Understanding this relatively rare disorder begins in the blood with the plasma cells, a type of white blood cell found in the bone marrow whose main job is to fight infection. When some of those cells produce too much of a specific protein, called a monoclonal protein, it’s considered abnormal. The condition is called monoclonal gammopathy of undetermined significance or MGUS. There is no known cause and the condition itself generally doesn’t cause any symptoms. But it can lead to other serious conditions, including multiple myeloma.
In my case, a serum immunofixation test, a type of blood test, was ordered after the MRI on 8 September. It showed "IgA monoclonal protein with kappa light chain specificity." If you’re curious about what that means, here’s an article for you: https://academic.oup.com/clinchem/article/46/8/1230/5641492 . It’s not exactly light reading. You might find a simpler one, if you’re interested in looking. The bottom line is the normal range for this particular protein is 87 - 352. My result was 1567. There were two other proteins identified in the test that are out-of-whack but on the low end: 1) IgG with a normal range of 586 - 1602, mine being 357; and 2) IgM with a normal range of 26 - 217, mine being 12. I also had a serum immunoglobulins test with similar results. This confirmed the MGUS diagnosis, but it would take a bone marrow biopsy to confirm a diagnosis of multiple myeloma.
When my son, Keifer, accompanied me to the oncologist’s office for the results of the biopsy, my doctor had only one part of the results available. He explained there were two parts to the test, one involved the blood and the other the bone specimen. Interesting enough, the blood portion was inconclusive. He didn’t understand this, however, in light of the serum test results. He chatted with me about it while we waited for the call from the doctor who was analyzing the bone part of the biopsy, and he expected the call to come “at any moment.” The visit had lasted about 20 minutes when he decided to let us go and told me he would call the very moment he received the results.
It was a little after 10 in the morning, and I suggested to Keifer that we go to Chick-fil-a for a chicken biscuit for breakfast, since neither of us had eaten. We had driven no more than a mile or so from the medical center when my phone rang. The results had just come in. If I wasn’t too far away, could I come back to talk to the doctor about them. Of course, we turned around immediately.
“The bone portion of the biopsy confirms multiple myeloma,” the doctor reported. He then explained the treatment plan, which would include chemotherapy with the goal of getting me into remission. Once in remission, my own healthy bone marrow would be harvested in preparation for a bone marrow transplant.
I had my first chemotherapy injection on Thursday, 19 November, with a second one on the 23rd. The injection, which will generally happen twice per week, is only part of the chemo. The other is in the form of a pill which arrived at my door last Saturday. I will take it for 21-day cycles with 7 days in between. On the injection days and the day after, I will also take Decadron, a steroid to help alleviate nausea and inflammation. Once a month, I will also have a 30-minute IV treatment of Zometa, a bone-strengthening drug.
I don’t know how long it will take to achieve remission, nor what the bone marrow “harvesting” will entail, but I plan to ask on my next appointment.
More to come.
Reference
Mohammed Attaelmannan, Stanley S Levinson, Understanding and Identifying Monoclonal Gammopathies, Clinical Chemistry, Volume 46, Issue 8, 1 August 2000, Pages 1230–1238, https://doi.org/10.1093/clinchem/46.8.1230
Prayers are with you! Maggie sends her love also.