hematology. They ordered Iron studies which are normal now, CT Skeletal no lesions seen, and Bone Marrow Biopsy - came back as Plasma Cell Myeloma with approx 20% plasma cells. Slightly hupocellular. Plasma Cell morphology abnormal large cells with large nucleoli and binucleation. Plasma Cells express: monotypic kappa light chains, CD38 & CD138. They do not express CD18 or CD45.

Final DX after meeting with specialist.
Smoldering Multiple Myeloma Subtype IgA Kappa Light Chain with an average risk of progression. 20% Plasma Cells, 1.6 M-Spike, 5 Kappa/Lambda ratio. On FISH I do have the 1q gain marker. At this point I am at a Watch & Wait with blood & physical exam every 3 months.

Interested in more discussions like this? Go to the Blood Cancers & Disorders Support Group.

asvetz5555 | @asvetz5555 | Aug 12, 2024

Hi, I'm new here. I was just diagnosed with light chain MGUS 3 weeks ago. I'll be following your post as I want to find out as much as possible about MGUS, SMM and multiple myeloma. I do not have an M spike as of right now but my IgA is elevated and my IgM is only 40. I have elevated kappa and lambda light chains and elevated ratio. Kidneys are very slightly affected. Hemoglobin is 11 and rbc is 3.70 so really not anemic yet. I have major spine issues so get lumbar MRI every year and this year and last year my lumbar vertebrae show anemia in the bone marrow but I'm not yet anemic on labs. I also have sjogrens which puts me at a higher risk of getting lymphoma and myeloma. Have not had a bone marrow biopsy yet. Since my MRI shows issues with lumber vertebrae bone marrow, would that put me in the SMM or MGUS like my hematologist diagnosed me? It's just all so confusing. I had a lip biopsy in 2014 to diagnosis the Sjogrens and it came back as lymphoplasmacytic infiltration which concerned my rheumatologist at the time. Sjogrens normally is just lymphocytic infiltration of the salivary glands.

cathy56 | @cathy56 | Dec 14, 2023

In reply to @barbdk "I haven’t read thru this whole thread, but in case it hasn’t been mentioned, there is..." + (show)

I feel this is medical gaslighting as I waited 2 days no call so I called oncologist and the person stated the oncologist told her “ she does not have cancer” then she said “ we are only seeing new patients and you have been here before” I was flabbergasted as the doctor obviously did not read thru the 43 pages my Radiation oncologist sent them all imaging , bone and marrow biopsies and reports that diagnosed C40.22 cancer Mets l lower limb and the incomplete bone biopsy 2020 that did not do flow cytometry to confirm what the findings: Atypical Lymphoid infiltrate suspicious B cell Non Hodgkin Lymphoma but suggest fresh biopsy w cytometry to confirm! Never called me,
I think the oncologist looked at the PET CT scan I had done 2 months ago which should of never been sent but it is a concern that he would not have looked thru every paper and ortho/onc should have dealt w this fibula !
I filed a complaint with patient experience but I feel that will not do me any good and after this insult to my character I do not care to see that hem/onc and ? If I can trust anyone at Mayo and like I stated I have always been nice friendly and open with these doctors but I can’t say that in how so many have judged me, even sent to shrink to rule out hypochondria!! And the shrink stated “ you are not a hypochondriac but you have a lot of medical stuff going on and the doctors are not listening to you !
Well I wonder why as my signs symptoms have been dismissed for years, bone scans misinterpreted as normal then changed to metastatic disease and I was happy to hear the truth behind those bone scans results as Dr Anderson told me “ they are often misread! “ it is no wonder cancer patients get diagnosed when they are metastatic and no treatment available!
Sick of this whole mess

barbdk | @barbdk | Dec 13, 2023

I haven’t read thru this whole thread, but in case it hasn’t been mentioned, there is an online support group for you, called Smolder Bolder. The co-leaders are Jessie Daw, a patient in South Dakota, and Teresa Miceli, a Mayo myeloma nurse who is also on the IMF Nurse Leadership Board. You can see their webpage at https://www.myeloma.org/smm.
I just returned from the American Society of Hematology annual meeting where there were quite a few sessions on MUGUS. I encourage you to check out our blogs from the meeting https://ash2023blogs.myeloma.org/.

cathy56 | @cathy56 | Dec 12, 2023

Heard back from oncology but they saw I have C40.22 and refer me to Ortho/Onc, one of specialist reviewed my records and told her to refer me to Hem/Onc?? for MGUS work up!
I am totally confused and this delay is not good !

