My husband has been monitored for MGUS for about 6 years now. Everything has stayed pretty much the same, until his last blood tests. Now lab results show:
IgA 26 (low) (70-100)
IgG 3820 (high) (700-1600)
IgM 14 (low) (40-230)
Kappa Free Lt chain. 20.8 (0.3 - 1.9)
Lambda Free Lt chains 0.2 (0.6- 2.6)
Kappa/Lambda Free Light Chain ratio 100.93 (high) (0.26-1.65)
He had a bone marrow biopsy yesterday so we don't have the results. He is scheduled for a PET scan Saturday. He did a 24-urine this past Saturday, but we don't have results from that yet either
How concerned should we be? I've been trying to determine what all this means. Seems to me from what I'm reading that the MGUS has progressed to multiple myeloma..
Forums
Re: Big increase in kappa-lambda ratio & IgG with MGUS
I wouldn’t draw any conclusions until all the results are in. Whatever happens it appears you have caught it reasonably early. And there are many treatment options available if he needs them.
Good luck.
Good luck.
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Arizonan - Name: Arizonan
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: April 2010
- Age at diagnosis: 54
Re: Big increase in kappa-lambda ratio & IgG with MGUS
Hi demaranch,
What sort of M-spike and serum free light chain results (kappa, lambda, and kappa-lambda ratio) has your husband had prior to his latest test results?
Also, are his latest immunoglobulin levels really different from what they have been in the past?
Finally, do you have any results for his hemoglobin and calcium levels, and have they changed much compared to his previous results?
The reason I ask is because you always want to be careful not to draw conclusions from a single test results. You want a complete picture, and you want to compare that complete picture to what it has been in the past. There can be errors in individual tests, and trends are really important.
Technically, a kappa-lambda ratio over 100 does qualify as a "myeloma-defining event" under the current criteria for diagnosing multiple myeloma. But free light chain results can bounce around a lot, so many doctors would want to know more about the patient's overall condition before deciding the disease has advanced fully to the active state, and starting treatment.
For what it's worth, it looks like your husband's M-spike is now around 3.0 g/dL (30 g/l), based on his latest IgG level and the fact that his IgG has two parts: the normal (healthy) IgG, and the monoclonal IgG that is produced by his monoclonal (unhealthy) plasma cells.
Would an M-spike of 3.0 g/dL be much higher than his previous M-spike levels?
Good luck, and please let us know what you find out and what you decide to do.
What sort of M-spike and serum free light chain results (kappa, lambda, and kappa-lambda ratio) has your husband had prior to his latest test results?
Also, are his latest immunoglobulin levels really different from what they have been in the past?
Finally, do you have any results for his hemoglobin and calcium levels, and have they changed much compared to his previous results?
The reason I ask is because you always want to be careful not to draw conclusions from a single test results. You want a complete picture, and you want to compare that complete picture to what it has been in the past. There can be errors in individual tests, and trends are really important.
Technically, a kappa-lambda ratio over 100 does qualify as a "myeloma-defining event" under the current criteria for diagnosing multiple myeloma. But free light chain results can bounce around a lot, so many doctors would want to know more about the patient's overall condition before deciding the disease has advanced fully to the active state, and starting treatment.
For what it's worth, it looks like your husband's M-spike is now around 3.0 g/dL (30 g/l), based on his latest IgG level and the fact that his IgG has two parts: the normal (healthy) IgG, and the monoclonal IgG that is produced by his monoclonal (unhealthy) plasma cells.
Would an M-spike of 3.0 g/dL be much higher than his previous M-spike levels?
Good luck, and please let us know what you find out and what you decide to do.
Re: Big increase in kappa-lambda ratio & IgG with MGUS
Thank you for responding.
I'm not sure how to find the M-spike. I don't see that listed anywhere.
Result Now May 3 2017
IgG 3820 2967
IgA 26 49
IgM 14 22
Kappa FLC 20.8 21.09
Lambda FLC 0.2 1.46
Kappa/Lambda Ratio 100.93 14.45
HGB 11.2 12.5
RBC 3.7 4.25
HCT 32.9 37.3
Calcium 8.7 8.6
Total protein 8.7 8.5
Albumin 3.6 3.9
I'm not sure what other numbers matter. Most everything else falls into normal range.
I'm not sure how to find the M-spike. I don't see that listed anywhere.
