My husband just completed his interval testing for smoldering multiple myeloma. His M-spike went down, and the serum free light chain ratio went up. Is there a biological connection between these two measured items? Is there any biological explanation for decreases in these values?
Thanks. We learn so much from this site.
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WholeNotherWorld - Who do you know with myeloma?: my husband
- When were you/they diagnosed?: Dec. 2016
- Age at diagnosis: 67
Re: Drop in M-spike, rise in free light chain ratio?
Can you post the numbers so we can how much change there was?
My guess is that it was just normal fluctuation in the numbers but it depends on how large a change in the numbers we're talking about here. I don't know if there is any biologically-induced inverse correlation in how they move, but maybe someone else more knowledgeable has a better answer.
For example, here are some numbers from my surveillance labs (I have SMM as well).
May 2016
M-spike = 1.8 g/dL
K/L ratio = 2.3
Nov 2016
M-spike = 1.6 g/dL
K/L ratio = 2.5
So you can see my M-spike went down and my K/L ratio went up. Then look at May 2017:
M-spike = 1.7 g/dL
K/L ratio = 2.0
M-spike went up, K/L ratio went down. There is nothing statistically significant about these, just normal fluctuation. And I don't know if this change is large enough to signal some sort of relationship between the two in how they move.
In September of this year my M-spike was 1.3 g/dL and my K/L ratio was 2.2. Now this is a different lab from the May 2016, Nov 2016, and May 2017 numbers, so you can't really compare them completely. These changes are small, so I don't know if this reflects some sort of inverse relationship between the two numbers.
Edited to add that I looked at my May 2015 and November 2015 numbers (same lab for both). My M-spike stayed the same on both dates, but my K/L ratio went from 1.8 to 3.6. Subsequently, from Nov 2015 to May 2016, my M-spike went up slightly but my K/L ratio went back down to where it usually is, right around 2.
My guess is that it was just normal fluctuation in the numbers but it depends on how large a change in the numbers we're talking about here. I don't know if there is any biologically-induced inverse correlation in how they move, but maybe someone else more knowledgeable has a better answer.
For example, here are some numbers from my surveillance labs (I have SMM as well).
May 2016
M-spike = 1.8 g/dL
K/L ratio = 2.3
Nov 2016
M-spike = 1.6 g/dL
K/L ratio = 2.5
So you can see my M-spike went down and my K/L ratio went up. Then look at May 2017:
M-spike = 1.7 g/dL
K/L ratio = 2.0
M-spike went up, K/L ratio went down. There is nothing statistically significant about these, just normal fluctuation. And I don't know if this change is large enough to signal some sort of relationship between the two in how they move.
In September of this year my M-spike was 1.3 g/dL and my K/L ratio was 2.2. Now this is a different lab from the May 2016, Nov 2016, and May 2017 numbers, so you can't really compare them completely. These changes are small, so I don't know if this reflects some sort of inverse relationship between the two numbers.
Edited to add that I looked at my May 2015 and November 2015 numbers (same lab for both). My M-spike stayed the same on both dates, but my K/L ratio went from 1.8 to 3.6. Subsequently, from Nov 2015 to May 2016, my M-spike went up slightly but my K/L ratio went back down to where it usually is, right around 2.
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FingersCrossed - Name: FingersCrossed
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Oct 2014 (Smoldering)
- Age at diagnosis: 44
Re: Drop in M-spike, rise in free light chain ratio?
He has testing about every 3 months for his IgG kappa smoldering multiple myeloma.
From the beginning of this 'adventure', the M-Spike had been (in g/dl):
0.6, 0.4, 0.4, 0.5, 0.6, and most recently 0.3
The free light chain ratio has been:
8.53, 9.17, 9.41, 11.81 and most recently 13.24.
He consistently has >500 mg urine protein (per 24 hours). We don't have the results from this cycle yet.
We understand that there are natural fluctuations in these values, and are trying to develop a better understand of 'tumor biology' that explains biologically, what is occurring that makes the M-spike grow and shrink, and what is happening biologically that creates increases in free light chains.
For example, if M-spike is a surrogate measure for the amount of malignant cells burden, and free light chains are a measure of the amount of protein thrown off by the malignant cells, wouldn't there be a direct relationship between M-spike and free light chains? The bigger the M-spike, the more free light chains and conversely the lower the M-spike, the fewer free light chains. If this premise is correct, imagine our confusion when M-spike goes down, and free light chain ratio goes up.
So, while the fluctuations are natural, NOTHING about this condition is natural. That's why the interest in understanding more about tumor biology.
Thank you all so much for this informative and supportive forum.
