Howdy,
My name is Myles, I am a 54 year old six foot six inch (1.98 m), 250 pound (113 kg) Caucasian male. My weight is down from 290 pounds last December. I have Type 2 diabetes and am taking Lantus once a day by injection and Humalog as well during meal times. My A1C has gone from 12.7 to 6.4 in the past year. My blood sugar has been in normal range past month or so. I have had to have no will power to lose the weight I've lost. I seem to have just lost my appetite.
I also have had neuropathy symptoms for the last two years, never particularly bothersome before. I have had no muscle or strength loss, no broken bones. The past two months the neuropathy has been intolerably bad. It has now spread to my fingers. I feel like I have been finger picking a guitar all day, but I haven't picked up a guitar in years.
I went to a podiatrist for my foot pain and he did a punch biopsy on my ankle. The biopsy showed 97% damage or loss of nerve tissues. Assessment mixed large / small fiber peripheral polyneuropathy
So off to the neurologist; his notes follow:
"This is a 54-year-old right-handed man presenting to the NM clinic for mixed large / small fiber peripheral polyneuropathy manifested by bilateral foot numbness / tingling / neuropathic pain with length dependent loss to small fiber modalities below mid calves and reduction to vibration below ankles with depressed ankle jerks bilaterally, likely secondary to DM II (A1c 12.7 2 years ago at diagnosis) and possibly alcohol usage in the past but other treatable cause of neuropathy cannot be ruled out unless checked."
He ordered: "Will pursue the following w/u studies including those for secondary / potentially treatable underlying conditions: B12, CRP, Serum immunofiation, Kappa/Lambda ratio, TSH. Also, start nortriptyline 25 mg daily and titrate up to 50 mg HS as tolerated"
The results of the tests were all mostly normal. The exception is why I am here.
MPA IgG, Serum 1710 mg/dL 717 - 1411 mg/dL H
MPA IgA, Serum 138 mg/dL 78 - 391 mg/dL
MPA IgM, Serum 74 mg/dL 53 - 334 mg/dL
MPA Kappa, Serum 2160 mg/dL 534 - 1267 mg/dL H
MPA Lambda, Serum 245 mg/dL 253 - 653 mg/dL L
MPA Kappa/Lambda Ratio 8.82 1 - 3 H
MPA Result:
M protein is present. (Ref range: No M protein is identified)
Interpretation (MPA): Atypical restricted bands are present in the IgG and kappa regions. Consistent with IgG kappa monoclonal gammopathy.
So, I have MGUS at a minimum. The numbers and the advancing neuropathy (the prescription from the neurologist has turned down the volume a bit) seem to suggest I have active (malignant) multiple myeloma.
I have limited knowledge, however, and would appreciate if others could help me understand whether these results indicate I have active multiple myeloma.
I have an appointment at the oncologist on Thursday for an all day outing i am told. I also had my primary care doctor draw blood and rerun the test to confirm the results
Forums
7 posts
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DavidMyles - Name: David
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: last week
- Age at diagnosis: 54
Re: Elevated kappa-lambda ratio with M-protein present
Hello David Myles,
Welcome to the forum, although I am sorry that it is medical problems that bring you here!
The elevated IgG and kappa levels might indicate IgG kappa type MGUS, smoldering myeloma, or active myeloma. I guess that is fairly obvious from the lab results. I hope that the hematologist can give you some advice on that , and I am sure that they would do a test to measure the monoclonal 'M' protein(s) too.
Since Type 2 diabetes and also myeloma can cause peripheral neuropathy, I hope that you can get the health issues under control. I remember having neuropathy, especially in my feet, before my diagnosis with myeloma. They would go numb after periods of standing. The irony is that even with my myeloma treatments of Velcade, given by injection, the neuropathy didn't clear up much since that treatment is known to cause neuropathy! Thus if you were being treated for myeloma, probably a drug regimen could be chosen without too much risk of neuropathy.
Good luck and hope you will let us know of your findings with the doctors.