Result Now May 3 2017
IgG 3820 2967
IgA 26 49
IgM 14 22
Kappa FLC 20.8 21.09
Lambda FLC 0.2 1.46
Kappa/Lambda Ratio 100.93 14.45
HGB 11.2 12.5
RBC 3.7 4.25
HCT 32.9 37.3
Calcium 8.7 8.6
Total protein 8.7 8.5
Albumin 3.6 3.9
I'm not sure what other numbers matter. Most everything else falls into normal range.
Re: Big increase in kappa-lambda ratio & IgG with MGUS
HI demaranch,
To find your m-spike, look for a test labelled "serum protein electrophoresis" (or something similar to that name). On that report, look for an entry labeled "m-spike", "abnormal protein", "monoclonal protein", "paraprotein" or something like that. It might appear in a separate notation on the lab report and won't always be included in the report if you are looking at your results online (in which case, you may have to get a copy of the original lab report or ask your doctor for that figure). Make sure to also include the units of measure (i.e. g/dL, etc) when you post the figure.
To add to Cheryl's great comments, I would note that not all doctors would automatically begin to consider treatment if a patient meets the criteria for a "Myeloma Defining Event" (even if the patient has consistently met the criteria over a sustained period of time). But it certainly is something that the doctor would factor into the equation when considering whether to start treatment or not.
To find your m-spike, look for a test labelled "serum protein electrophoresis" (or something similar to that name). On that report, look for an entry labeled "m-spike", "abnormal protein", "monoclonal protein", "paraprotein" or something like that. It might appear in a separate notation on the lab report and won't always be included in the report if you are looking at your results online (in which case, you may have to get a copy of the original lab report or ask your doctor for that figure). Make sure to also include the units of measure (i.e. g/dL, etc) when you post the figure.
To add to Cheryl's great comments, I would note that not all doctors would automatically begin to consider treatment if a patient meets the criteria for a "Myeloma Defining Event" (even if the patient has consistently met the criteria over a sustained period of time). But it certainly is something that the doctor would factor into the equation when considering whether to start treatment or not.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Big increase in kappa-lambda ratio & IgG with MGUS
Hi D'Anne,
I think Multibilly has answered many of your questions with his (as usual) very helpful feedback. I would just add that, based on your husband's IgG numbers, it looks like his M-spike has gone up about 0.8 or 0.9 g/dL since last May.
In addition, his hemoglobin level is now low enough that he would be considered to meet the "A" condition, Anemia, in the CRAB criteria for a multiple myeloma diagnosis. This is because his hemoglobin is 11.2, which is 2.3 below the lower limit of the reference range of 13.5 to 17.5 for men. Anything more than 2 below the lower limit is technically considered to be anemia for the sake of the CRAB criteria for a multiple myeloma diagnosis.
What is a bit odd in your husband's latest results is that the increase in his kappa-lambda ratio since last May was completely the result of his lambda level becoming very depressed. I believe that usually the ratio becomes more and more elevated as a result of the high ("involved") free light chain level becoming higher and higher.
The way your husband's kappa-lambda ratio has become so high may affect whether your husband's doctors feel it is necessary to start treating him.
In case you haven't seen these already, here is a link to a summary of the criteria for a multiple myeloma diagnosis:
https://myelomabeacon.org/forum/criteria-for-multiple-myeloma-diagnosis-t8505.html
And here is an article explaining the criteria in more detail:
https://myelomabeacon.org/news/2014/10/26/new-multiple-myeloma-diagnostic-criteria/
Good luck!
I think Multibilly has answered many of your questions with his (as usual) very helpful feedback. I would just add that, based on your husband's IgG numbers, it looks like his M-spike has gone up about 0.8 or 0.9 g/dL since last May.
In addition, his hemoglobin level is now low enough that he would be considered to meet the "A" condition, Anemia, in the CRAB criteria for a multiple myeloma diagnosis. This is because his hemoglobin is 11.2, which is 2.3 below the lower limit of the reference range of 13.5 to 17.5 for men. Anything more than 2 below the lower limit is technically considered to be anemia for the sake of the CRAB criteria for a multiple myeloma diagnosis.
What is a bit odd in your husband's latest results is that the increase in his kappa-lambda ratio since last May was completely the result of his lambda level becoming very depressed. I believe that usually the ratio becomes more and more elevated as a result of the high ("involved") free light chain level becoming higher and higher.
