Here we go again ...
Another hospital visit, another blood report, yet another test we have in our hands and don't fully comprehend.
Ian had ASCT in January of this year, and since then the serum free light chains normalized with a normal ratio.
Yesterday though, October 30, we got the report for late September (they sure keep us on the edge with results don't they? : ))
Kappa 17.79 mg/L.
Lambda.10.25 mg/L.
Ratio is ABNORMAL : 1.736 (normal ratio is 0.260-1.650)
In a context of complete response for Ian, what does this mean? Should we expect the sFLC to climb again soon? Or should we take it as a flop in the data?
I guess we have to see the next results, but not a great deal of papers on multiple myeloma light chain only after an auto transplant with abnormal ratio only.
Any reply is appreciated.
Thanking you, Joanna
Forums
6 posts
• Page 1 of 1
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johanna - Name: Joanna
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: august 2012
- Age at diagnosis: 60
Re: Abnormal serum FLC ratio after ASCT - meaning?
I would not get worked up by this test. The kappa and lambda numbers are within the normal range and the ratio is barely higher then the 1.65 normal limit. A single test is not a trend.
Is Ian on any maintenance therapy? If he is not, perhaps he should be. If his numbers continue to trend up, then drugs will be added in to knock them back down.
Ron
Is Ian on any maintenance therapy? If he is not, perhaps he should be. If his numbers continue to trend up, then drugs will be added in to knock them back down.
Ron
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Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
Re: Abnormal serum FLC ratio after ASCT - meaning?
Hello , and a Happy New Year to all!
We are wondering if anybody can give us an answer to our questions as we are still struggling to understand the meaning of our results.
Ian's LCMM (kappa light chain multiple myeloma) is under control just now, but the last 4 readings have been abnormal, except for the kappa / lambda ratio! Kappa and lambda levels were normal.
Since the ASCT (January 2014) we have had :
But of course oligoclonality (with or without an abnormal ratio) also dictates that the person must be in CR & < or = 5% PC in BM. No monoclonal component in serum IF or urine.
Since Ian's multiple myeloma is diffuse (pockets of multiple myeloma here and there, but not evenly spread, so you might drill in a clean place and get a false reading of CR), how can we know if the BM is clean or not?
He never had a monoclonal component in serum (IFx) & and no Bence Jones protein in urine.
Since he had right after ASCT a few good months of normal readings, including RATIO, and now the ratio is abnormal, does that mean we are near a relapse or near a CR?
Studies imply you have to develop an abnormal light chain ratio right after the transplant and maintain yourself there as long as possible. Since Ian developed an abnormal ratio well after the transplant, what does that mean ?
Like I said: Late good immune reconstitution? Or early relapse?
Thank you kindly,
Joanna & Ian
We are wondering if anybody can give us an answer to our questions as we are still struggling to understand the meaning of our results.
Ian's LCMM (kappa light chain multiple myeloma) is under control just now, but the last 4 readings have been abnormal, except for the kappa / lambda ratio! Kappa and lambda levels were normal.
Since the ASCT (January 2014) we have had :
- 5 Normal readings with kappa and lambda levels and kappa-lambda ratio normal
- 4 readings with normal kappa, normal lambda and abnormal ratio
- The ratio started to climb since September is sitting at 1.85 just now, compared to the normal range of 0.260 - 1.650
But of course oligoclonality (with or without an abnormal ratio) also dictates that the person must be in CR & < or = 5% PC in BM. No monoclonal component in serum IF or urine.
Since Ian's multiple myeloma is diffuse (pockets of multiple myeloma here and there, but not evenly spread, so you might drill in a clean place and get a false reading of CR), how can we know if the BM is clean or not?
He never had a monoclonal component in serum (IFx) & and no Bence Jones protein in urine.
Since he had right after ASCT a few good months of normal readings, including RATIO, and now the ratio is abnormal, does that mean we are near a relapse or near a CR?
Studies imply you have to develop an abnormal light chain ratio right after the transplant and maintain yourself there as long as possible. Since Ian developed an abnormal ratio well after the transplant, what does that mean ?
Like I said: Late good immune reconstitution? Or early relapse?
Thank you kindly,
Joanna & Ian
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johanna - Name: Joanna
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: august 2012
- Age at diagnosis: 60
Re: Abnormal serum FLC ratio after ASCT - meaning?
I have not heard that an abnormal ratio is positive. Where did you read this?
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blair77 - Who do you know with myeloma?: My husband
- When were you/they diagnosed?: April 2013
- Age at diagnosis: 43
Re: Abnormal serum FLC ratio after ASCT - meaning?
I'd also be interested in information about any studies that have shown that an abnormal kappa-lambda free light chain ratio after transplant is a positive prognostic indicator. I haven't heard of such a finding.
In general, I think it's hard to draw conclusions from changes in the kappa-lambda ratio without knowing what is happening to the underlying kappa and lambda levels. For example, Ian has kappa-type myeloma. If his k-l ratio is increasing because his lambda FLC levels are dropping, but are still well within the normal range, that means something very different than if the ratio is increasing because the kappa level has been steadily increasing.
In addition, I'd add that the sort of ratios you're seeing right now for Ian aren't really that high.
Finally, I find this statement in one of the postings above to be confusing:
I may be mistaken about this -- I'm not a physician -- but I don't think someone can have oligoclonal disease if they have no monoclonal disease detected by immunofixation. By definition, oligoclonal disease means that a myeloma patient has more than one type of myeloma (say, IgG kappa and IgG lambda) detected in a blood sample. That can't happen if the immunofixation turns up no sign of monoclonal disease.
