[curiousG]

Diagnosed IgG lambda, kappa levels increasing?

by curiousG on Sat Mar 26, 2016 9:49 am

Hi everyone -

My mom was diagnosed with IgG lambda multiple myeloma in September, 2014. She completed cyclophosphamide, Velcade, and dexamethasone (CyBorD) induction therapy and in April 2015 she had a stem cell transplant. She has just been doing awesome since recovering and has received no maintenance therapy. Her oncologist routinely runs SPEP and kappa / lambda light chain tests every three months.

Below are her results at the time of diagnosis, after stem cell transplant, to current.

My concern is that her latest K/L results are not in range due to the kappa light chains increasing.

Is this considered a possible relapse or is it possible she is developing secondary MGUS? Or is it both?

I assume, if this is a relapse, mom will go on Revlimid maintenance therapy. But if this is secondary MGUS, what are the possible treatment options if any?

I want to be armed with as much information as possible before mom meets with her oncologist next week to go over results. Thanks in advance for any information you can offer!

Crystal

SPEP 09-14 07-15 10-15 01-16 03-16 Range

Total Protein 11.9 6.6 6.9 6.5 7.1 6.0-8.2 g/dl
Albumin 2.9 3.5 3.6 3.2 3.5 3.3-5.0 g/dl
Alpha 1 0.5 0.3 0.3 0.3 0.3 0.1-0.3 g/dl
Alpha 2 0.9 1.1 0.9 0.9 0.9 0.5-1.0 g/dl
Beta 1.1 0.9 1.2 1.0 1.1 0.7-1.5 g/dl
Gamma 6.5 0.8 0.9 1.2 1.2 0.5-1.7 g/dl
A/G Ratio 0.3 1.1 1.1 0.9 1.0

FLC

LC Kappa 9.49 8.79 22.3 31.83 38.95 3.30-19.40 mg/L
LC Lambda 199 18.5 22.2 20.75 22.66 5.71-26.30 mg/L
LC K/L Ratio 0.0477 0.4751 1.00 1.53 1.72 0.26-1.65

[goldmine848]

Re: Diagnosed IgG lambda, kappa levels increasing?

by goldmine848 on Sat Mar 26, 2016 9:36 pm

Does she have an M-spike and if so is it kappa or lambda?

[curiousG]

Re: Diagnosed IgG lambda, kappa levels increasing?

by curiousG on Sun Mar 27, 2016 9:08 am

Hi Andrew -

Our lab doesn't upload lab reports, just test result values. We won't know if she has an M-spike until meeting with the oncologist. I assume if she does have an M-spike and it's lambda that might indicate relapse? If it's kappa, that might indicate secondary MGUS? Am I understanding this correct?

In the information I read about secondary MGUS, it seems to present itself around 6-12 months after a stem cell transplant and self corrects in about 6 months? No additional treatment would be required?

Before these labs, mom was telling me she felt like something was going on with her body. She said she could feel something was changing but couldn't determine if it was good or bad. She said it felt like a dull electricity running through her body sometimes. I hope this is a sign of the immune system reconstructing!

[goldmine848]

Re: Diagnosed IgG lambda, kappa levels increasing?

by goldmine848 on Sun Mar 27, 2016 5:53 pm

I think that you are generally correct. If the M-spike is the initially involved clone, it is a relapse, and if it is different, it can be secondary MGUS. The elevated kappa light chain may be a reflection of secondary MGUS and, in any case, although it is out of range, it is not elevated as to be a cause for concern in and of itself.

Your characterization of secondary MGUS may be a bit too narrow although it is not a well under­stood phenomenon. It can appear even before transplant in patients whom receive induction with novel agents such as Revlimid and Velcade. And although it can disappear quickly, it is not unheard for it to last for years.

If it is a relapse, that would call for consideration of the next line of treatment, not maintenance. Maintenance treatment is ordinarily commenced within 2-3 months after transplant and continued for a period of time thereafter, even in the absence of relapse.

[Multibilly]

Re: Diagnosed IgG lambda, kappa levels increasing?

by Multibilly on Sun Mar 27, 2016 6:23 pm

Hi Crystal,

I'm going to guess that you might have already read through the article below based on your well-informed comments. But if you haven't, it's worth a read.

RK Wadhera et al, "Incidence, clinical course, and prognosis of secondary monoclonal gammopathy of undetermined significance in patients with multiple myeloma," Blood, Sep 15, 2011 (full text of article)

Abstract:

During the course of multiple myeloma, new monoclonal proteins of an isotype distinct from the original clone, referred to as secondary monoclonal gammopathy of unde­ter­mined significance (MGUS), have been described. We report on the frequency, char­acteristics, and outcome of secondary MGUS. Of the 1942 patients with multiple myeloma, 128 (6.6%) developed a secondary MGUS, at a median of 12 months from the diagnosis of multiple myeloma. The median duration of secondary MGUS was 5.9 months. Secondary MGUS was more common in patients after stem cell transplantation than in those who had not undergone such treatment (22.7% vs 1.6%, P < .001). Overall survival was significantly superior in multiple myeloma patients who developed sec­ond­ary MGUS compared with the rest of the cohort (73 vs 38 months, respectively; P < .001). The time of onset and the duration of secondary MGUS, as well as failure to resolve spontaneously, had an effect on overall survival and require further study.