Welcome to the forum, although I am sorry that it is medical problems that bring you here!
The elevated IgG and kappa levels might indicate IgG kappa type MGUS, smoldering myeloma, or active myeloma. I guess that is fairly obvious from the lab results. I hope that the hematologist can give you some advice on that , and I am sure that they would do a test to measure the monoclonal 'M' protein(s) too.
Since Type 2 diabetes and also myeloma can cause peripheral neuropathy, I hope that you can get the health issues under control. I remember having neuropathy, especially in my feet, before my diagnosis with myeloma. They would go numb after periods of standing. The irony is that even with my myeloma treatments of Velcade, given by injection, the neuropathy didn't clear up much since that treatment is known to cause neuropathy! Thus if you were being treated for myeloma, probably a drug regimen could be chosen without too much risk of neuropathy.
Good luck and hope you will let us know of your findings with the doctors.
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: Elevated kappa-lambda ratio with M-protein present
Hi David,
Welcome to the forum, but sorry to hear about your situation.
You will need some more tests to come up with an accurate diagnosis. To begin with, you will need a serum protein electrophoresis and a serum free light chain assay. Your oncologist will also be looking at your CBC and comprehensive metabolic lab results to see if you have a low hemoglobin level, a high calcium level, and / or a high creatinine level (you may want to also go back and check these levels yourself). The oncologist may also order some imaging of your skeleton to look for any myeloma-related damage to your skeleton. Depending on what turns up on all your test results, a bone marrow biopsy may also be ordered.
Given the extent of your neuropathy, the doctor should also be doing tests to rule out amyloidosis. The tests for amyloidosis may include a fat pad biopsy of your abdomen or some additional analysis of your bone marrow biopsy sample. A 24-hour urine test (UPEP) would also be likely, especially if amyloidosis were suspected.
The good news is that with an IgG level of 1710 mg/dL, the level of your IgG monoclonal protein in your blood (aka your "M-spike") won't be that high and should come out roughly somewhere between 0.4 g/dL and 0.9 g/dL. Unfortunately, it looks like the doctor ordered a TOTAL light chain assay instead of a serum FREE light chain assay, so it's hard to tell what's going on with your free light chains. Knowing what's going on with your free light chains will be another key to understanding just how advanced your plasma cell disorder is.
I think one of the challenges in your situation is to determine if your neuropathy is due to your diabetes or your plasma cell disorder. I have no idea how doctors would make that call, but I imagine they know how to. MGUS patients can and sometimes do experience neuropathy, but technically neuropathy isn't a criteria for being diagnosed with active multiple myeloma. Having said that, your oncologist may determine that some sort of treatment may still be warranted if your neuropathy is attributed to your plasma cell disorder. But keep in mind that several of the myeloma and amyloidosis treatments themselves can also cause neuropathy. So, this will be something that you will obviously need to discuss with your oncologist.
Hope this helps a bit.
Welcome to the forum, but sorry to hear about your situation.
You will need some more tests to come up with an accurate diagnosis. To begin with, you will need a serum protein electrophoresis and a serum free light chain assay. Your oncologist will also be looking at your CBC and comprehensive metabolic lab results to see if you have a low hemoglobin level, a high calcium level, and / or a high creatinine level (you may want to also go back and check these levels yourself). The oncologist may also order some imaging of your skeleton to look for any myeloma-related damage to your skeleton. Depending on what turns up on all your test results, a bone marrow biopsy may also be ordered.
Given the extent of your neuropathy, the doctor should also be doing tests to rule out amyloidosis. The tests for amyloidosis may include a fat pad biopsy of your abdomen or some additional analysis of your bone marrow biopsy sample. A 24-hour urine test (UPEP) would also be likely, especially if amyloidosis were suspected.
