Early on in my Waldenstrom’s history, I became intrigued with the drop in my cholesterol. The internist who was my regular doctor at that time felt it was due to interference with the test due to the elevated IgM. When I found this was true of other patients also, I checked with the clinical pathologist at our local hospital. He said that with current methods for running lipid profiles there should be no interference, the cholesterol levels should be accurate.
Over the years through the cooperation of the members of the IWMF talk list, I have collected data of total proteins and albumin (usually run as a part of annual screening blood tests and pre-diagnosis), IgM (after diagnosis) paired with lipid profiles (total cholesterol, HDL, LDL and triglycerides). At this time I have data from 45 WM’ers and 178 pairs of tests. These clearly show the inverse relationship of IgM to total cholesterol. If the IgM goes up the cholesterol goes down, and after treatment when the IgM goes down the cholesterol goes back up. Reference Chart I
In August 2003 I sent the basic data and the charts to Dr. Kyle (Mayo), Dr. Gertz (Mayo), Dr. Treon (Dana Farber), Dr. Weber (M.D. Anderson) and Dr. Maloney (Fred Hutchinson). I had prompt responses from the first three. All basically agreed in their answers and I quote Dr. Kyle’s response in full.
1) The occurrence of low cholesterol levels in patients with Waldenstrom's macroglobulinemia is a commonly recognized phenomenon. I have seen this in many patients and have commented on it in chapters that I have written.
2) I have no idea why this occurs. I doubt that it is related to interference with the determination of cholesterol in the laboratory. I suspect that it is a real phenomenon but I do not know the reason.
3) Waldenstrom's macroglobulinemia would be one consideration when seeing a patient with an extremely low cholesterol level. Usually the patient has other symptoms such as anemia or constitutional symptoms that direct the physician toward a diagnosis of macroglobulinemia. If the patient has asymptomatic Waldenstrom's macroglobulinemia one would not do anything about it. It is common practice to order a serum protein electrophoresis in a patient who has few symptoms. In short, I doubt that the presence of a low cholesterol would be of practical benefit in making a diagnosis of Waldenstrom’s macroglobulinemia.
I believe that the cholesterol will increase when the monoclonal protein decreases because of therapy. However, this point has not really been studied because the physician simply orders serum protein electrophoresis or quantitates the IgM level.
4) I am not aware of low cholesterol levels in patients with other B-cell lymphomas but I do not know of any formal studies. I suspect, however, that the low cholesterol is related directly to the monoclonal protein rather than the fact that it is a B-cell malignancy.
Dr. Treon said basically the same thing, but did say he would assign a member of their staff to review the records at Dana Farber to confirm my information.
As I collected more data that verified the impression that the cholesterol did increase when the monoclonal protein decreased, I again contacted the three doctors with a new question. Reference Chart II Isn’t there a possibility that if we understood the metabolic reasons for the drop in cholesterol, we might discover another avenue to attack the abnormal WM B-cells and additional possibilities of treatment? Unfortunately in the responses to this additional question, there seemed to be little interest in pursuing this line of research.
As I was putting this together for presentation to the editor of the Torch one other question came to mind. Does anybody have any information on the death rate of us Waldenstromers from heart attacks and stroke compared to the general population? Does our cholesterol response to IgM protect us from the harmful effects of injudicious diets and their plugged arteries? I hope so because I love steak and chocolate ice cream sundaes!!
If anyone wishes to send me additional data, it would be welcome. Note the items I use outlined above. Send to cwbiedel@telebyte.net
This chart shows the correlation between the IgM levels and the total cholesterol for 45 different patients and 178 pairs of data.
These graphs are for patients for whom I had enough data over a period of time to show the change for each individual. The left-hand scale is the IgM and the right-hand scale is the cholesterol. The x-axis is not a numerical one, but merely a separator of the points of data.
