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LabCorp (various) LabCorp Multiple Myeloma

M-Spike

Other names: Monoclonal Protein 1

Optimal Result: 0 - 0.001 g/dL.

Other names: 

Monoclonal protein, myeloma protein, M-protein, M-spike

What is M-protein and M-spike?

- M-protein is an abnormal protein produced by myeloma cells that accumulates in and damages bone and bone marrow.

- Antibodies or parts of antibodies found in unusually large amounts in the blood or urine of myeloma patients.

- A monoclonal spike (M-Spike), the sharp pattern that occurs on protein electrophoresis, is the telltale indicator of M-protein in the blood, a marker for the activity of myeloma cells.

What is multiple myeloma?

Myeloma is a cancer of plasma cells, a type of white blood cell (WBC) in the bone marrow that is responsible for making immunoglobulins. In Greek, the language of most medical terms, “myelo” refers to the blood-producing cells in the bone marrow, and “oma” refers to a tumor or mass of cancer cells. A malignant plasma cell is called a myeloma cell.

Myeloma most often grows in the marrow within the bones of the spine, skull, pelvis, rib cage, shoulders, and hips. Usually, the bones of the hands, feet, and lower parts of the arms and legs are not affected, preserving the function of these critical areas.

MGUS, SMM, and active myeloma:

The earliest stage of myeloma is not cancer at all, but is a benign condition called MGUS, the presence of a low level of monoclonal protein (M-protein) without any indicators of active myeloma. People with MGUS are monitored carefully to make sure the diagnosis is correct and there is no change in their status. As time goes by, if the level of M-protein remains stable and there are no other health changes, the time between visits to the hematologist can be extended. All myeloma patients have MGUS before they progress to active myeloma, but only 20% of people diagnosed with MGUS eventually get myeloma.

The risk of progression from MGUS to myeloma is 1% per year.

The stage of myeloma between MGUS and active myeloma is called smoldering multiple myeloma (SMM), which is characterized by a higher level of M-protein than MGUS but with no indicators of active myeloma. The risk of progression to active myeloma among patients with standard-risk SMM is 10% per year for the first five years, 3% per year for the next five years, and 1%–2% per year for the next 10 years.

Basic definitions:

NAME

DEFINITION

Monoclonal Gammopathy of Undetermined Significance (MGUS)

- Monoclonal protein present but usually < 3.0 g/dL

- No CRAB features or other indicators of active myeloma

- Bone marrow monoclonal plasma cells < 10%

Smoldering Multiple Myeloma (SMM)

- Higher level of disease than MGUS: serum M-component can be > 3.0 g/dL and/or bone marrow plasma cells between 10% and 60%, but

- No CRAB features or other indicators of active myeloma

Myeloma based on MDE

> 60% bone marrow plasma cells • Free light chain ratio > 100
> 1 MRI focal lesion

Myeloma based on CRAB

- Monoclonal protein present, and
- One or more CRAB features and/or indicators of organ damage

References:

- Glavey SV, et al. Monoclonal gammopathy: The good, the bad and the ugly. Blood Reviews. In press. http://dx.doi.org/10.1016/j.blre.2015.12.001.

- Rajkumar SV. Diagnosis of monoclonal gammopathy of undetermined significance. http://www.uptodate.com/home.

- International Myeloma Foundation: https://www.myeloma.org/what-is-multiple-myeloma

What does it mean if your M-Spike result is too high?

A monoclonal spike (M spike or paraprotein) on serum protein electrophoresis (SPEP) is a frequent finding in the general population and typically is pathognomonic of an asymptomatic, premalignant condition called monoclonal gammopathy of undetermined significance (MGUS).

MGUS occurs in around 3% of people older than 50 and is associated with a lifelong, low, yet non negligible, risk of progression to multiple myeloma (MM) or a related plasma cell dyscrasia. It is generally an incidental diagnosis during the evaluation of patients complaining of various symptoms such as fatigue, forgetfulness, or neuropathy. 

Other diseases that can present with an M spike, such as chronic lymphocytic leukemia, B and T cell lymphomas, chronic myeloid leukemia and other PC dyscrasias (systemic AL amyloidosis, Waldenström’s macroglobulinemia (WM) and heavy chain disease) should be excluded before making a diagnosis of MGUS. 

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