For the 2nd month in a row (7 months post transplant), my husband's free light chains are BOTH elevated with a normal ratio. His kidney function is normal.
So what could be causing both the light chains to be elevated?
Forums
-
blair77 - Who do you know with myeloma?: My husband
- When were you/they diagnosed?: April 2013
- Age at diagnosis: 43
Re: Kappa & lambda free light chains elevated (normal ratio)
The following came from wikilite.com in chapter 26.3
4. Elevated concentrations of both and with a normal ratio. May be due to the following:-
- renal impairment (common).
- over-production of polyclonal FLCs from inflammatory conditions (common).
- biclonal gammopathies of different FLC types (rare).
The most common cause is renal impairement, but your husband's tests indicated that renal function was normal.
The next most common cause would be inflamation caused by some other factor. Does he have inflamation?
Ron
4. Elevated concentrations of both and with a normal ratio. May be due to the following:-
- renal impairment (common).
- over-production of polyclonal FLCs from inflammatory conditions (common).
- biclonal gammopathies of different FLC types (rare).
The most common cause is renal impairement, but your husband's tests indicated that renal function was normal.
The next most common cause would be inflamation caused by some other factor. Does he have inflamation?
Ron
-
Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
Re: Kappa & lambda free light chains elevated (normal ratio)
Hi Ron,
My husband ended up at the ER yesterday because of a unrelenting headache. CT was normal, however liver enzymes were high at 273 and 276 (ALT and AST). His oncologist told him to stop all meds (he's on Revlimid maintenance, aspirin, Losartan for high blood pressure, and acyclovir).
On January 31st before he started the Revlimid his liver enzymes were normal. I am wondering if Revlimid could have caused liver inflammation and this could have also been causing the elevated free light chain numbers. They were also normal as of 2/28 before he began maintenance in mid March. His liver enzymes haven't been checked since 1/31.
I guess we will see if everything comes down now that he has stopped all meds!
My husband ended up at the ER yesterday because of a unrelenting headache. CT was normal, however liver enzymes were high at 273 and 276 (ALT and AST). His oncologist told him to stop all meds (he's on Revlimid maintenance, aspirin, Losartan for high blood pressure, and acyclovir).
On January 31st before he started the Revlimid his liver enzymes were normal. I am wondering if Revlimid could have caused liver inflammation and this could have also been causing the elevated free light chain numbers. They were also normal as of 2/28 before he began maintenance in mid March. His liver enzymes haven't been checked since 1/31.
I guess we will see if everything comes down now that he has stopped all meds!
-
blair77 - Who do you know with myeloma?: My husband
- When were you/they diagnosed?: April 2013
- Age at diagnosis: 43
Re: Kappa & lambda free light chains elevated (normal ratio)
I hope all is well with your husband. Best wishes!
By elevated, how much above normal range are the kappas and lambdas?
By elevated, how much above normal range are the kappas and lambdas?
Last edited by dnalex on Thu Jun 26, 2014 4:14 am, edited 1 time in total.
-
dnalex - Name: Alex N.
- Who do you know with myeloma?: mother
- When were you/they diagnosed?: 2007
- Age at diagnosis: 56
Re: Kappa & lambda free light chains elevated (normal ratio)
usually it means chemo you are on stopped working and you need to go on something else. chemos can get use to our bodys like my dr explained if you use a weed killer on weeds after a while it don't kill them. if you have been on this chemo for a good length of time that could be the problem. Hope this helps since there are so many chem0s.
-
Dot Foley
Re: Kappa & lambda free light chains elevated (normal ratio)
Dear Blair 77,
Liver inflammation from Revlimid is not common but has been reported. I would certainly look into other causes as well (e.g. viral causes).
If it was the Revlimid, you will need to talk to the oncologist about the pros/cons of re-starting treatment. If treatment is re-started and the Revlimid was felt to be the culprit (or the culprit was not clear), I would use a lower dose initially and monitor liver tests closely. If no liver inflammation occurs, you coud then consider attempting to escalate to the original dose.
Also, realize that Velcade can be used in a maintenance fashion after transplant, typically one dose every 2 weeks.
I have seen modest increases in both the serum free kappa and lambda light chain levels on Revlimid maintenance, even in the absence of any overt inflammatory condition. The normal ratio is reassuring and would indicate that the light chain changes are NOT due to myeloma relapsing.
I hope things go better -- good luck!
Pete V.
Liver inflammation from Revlimid is not common but has been reported. I would certainly look into other causes as well (e.g. viral causes).
If it was the Revlimid, you will need to talk to the oncologist about the pros/cons of re-starting treatment. If treatment is re-started and the Revlimid was felt to be the culprit (or the culprit was not clear), I would use a lower dose initially and monitor liver tests closely. If no liver inflammation occurs, you coud then consider attempting to escalate to the original dose.
Also, realize that Velcade can be used in a maintenance fashion after transplant, typically one dose every 2 weeks.
I have seen modest increases in both the serum free kappa and lambda light chain levels on Revlimid maintenance, even in the absence of any overt inflammatory condition. The normal ratio is reassuring and would indicate that the light chain changes are NOT due to myeloma relapsing.
I hope things go better -- good luck!
Pete V.
-
Dr. Peter Voorhees - Name: Peter Voorhees, M.D.