The good news is that with an IgG level of 1710 mg/dL, the level of your IgG monoclonal protein in your blood (aka your "M-spike") won't be that high and should come out roughly somewhere between 0.4 g/dL and 0.9 g/dL. Unfortunately, it looks like the doctor ordered a TOTAL light chain assay instead of a serum FREE light chain assay, so it's hard to tell what's going on with your free light chains. Knowing what's going on with your free light chains will be another key to understanding just how advanced your plasma cell disorder is.
I think one of the challenges in your situation is to determine if your neuropathy is due to your diabetes or your plasma cell disorder. I have no idea how doctors would make that call, but I imagine they know how to. MGUS patients can and sometimes do experience neuropathy, but technically neuropathy isn't a criteria for being diagnosed with active multiple myeloma. Having said that, your oncologist may determine that some sort of treatment may still be warranted if your neuropathy is attributed to your plasma cell disorder. But keep in mind that several of the myeloma and amyloidosis treatments themselves can also cause neuropathy. So, this will be something that you will obviously need to discuss with your oncologist.
Hope this helps a bit.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Elevated kappa-lambda ratio with M-protein present
Thank you for your kind replies. I am assuming a secondary cause for the neuropathy as sugar has been fully controlled for 8 months and the symptoms continue to increase. From the research I have been doing, including reading past posts here, I have come to the conclusion that there is not enough data to accurately predict anything at the moment. But the symptoms and the above numbers suggest some level of active process working on my peripheral nervous system. I am hoping we stop at smoldering MGUS.
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DavidMyles - Name: David
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: last week
- Age at diagnosis: 54
Re: Elevated kappa-lambda ratio with M-protein present
New test results in.
Protein Electrophoresis
Albumin 4.4 2-4.9
% Albumin 56
Globulin 3.5 2.0-3.8
A/G ratio 1.3 1.2-1.9
Alpha-1 0.3 0.2-0.5
% Alpha-1 4.0
Alpha-2 0.9 0.0-1.0
% Alpha-2 12.0
Beta 7.0 0.5-1.2
% Beta 9.0
Gamma 1.6 H 0.7-1.55
% Gamma 20.0
Monoclonal Protein 1.0 H
Protein total 7.9
Interpetation: Monoclonal protein seen in gamma fraction.
Protein Electrophoresis
Albumin 4.4 2-4.9
% Albumin 56
Globulin 3.5 2.0-3.8
A/G ratio 1.3 1.2-1.9
Alpha-1 0.3 0.2-0.5
% Alpha-1 4.0
Alpha-2 0.9 0.0-1.0
% Alpha-2 12.0
Beta 7.0 0.5-1.2
% Beta 9.0
Gamma 1.6 H 0.7-1.55
% Gamma 20.0
Monoclonal Protein 1.0 H
Protein total 7.9
Interpetation: Monoclonal protein seen in gamma fraction.
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DavidMyles - Name: David
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: last week
- Age at diagnosis: 54
Re: Elevated kappa-lambda ratio with M-protein present
Protein Electrophoresis With Interpretation
Component Your Value Standard Range Flag
Protein, Total 8.1 g/dL 6.0 - 8.4 g/dL
Albumin for SPE 4.01 gm/dL 3.37 - 4.23 gm/dL
Alpha 1 Globulin 0.25 gm/dL 0.18 - 0.31 gm/dL
Alpha 2 Globulin 0.98 gm/dL 0.52 - 0.97 gm/dL H
Beta Globulin 1.08 gm/dL 0.84 - 1.36 gm/dL
Gamma Globulin 1.78 gm/dL 0.70 - 1.44 gm/dL H
Interpretation (Prot Electro): An M protein is identified on protein electrophoresis. See separate immunofixation report for characterization of the M protein.
M-Protein Location Gamma fraction
M-Protein Concentration 1.28 gm/dL 0.00 gm/dL H
MPA IgG, Serum 1820 mg/dL 717 - 1411 mg/dL H
MPA IgA, Serum 145 mg/dL 78 - 391 mg/dL
MPA IgM, Serum 71 mg/dL 53 - 334 mg/dL
MPA Kappa, Serum 2140 mg/dL 534 - 1267 mg/dL H
MPA Lambda, Serum 224 mg/dL 253 - 653 mg/dL L
MPA Kappa/Lambda Ratio 9.55 1 - 3 H
MPA Result: M protein is present
Standard range: No M protein is identified.