Finally, just to be clear, the kappa-lambda ratio does not determine whether or not a patient is in complete response. The ratio only plays a role in determining if a myeloma patient has achieved a stringent complete response. See Table 1 in this paper for definitions of the different responses to treatment in myeloma:
http://www.bloodjournal.org/content/bloodjournal/117/18/4691.full.pdf?sso-checked=true
In general, I think it's hard to draw conclusions from changes in the kappa-lambda ratio without knowing what is happening to the underlying kappa and lambda levels. For example, Ian has kappa-type myeloma. If his k-l ratio is increasing because his lambda FLC levels are dropping, but are still well within the normal range, that means something very different than if the ratio is increasing because the kappa level has been steadily increasing.
In addition, I'd add that the sort of ratios you're seeing right now for Ian aren't really that high.
Finally, I find this statement in one of the postings above to be confusing:
But of course oligoclonality (with or without an abnormal ratio) also dictates that the person must be in CR & < or = 5% PC in BM. No monoclonal component in serum IF or urine."
I may be mistaken about this -- I'm not a physician -- but I don't think someone can have oligoclonal disease if they have no monoclonal disease detected by immunofixation. By definition, oligoclonal disease means that a myeloma patient has more than one type of myeloma (say, IgG kappa and IgG lambda) detected in a blood sample. That can't happen if the immunofixation turns up no sign of monoclonal disease.
Finally, just to be clear, the kappa-lambda ratio does not determine whether or not a patient is in complete response. The ratio only plays a role in determining if a myeloma patient has achieved a stringent complete response. See Table 1 in this paper for definitions of the different responses to treatment in myeloma:
http://www.bloodjournal.org/content/bloodjournal/117/18/4691.full.pdf?sso-checked=true
Re: Abnormal serum FLC ratio after ASCT - meaning?
Abnormal serum free light chain ratio in patients with multiple myeloma in complete remission has strong association with the presence of oligoclonal bands: implications for stringent complete remission definition.
Carlos Fernández de Larrea María Teresa Cibeira Montserrat Elena Juan Ignacio Arostegui Laura Rosiñol Montserrat Rovira Xavier Filella Jordi Yagüe Joan Bladé
[more]
Departments of Hematology, Hospital Clínic, Barcelona and Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain.
Blood (Impact Factor: 9.78). 10/2009; 114(24):4954-6. DOI: 10.1182/blood-2009-06-224832
Source: PubMed
ABSTRACT The prevalence of an abnormal serum free light chain (FLC) ratio in 34 patients with multiple myeloma in complete response (CR) after hematopoietic stem cell transplantation was studied. Fourteen of 34 patients (41.2%) showed an abnormal FLC ratio. The frequency of abnormal FLC ratio in patients with or without oligoclonal bands was 72.7% versus 26%, respectively (P = .023). The median value of FLC ratio was 2.55 (95% confidence interval, 1.89-3.20) in patients with oligoclonal bands versus 0.87 (95% confidence interval, 0.70-1.04) for those with no oligoclonal bands (P = .011). This is the first report showing that the presence of oligoclonal bands in patients with multiple myeloma in CR frequently results in an abnormal FLC ratio. Because an oligoclonal immune response is associated with a good outcome, our results question the current definition of stringent CR and support that the prognostic impact of oligoclonal bands should be also assessed on multivariate analysis.
There are plenty articles online published that argue for both sides....abnormal vs normal. with either of them being associated to a good outcome. Ian's LC are normal, having said that if we do serum IFx it might show traces of oligoclonality ....plenty cases that had LC , and when progressed , there was Ig's attached to the LC , like IgA k
Carlos Fernández de Larrea María Teresa Cibeira Montserrat Elena Juan Ignacio Arostegui Laura Rosiñol Montserrat Rovira Xavier Filella Jordi Yagüe Joan Bladé
[more]
Departments of Hematology, Hospital Clínic, Barcelona and Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain.
Blood (Impact Factor: 9.78). 10/2009; 114(24):4954-6. DOI: 10.1182/blood-2009-06-224832
Source: PubMed
ABSTRACT The prevalence of an abnormal serum free light chain (FLC) ratio in 34 patients with multiple myeloma in complete response (CR) after hematopoietic stem cell transplantation was studied. Fourteen of 34 patients (41.2%) showed an abnormal FLC ratio. The frequency of abnormal FLC ratio in patients with or without oligoclonal bands was 72.7% versus 26%, respectively (P = .023). The median value of FLC ratio was 2.55 (95% confidence interval, 1.89-3.20) in patients with oligoclonal bands versus 0.87 (95% confidence interval, 0.70-1.04) for those with no oligoclonal bands (P = .011). This is the first report showing that the presence of oligoclonal bands in patients with multiple myeloma in CR frequently results in an abnormal FLC ratio. Because an oligoclonal immune response is associated with a good outcome, our results question the current definition of stringent CR and support that the prognostic impact of oligoclonal bands should be also assessed on multivariate analysis.
There are plenty articles online published that argue for both sides....abnormal vs normal. with either of them being associated to a good outcome. Ian's LC are normal, having said that if we do serum IFx it might show traces of oligoclonality ....plenty cases that had LC , and when progressed , there was Ig's attached to the LC , like IgA k
-
johanna - Name: Joanna
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: august 2012
- Age at diagnosis: 60
6 posts
• Page 1 of 1