The way your husband's kappa-lambda ratio has become so high may affect whether your husband's doctors feel it is necessary to start treating him.
In case you haven't seen these already, here is a link to a summary of the criteria for a multiple myeloma diagnosis:
https://myelomabeacon.org/forum/criteria-for-multiple-myeloma-diagnosis-t8505.html
And here is an article explaining the criteria in more detail:
https://myelomabeacon.org/news/2014/10/26/new-multiple-myeloma-diagnostic-criteria/
Good luck!
Re: Big increase in kappa-lambda ratio & IgG with MGUS
Hey Cheryl,
I believe the criteria for the "A" in CRAB is 2 g/dL under the patient's reference range for the particular lab they are using (or less than 10 g/dL, in general). I have two lab results where the lower normal limits for Hgb are listed as 12.7 g/dL and 13.0 g/dL. So it will be important for D'Anne to go back and look at what her lab's Hgb reference range is.
I believe the criteria for the "A" in CRAB is 2 g/dL under the patient's reference range for the particular lab they are using (or less than 10 g/dL, in general). I have two lab results where the lower normal limits for Hgb are listed as 12.7 g/dL and 13.0 g/dL. So it will be important for D'Anne to go back and look at what her lab's Hgb reference range is.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Big increase in kappa-lambda ratio & IgG with MGUS
Good point, Multibilly. Thanks. I didn't realize that the lower end of the hemoglobin reference range for men can get as low as you mentioned. The most common range I saw was 13.5 to 17.5 g/dL, Other ranges I've seen are 13.2 to 17.1 and 14 to 17.5 g/dL.
As you pointed out, the key for meeting the "A" in the CRAB criteria is whether the measured hemoglobin level is at least 2 g/dL less than the lab's reference range, or less than 10 g/dL.
As you pointed out, the key for meeting the "A" in the CRAB criteria is whether the measured hemoglobin level is at least 2 g/dL less than the lab's reference range, or less than 10 g/dL.
Re: Big increase in kappa-lambda ratio & IgG with MGUS
Thank you all for the input/replies.
Result Jan 2, 2018 Jan 8, 2018
HGB 11.2 10.9 (13.5-18,0)
RBC 3.7 3.62 (4.2_6.0)
HCT 32.9 33.0 (40.0-52.0)
I have 2 values for some of these tests because he had blood work done just prior to going to the doctor and then another one when he got his bone marrow biopsy. The values are close but not the same
Yes, his lambda free light chain level has gone down. No idea what that might mean. Guess we find out tomorrow when we meet with the doctor
Result Jan 2, 2018 Jan 8, 2018
HGB 11.2 10.9 (13.5-18,0)
RBC 3.7 3.62 (4.2_6.0)
HCT 32.9 33.0 (40.0-52.0)
I have 2 values for some of these tests because he had blood work done just prior to going to the doctor and then another one when he got his bone marrow biopsy. The values are close but not the same
Yes, his lambda free light chain level has gone down. No idea what that might mean. Guess we find out tomorrow when we meet with the doctor
Re: Big increase in kappa-lambda ratio & IgG with MGUS
Just got back from the doctors. The bone marrow biopsy shows 8% with a notation that says `progression to multiple myeloma,` and the PET scan shows no lesions.
Doctor says the anemia may be caused by something else but didn't know what. She's saying it isn't even to the level of smoldering multiple myeloma yet. Because she's not considering his anemia to be caused by multiple myeloma or be a CRAB criteria since his bone marrow biopsy needs to be 10% before they would label it multiple myeloma.
She has increased his monitoring from twice a year to every 2 months.
I'm not totally comforted, but she really seemed to know what she was talking about and said she has many multiple myeloma patients.
Thanks for your feedback.
Doctor says the anemia may be caused by something else but didn't know what. She's saying it isn't even to the level of smoldering multiple myeloma yet. Because she's not considering his anemia to be caused by multiple myeloma or be a CRAB criteria since his bone marrow biopsy needs to be 10% before they would label it multiple myeloma.
She has increased his monitoring from twice a year to every 2 months.
I'm not totally comforted, but she really seemed to know what she was talking about and said she has many multiple myeloma patients.
Thanks for your feedback.
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