Beacon Medical Advisor
Re: Kappa & lambda free light chains elevated (normal ratio)
We are currently facing the same problem. Dad has undergone an ASCT approximately 10 months ago. His kappa level was in upper 20s, and his lambda level was in the normal range. Three months later, as of yesterday, his kappa has risen up to 41 and his lambda is at 57.
He has p53d. I hope he's not relapsing. It's too soon to happen.
He has p53d. I hope he's not relapsing. It's too soon to happen.
Re: Kappa & lambda free light chains elevated (normal ratio)
Hi,
I underwent a stem cell transplant in June and achieved minimal residual disease (MRD negative status and stringent complete response. I was diagnosed with Stage III IgG kappa and at presentation had light chains of 6900 with stage 2 kidney failure and L3/L4 collapse.
Four weeks ago my bloods were perfect. Last week's bloods have shown a paraprotein (M-spike) of 6 g/l (0.6 g/dL) and slightly elevated kappa and lambda free light chain levels. The free light chain ratio, however, is normal.
I have been told that this is a serological relapse and further treatment has been discussed.
I have never had an elevated lambda free light chain level before, and the way I understood it is that an abnormal ratio is an indicator of relapse. My ratio is normal. Why might this be happening?
Many thanks.
I underwent a stem cell transplant in June and achieved minimal residual disease (MRD negative status and stringent complete response. I was diagnosed with Stage III IgG kappa and at presentation had light chains of 6900 with stage 2 kidney failure and L3/L4 collapse.
Four weeks ago my bloods were perfect. Last week's bloods have shown a paraprotein (M-spike) of 6 g/l (0.6 g/dL) and slightly elevated kappa and lambda free light chain levels. The free light chain ratio, however, is normal.
I have been told that this is a serological relapse and further treatment has been discussed.
I have never had an elevated lambda free light chain level before, and the way I understood it is that an abnormal ratio is an indicator of relapse. My ratio is normal. Why might this be happening?
Many thanks.
-
SusanTR1964 - Name: Susan
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 8th February 2016
- Age at diagnosis: 51
Re: Kappa & lambda free light chains elevated (normal ratio)
Hi Susan,
Oh, man! It sounds like you are in some degree of shock after hearing these latest lab results. I don't blame you – I would be too. You have every right to hope/expect that with stringent complete response (sCR) and minimal residual disease (MRD) negative (I saw you mention that in a different post) that your numbers would continue to be good for a longer period than just a few weeks!
The first thing I think of when you say that both the kappa and lambda free light chain (FLC) levels are high, but with a normal ratio, is that you might have some sort of infection. But then the elevated M-spike suggests that there is some monoclonal activity.
It is often the case that the FLC ratio is more sensitive and starts to move earlier than the M-spike when a relapse is starting. But because myeloma is such an individualized disease, that doesn't always happen.
I would suggest that you ask your doctor to be retested. I certainly would not start a new line of treatment based only on these results. I expect your doctor would say the same thing.
Best wishes. Please keep us posted.
Mike
Oh, man! It sounds like you are in some degree of shock after hearing these latest lab results. I don't blame you – I would be too. You have every right to hope/expect that with stringent complete response (sCR) and minimal residual disease (MRD) negative (I saw you mention that in a different post) that your numbers would continue to be good for a longer period than just a few weeks!
The first thing I think of when you say that both the kappa and lambda free light chain (FLC) levels are high, but with a normal ratio, is that you might have some sort of infection. But then the elevated M-spike suggests that there is some monoclonal activity.
It is often the case that the FLC ratio is more sensitive and starts to move earlier than the M-spike when a relapse is starting. But because myeloma is such an individualized disease, that doesn't always happen.
I would suggest that you ask your doctor to be retested. I certainly would not start a new line of treatment based only on these results. I expect your doctor would say the same thing.
Best wishes. Please keep us posted.
Mike
-
mikeb - Name: mikeb
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2009 (MGUS at that time)
- Age at diagnosis: 55
Re: Kappa & lambda free light chains elevated (normal ratio)
Hi Mike
Thank you for posting a reply. Shocked at being told I had serologically relapsed after being told I was MRD negative at the end of October is an understatement. I feel like I have had the wind knocked out of my sails! It took me 3 weeks to get my head round the good news of being in remission and now this!
I am having repeat bloods done tomorrow so I will see what these show. There is a trial in a city near us for Darzalex and I think I would be interested in this (if I'm eligible!). With regards to inflammation, I do have extremely severe shoulder pain and am unable to lift my arms above my head, but this wouldn't account for the increase in M-spike. What a year!
Many thanks.
Thank you for posting a reply. Shocked at being told I had serologically relapsed after being told I was MRD negative at the end of October is an understatement. I feel like I have had the wind knocked out of my sails! It took me 3 weeks to get my head round the good news of being in remission and now this!
I am having repeat bloods done tomorrow so I will see what these show. There is a trial in a city near us for Darzalex and I think I would be interested in this (if I'm eligible!). With regards to inflammation, I do have extremely severe shoulder pain and am unable to lift my arms above my head, but this wouldn't account for the increase in M-spike. What a year!
Many thanks.
-
SusanTR1964 - Name: Susan
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 8th February 2016
- Age at diagnosis: 51
25 posts
• Page 1 of 3 • 1, 2, 3