[Paulasuzor]

Changes in beta 2 microglobulin & free light chains

by Paulasuzor on Sun Jan 24, 2016 12:30 am

Hello everyone,

Thinking of you all and have greatly appreciated all of the love and support around here over the past year since my dear mom was affected by multiple myeloma. She was diagnosed in late February of 2015 after multiple compression fractures in her spine. She had surgery on her back involving rods and screws to stabilize her spine and has had a very tough year.

She went through targeted radiation and after 6 rounds of Revlimid / dexamethasone, she was told she was in remission due to "no evidence of M-proteins present". This was September 2015. On December 2, her blood work indicated that the abnormal protein, as noted by the doctor as, " a restricted band (M-spike) migrating in the gamma globulin region," was at a level of 0.3.

In January, she had a follow up with the neuro-oncologist, and he noticed something wrong with her kidneys from an MRI. We asked her primary oncologist to do blood tests again, as we felt due to the circumstances, it didn't make sense to wait three months as he had scheduled while the M-spike had returned and now is having trouble with her kidneys.

She was referred to a urologist who noted that there appears to be some sort of blockage in her kidneys, but has not given us thorough results yet. I also requested a copy of the blood work, as the oncologist did not report anything to us in nearly two weeks and I would greatly appreciate some help trying to figure out what her abnormal results may be indicating?

The doctor didn't test the abnormal protein levels on January 12th, but the following results stood out to me indicating some changes from Dec 2, 2015 to Jan 12, 2016.

Beta 2 microglobulin - High- 3.87 mg/l - up from 3.25 mg/l in December

Kappa free light chain - normal 10.5 MG/L - December 9.6 MG/L

Lambda free light chain - high - 118.3 MG/L - December was 57.4 MG/L

Kappa / lambda free light chain ratio - Low 0.09 - December was 0.17

Her total protein was low, 6.0 g/dl, down from 6.3 g/dl in December, which made me think that with the presence of the M-spike, and decreasing protein that the effects of the myeloma may be affecting her organs?

After doing some further research into the kappa/lambda free light chains, I began to wonder if she was being affected possibly be light chain deposition disease (LCDD) (which is rare for the lambda to be high) or amyloidosis??

I would greatly appreciate any information you may have!

Thank you,
Paula

[Multibilly]

Re: Changes in beta 2 microglobulin & free light chains

by Multibilly on Sun Jan 24, 2016 9:10 am

Hi Paula,

Sorry to hear about your mom's situation.

I'm not a doc. But given there was a blockage detected in her kidneys and she has an elevated lambda level, checking for amyloidosis seems like a fairly prudent thing to do. Testing for amyloidosis in her situation would involve performing a renal biopsy, which was a fairly simple and painless procedure that I underwent 3 years ago. You are right that lambda-type LCDD is rare. But since LCDD also requires a renal biopsy to confirm a diagnosis, it seems like a pretty easy thing to look for if one is already signed up to get a renal biopsy.

I assume that the urologist ordered a 24 hour urine protein electrophoresis (UPEP)? A 24 hr UPEP may provide some additional clues if either disease is in play, but won't provide a definitive diagnosis for LCDD or amyloidosis.

Based on my own experience getting to the bottom of some peculiar kidney issues I had that were related to smoldering multiple myeloma, my only advice is that she ought to be working closely in concert with a multiple myeloma specialist and not rely solely on a urologist or nephrologist when trying to get to the bottom of this.

[philatour]

Re: Changes in beta 2 microglobulin & free light chains

by philatour on Wed Jan 27, 2016 7:27 pm

Have you been referred to a nephrologist (kidney specialist)?