From the beginning of this 'adventure', the M-Spike had been (in g/dl):
0.6, 0.4, 0.4, 0.5, 0.6, and most recently 0.3
The free light chain ratio has been:
8.53, 9.17, 9.41, 11.81 and most recently 13.24.
He consistently has >500 mg urine protein (per 24 hours). We don't have the results from this cycle yet.
We understand that there are natural fluctuations in these values, and are trying to develop a better understand of 'tumor biology' that explains biologically, what is occurring that makes the M-spike grow and shrink, and what is happening biologically that creates increases in free light chains.
For example, if M-spike is a surrogate measure for the amount of malignant cells burden, and free light chains are a measure of the amount of protein thrown off by the malignant cells, wouldn't there be a direct relationship between M-spike and free light chains? The bigger the M-spike, the more free light chains and conversely the lower the M-spike, the fewer free light chains. If this premise is correct, imagine our confusion when M-spike goes down, and free light chain ratio goes up.
So, while the fluctuations are natural, NOTHING about this condition is natural. That's why the interest in understanding more about tumor biology.
Thank you all so much for this informative and supportive forum.
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WholeNotherWorld - Who do you know with myeloma?: my husband
- When were you/they diagnosed?: Dec. 2016
- Age at diagnosis: 67
Re: Drop in M-spike, rise in free light chain ratio?
Hi WholeNotherWorld,
It looks like your husband's M-spike is basically flat with some variation. There's some evidence of a downward trend, but there really aren't enough points to conclude that for certain.
His kappa-lambda ratio does seem to be trending up, but I'm not sure I would conclude that the upward movement is a permanent trend. If you look, for example, at Multibilly's free light chain ratio from the time of his smoldering diagnosis until about a year afterwards, you'll see it climbed rather consistently. However, it then reversed itself. Here are the latest graphs with Multibilly's key lab results since his diagnosis.
(Multibilly has IgG lambda smoldering myeloma, so he tracks his lambda-kappa ratio, rather than the kappa-lambda ratio. The two are just reciprocals of one another.)
It's also possible that your husband has more than one myeloma clone in his body, one which produces an M-spike and some kappa free light chains, and another that mainly secretes kappa free light chains. The first clone may be basically dormant, but perhaps the second clone has expanded a bit, causing the upswing in the kappa-lambda ratio.
The second clone may even be competing with, and crowding out, the myeloma cells from the first clone, causing the slight drop in the M-spike.
This article is useful for understanding myeloma clones and how they can change over time:
Morgan, GJ, "Evolution, Intra-Clonal Heterogeneity, And Multiple Myeloma," The Myeloma Beacon, Nov 3, 2014
It's always useful to remember with M-spike and free light chain results that there is some natural variation in the numbers, partly due to test variability, and partly due to biologic processes that can cause ups and owns in the numbers.
Good luck!
It looks like your husband's M-spike is basically flat with some variation. There's some evidence of a downward trend, but there really aren't enough points to conclude that for certain.
His kappa-lambda ratio does seem to be trending up, but I'm not sure I would conclude that the upward movement is a permanent trend. If you look, for example, at Multibilly's free light chain ratio from the time of his smoldering diagnosis until about a year afterwards, you'll see it climbed rather consistently. However, it then reversed itself. Here are the latest graphs with Multibilly's key lab results since his diagnosis.
(Multibilly has IgG lambda smoldering myeloma, so he tracks his lambda-kappa ratio, rather than the kappa-lambda ratio. The two are just reciprocals of one another.)
It's also possible that your husband has more than one myeloma clone in his body, one which produces an M-spike and some kappa free light chains, and another that mainly secretes kappa free light chains. The first clone may be basically dormant, but perhaps the second clone has expanded a bit, causing the upswing in the kappa-lambda ratio.
The second clone may even be competing with, and crowding out, the myeloma cells from the first clone, causing the slight drop in the M-spike.
This article is useful for understanding myeloma clones and how they can change over time:
Morgan, GJ, "Evolution, Intra-Clonal Heterogeneity, And Multiple Myeloma," The Myeloma Beacon, Nov 3, 2014
It's always useful to remember with M-spike and free light chain results that there is some natural variation in the numbers, partly due to test variability, and partly due to biologic processes that can cause ups and owns in the numbers.
Good luck!
Re: Drop in M-spike, rise in free light chain ratio?
Thanks for the link to Dr. Morgan's article on 'Evolution, Intra-Clonal Heterogeneity, And Multiple Myeloma'. That was fantastic.
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WholeNotherWorld - Who do you know with myeloma?: my husband
- When were you/they diagnosed?: Dec. 2016
- Age at diagnosis: 67
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