Thursday, July 4, 2013

Another false alarm?

The Iron Law of Oligarchy.

I remember literally nothing else about a class I took in comparative political structures of developing nations during my junior year at UCLA except the professor's name (Edward Kannyo...I just looked him up and he's still kicking around, writing articles about post-Gaddafi Libya) and the fact that we read some book called the Iron Law of Oligarchy (or, rather, were supposed to have read it).  I just knew to throw that phrase around once or twice in a paper.  Somehow I did well in the class.  Hmm.

I should have been studying microbiology, instead, it seems.

Oligo = numerous, mono = one.  Oligarchy is rule by a few, monarchy is rule by a...wait for it...monarch.  One.  Oligopoly is control by a few, monopoly is...well, we all know.

Oligoclonal means several bands of duplicated protein.  Monoclonal is one.  One bad protein, reflective of cancer.

If monoclonal proteins show back up for me, it means the whole attempt at a cure is obviously shot, and more depressingly it means the disease is most likely drug resistant and high risk in its profile, given the experience in the still fairly low (less than half) of low-risk, newly-diagnosed MM patients that relapse under Total Therapy 3 (or 4, its successor therapy) at Arkansas.

I would, needless to say, not like to see a return of the monoclonal protein.

When one is recovering from a transplant, it is not uncommon to find oligoclonal bands in one's blood or urine.  This is actually a sign of a recovering immune system, and is in fact consistent with remission and the natural healing of the body.  Here's an abstract from the NIH on the topic.

I had this when I was first in remission, and it was noted for maybe six months.  Then, nothing.  Not a trace of anything untoward in my blood, for more than three years.  Good stuff.

Imagine my dismay, then, when yesterday my labs from two weeks ago were ready and there was no monoclonal protein in my blood under SPEP (Serum Protein Electro Phoresis, a relatively blunt instrument relative to the other tests but still capable of detecting low levels of monoclonal protein).  However, under the more sensitive immunofixation test, the following result came back:

Faint monoclonal lamba light chain observed in the gamma region.

That's not good.

I had IgG lamba myeloma.

Of course I immediately texted BB and reported the precise wording of the test, including the fact that SPEP was negative.  I ended my text with "should I be concerned?"   This is kinda like the Hindenberg reporter saying "uh, looks like sparks up there, hope it all works out."  In other words, I was already quite concerned.

The next fifteen minutes were pretty tense.  Thankfully, as busy as BB is, he checked he cell phone and within fifteen minutes he wrote back:  "No.  Oligoclonal."

Now...this MIGHT be the case.  It could simply be that the one band is so faint that others which could be there are even fainter.  It could also be that as a light chain (my light chains are normal and the ratio is in balance) versus blood, it might not be anything to be concerned about.  And I did a scan of the Internet and found a site where a doctor said that such a signature was, in fact, nothing to be worried about.

That said, it scares the crap outta me.

I tested negative for any disease with the extremely sensitive MRD test in Arkansas in March -- that's about 60 times more sensitive than immunofixation.  And my marrow was clean as a whistle.  So I'm probably worried about nothing.  Maybe, when I get my next test results back on or around the 23rd of the month, it will show nothing, again, under immunofixation.  It might be a plain ol' false positive, after all.  I've had friends with false positives for this disease.

But like I said, it scares the crap outta me.

Not much I can do other than wait it out and stay strong.  I am once again humbled by the bravery of those patients who struggle to stay in remission and watch their disease progress -- I have very little to complain about.

Have a jubilant Independence Day!