Patty, Volunteer Mentor | @pmm | Dec 4, 2023

In reply to @cathy56 "I just called oncology they are reviewing my oncology records so I should hear back soon..." + (show)

Yay! You’ve got this.

cathy56 | @cathy56 | Dec 4, 2023

In reply to @pmm "@cathy56 I audibly gasped when I read the cruel (and untrue) comment about nurses. I have..." + (show)

I just called oncology they are reviewing my oncology records so I should hear back soon ! Finally answers

cathy56 | @cathy56 | Dec 4, 2023

You don’t know the half of the cruelty I have been subjected to!! I am pleasant and never bring up my former profession but it is obviously on my records ! UF Shands oncology who I was referred to had the insensitive remark with no medical documentation to accuse me of being alcoholic due to my abdomen being 45 plus inches as I have NAFLD that has progressed to NASH ! And I could go on and on about these UF Shands so called professionals I have been referred to by my oncologist just to be dismissed! I have been treated like dirty gum to their feet! I don’t understand it and yes I know Mayo will never treat me like a sub human !

Patty, Volunteer Mentor | @pmm | Dec 4, 2023

In reply to @cathy56 "I made error it was k1 67 with multiple c + markers that showed not lambda..." + (show)

@cathy56
I audibly gasped when I read the cruel (and untrue) comment about nurses. I have worked with hundreds of nurses in a hospital setting and wish I had a dollar for every catch they made, often that docs missed. Working in a teaching hospital taught me to trust, but verify.
I’m so sorry this has been such a difficult journey for you.
Be the squeaky wheel. Pleasant but insistent. It will serve you well.
I believe you would be well served to get a Mayo workup. One big advantage is that the various subspecialties have immediate access to one another’s notes. There is less likelihood that important results will be missed.
Best of luck. Wishing you the best possible outcome.
Patty

cathy56 | @cathy56 | Dec 3, 2023

In reply to @gingerw "@cathy56 Contact the person you spoke to and confirm the records were received. Ask them their..." + (show)

I made error it was k1 67 with multiple c + markers that showed not lambda kappa on bone biopsy . But I am not sure if I am advocating for myself correctly but was a great advocate for my patients! I should of made sure my medical records were transferred to different specialties as I think this is were the issues arise and why I was given wrong cancer PET scan 2 months ago and the radiation onc was unaware of fibula cancer Mets dx as he was looking for some plasma type cancer and only scanned knees up! I also want the Quebec Platelet Disorder tested and my advanced NASH !
You see it is too many things at this point ! My only hope is Mayo as I know they care for the patients wellbeing and being a former RN I feel makes my situation worse I feel as I had one specialist tell me “ RNs know enough to be dangerous “ how cruel as I never come off as a professional in med field as in my state of health I am far from medical knowledge as I am not a doctor but a sick patient only wanting answers!
Thank u for your response

Ginger, Volunteer Mentor | @gingerw | Dec 2, 2023

In reply to @cathy56 "Yes my local radiation Oncologist referred me back to Mayo last week as PET scan incorrect..." + (show)

@cathy56 Contact the person you spoke to and confirm the records were received. Ask them their thoughts on what your next should be. It sounds like you have all the documentation showing incorrect procedures/diagnosis. So you may need to start from first step again, which you don't want to do.

As a retired RN, you are in a better position than many, with medical knowledge. This also makes it a burden, knowing the small details. Right?! I hope you will let us know what your contact has to say.

As an aside, the International Myeloma Foundation offers a virtual smoldering myeloma support group, the next one is in January 2024. The patient advocate who facilitates it is a retired oncology nurse from Mayo Clinic [Rochester, MN]. Here is the link to get on the email list: https://www.myeloma.org/smm
Ginger

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