Interpretation (MPA): Atypical restricted bands are present in the IgG and kappa regions. Consistent with IgG kappa monoclonal gammopathy.
They did a full skeletal workup only one anomaly.
Lateral skull: Negative.
Spine: Mild degenerative changes thoracic spine. No lytic or sclerotic osseous lesion. No compression fracture.
Bilateral upper extremities: 5 millimeterlucency in the right proximal humerus appears to have sclerotic margins and appears benign. Appearances not typical for multiple myeloma. Mild degenerative change bilaterally see joints.
Frontal chest/ribs: Remote healed fracture of the left 5th rib laterally. No lytic or expansile osseous lesion.
AP pelvis and bilateral lower extremities: Mild degenerative change right hip. No lytic or sclerotic osseous lesion identified involving the pelvis or lower extremities.
Is the rise in the ratio to be of concern?
Component Your Value Standard Range Flag
Protein, Total 8.1 g/dL 6.0 - 8.4 g/dL
Albumin for SPE 4.01 gm/dL 3.37 - 4.23 gm/dL
Alpha 1 Globulin 0.25 gm/dL 0.18 - 0.31 gm/dL
Alpha 2 Globulin 0.98 gm/dL 0.52 - 0.97 gm/dL H
Beta Globulin 1.08 gm/dL 0.84 - 1.36 gm/dL
Gamma Globulin 1.78 gm/dL 0.70 - 1.44 gm/dL H
Interpretation (Prot Electro): An M protein is identified on protein electrophoresis. See separate immunofixation report for characterization of the M protein.
M-Protein Location Gamma fraction
M-Protein Concentration 1.28 gm/dL 0.00 gm/dL H
MPA IgG, Serum 1820 mg/dL 717 - 1411 mg/dL H
MPA IgA, Serum 145 mg/dL 78 - 391 mg/dL
MPA IgM, Serum 71 mg/dL 53 - 334 mg/dL
MPA Kappa, Serum 2140 mg/dL 534 - 1267 mg/dL H
MPA Lambda, Serum 224 mg/dL 253 - 653 mg/dL L
MPA Kappa/Lambda Ratio 9.55 1 - 3 H
MPA Result: M protein is present
Standard range: No M protein is identified.
Interpretation (MPA): Atypical restricted bands are present in the IgG and kappa regions. Consistent with IgG kappa monoclonal gammopathy.
They did a full skeletal workup only one anomaly.
Lateral skull: Negative.
Spine: Mild degenerative changes thoracic spine. No lytic or sclerotic osseous lesion. No compression fracture.
Bilateral upper extremities: 5 millimeterlucency in the right proximal humerus appears to have sclerotic margins and appears benign. Appearances not typical for multiple myeloma. Mild degenerative change bilaterally see joints.
Frontal chest/ribs: Remote healed fracture of the left 5th rib laterally. No lytic or expansile osseous lesion.
AP pelvis and bilateral lower extremities: Mild degenerative change right hip. No lytic or sclerotic osseous lesion identified involving the pelvis or lower extremities.
Is the rise in the ratio to be of concern?
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DavidMyles - Name: David
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: last week
- Age at diagnosis: 54
Re: Elevated kappa-lambda ratio with M-protein present
I wouldn't worry about the very slight rise in your free light chain ratio. All of your numbers are going to bounce around a bit over time. You can get an idea from by looking at my numbers to understand just how much your numbers will normally vary over time.
https://myelomabeacon.org/forum/fenofibrate-tricor-and-multiple-myeloma-t2690-80.html#p52895
https://myelomabeacon.org/forum/fenofibrate-tricor-and-multiple-myeloma-t2690-80.html#p52895
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
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