[Zodiaccatznz]

Elevated lambda free light chain level - meaning?

by Zodiaccatznz on Sun May 15, 2016 7:29 am

Hello from New Zealand,

Last year while having some blood investigations done, they found a monoclonal IgG paraprotein, lambda type, in my blood.

My results were

IgG 11.3 g/L (7.0-14)
IgA and IgM I currently don't have on me

My doctor talked about MGUS and I was told not to worry. I recently asked to be retested and also to test my serum free light chains and SPE.

The test results from this week are:

Immunoglobulins

IgG 11.8 g/L slightly raised
IgA 1.4 g/L (0.8-3.5)
IgM 0.8 g/L (0.5-2.0)

Serum light chains

Kappa light chains 11.70 (3.30-19.40)
Lambda light chain 238 mg/L (5.71 - 26.30) H
Kappa/lambda ratio 0.05 (0.26-1.65) L

My doctor has referred me to haematology at the hospital, but the wait is 2 months. I'm quite concerned. I am a registered nurse but am struggling to understand what this could mean.

I'm 35 years of age, very fatigued, every day is a struggle. I get headaches a lot, weird muscle aches, and generally feel like crap.

My blood count was fine, iron fine, kidneys OK.

I was just wondering if anyone else has been in this situation or knows about this who could shed some light . All of a sudden I'm noticing all these patients I have with multiple myeloma, and I'm feeling very anxious

Thanks kindly

[Multibilly]

Re: Elevated lambda free light chain level - meaning?

by Multibilly on Sun May 15, 2016 1:48 pm

Hi Zodiaccatznz,

Welcome to the forum.

Do you know what your paraprotein level is (this can be found on your serum protein electrophoresis test)? It may also be called an abnormal band, M-spike, etc.

Given your IgG level is well within normal limits, your M-spike is likely quite small, which is good news. But it will still be key to know your M-spike level in order to distinguish between a diagnosis of MGUS and something like smoldering multiple myeloma.

Your involved/uninvolved free light chain ratio (lambda/kappa) is not too worrisome at 20. You need to start being concerned if that ratio really starts to trend upwards and/or approaches 100.

While MGUS is typically considered to be an asymptomatic diagnosis, there are definitely folks that experience fatigue and other symptoms with this diagnosis. The good news is that the risk of MGUS evolving into multiple myeloma is only about 1.5 - 2.0% /year.

You say your blood count is fine, but you are feeling fatigued. What exactly are your hemoglobin, hematocrit and red blood cell levels (including units of measure and normal reference ranges)?

In your circumstance with your symptoms (headaches, muscle aches, fatigue), I might also ask the hematologist about ruling out amyloidosis.

I'm not a doc, but given the numbers you have shared thus far, I wouldn't be worried about having to wait two months to see a specialist. Hope this helps a bit.

[Zodiaccatznz]

Re: Elevated lambda free light chain level - meaning?

by Zodiaccatznz on Sun May 15, 2016 7:19 pm

Hello,

Thanks heaps for your reply.

My paraprotein level in the serum electrophoresis test off the top off my head was an abnormal monoclonal lambda type in the gamma region. I don't recall a level with it. I left all my info at work so I will get it.

You wrote, "Your involved/uninvolved free light chain ratio (lambda/kappa) is not too worrisome at 20. You need to start being concerned if that ratio really starts to trend upwards and/or approaches 100."

Excuse my lack of knowledge, but could you please tell me where the 20 is you were referring to?

Thanks heaps

[Multibilly]

Re: Elevated lambda free light chain level - meaning?

by Multibilly on Sun May 15, 2016 8:02 pm

How to refer to free light chain (FLC) ratios tends to confuse a lot of new patients.

Your lab says your kappa/kambda FLC ratio = 0.05. BUT most of the medical industry refers to an individual's FLC ratio as being the involved/uninvolved free light chain ratio. In your case, your "involved" FLC is the lambda FLC (the FLC that is reading high on your lab report). So your FLC ratio = 238/11.7=20 (the inverse of 0.05 that was reported on your lab results). Some patients have "kappa involved" myeloma, so they would use the kappa/lambda ratio value when referring to their FLC ratio.

Make sense?

[Zodiaccatznz]

Re: Elevated lambda free light chain level - meaning?

by Zodiaccatznz on Sun May 15, 2016 8:42 pm

Ahhh, thanks very much. Now I understand. I'm not sure why I'm struggling to understand this stuff. Science is something I'm normally ok at lol

[Davidg]

Re: Elevated lambda free light chain level - meaning?

by Davidg on Mon May 16, 2016 10:08 am

As Multibilly said, it would be worth making sure that amyloidosis is ruled out. If your kidney function is fine and there is no protein in your urine (did they do a dip?), then that is unlikely to be an issue - but with high lambda light chains it's always worth getting it checked.

[Zodiaccatznz]

Re: Elevated lambda free light chain level - meaning?

by Zodiaccatznz on Tue May 17, 2016 11:58 pm

Thanks for your reply. No they didn't dip, but I can tomorrow

Can anyone tell me, can my lambda light chains go down themselves?

Thanks

[Multibilly]

Re: Elevated lambda free light chain level - meaning?

by Multibilly on Wed May 18, 2016 6:30 am

All of your markers can fluctuate quite a bit on their own, including your involved free light chain and ratio values.

But if you have a plasma cell dyscrasia (disorder), it's not going to fully resolve itself on its own. You can get an idea of how my markers have changed over time without any treatment by looking at this link:

https://myelomabeacon.org/forum/fenofibrate-tricor-and-multiple-myeloma-t2690-50.html#p41916

[Zodiaccatznz]

Re: Elevated lambda free light chain level - meaning?

by Zodiaccatznz on Wed Jul 13, 2016 5:55 am

Hello

After talking to a doctor I work with, I pushed my GP to test my serum light chains. Below are the results from this test.
Immunoglobulins

IgG 11.8 g/L slightly raised
IgA 1.4 g/L (0.8-3.5)
IgM 0.8 g/L (0.5-2.0)

Serum light chains

Kappa light chains 11.70 (3.30-19.40)
Lambda light chain 238 mg/L (5.71 - 26.30) H
Kappa/lambda ratio 0.05 (0.26-1.65) L

I got referred to haematology, had an appointment and was basically told they will check me for myeloma but doubt that's what it would be. Had a bone marrow biopsy the next day, then a CT and got my results a few days ago.

Had bloods taken 30 mins before my appointment. I noted that 8 tubes of blood seemed a lot. I went into my appointment being quite positive, but a bit of a shock after being told its smoldering myeloma and looks like a have a lesion on my pelvis.

I'm 35. From here they are checking for amyloidosis, echo for my heart, PET scan to look at lesion found, and plan of either chemo or radiation to treat it.

I'm feeling very scared. I have 3 kids, no savings, and little leave after breaking my thumb recently. I don't quite understand my bone marrow biopsy results and was wondering if anyone can make any sense of it for me please?

All my CRAB is normal

Thanks

Bone Marrow Biopsy-Trephine

Indication: IgG lambda paraprotein. MGUS, Myeloma. Aspirate shows 4% plasma cells.
Site: Left posterior iliac crest.
Size of sample: 24 millimeter
Bone trabeculae: Normal.
Cellularity: Slightly hypocellular. Approximately 50%
Cell types: All haemopoietic cells are present. There is a small excess of CD138 positive cells expressing lambda light chains.
Reticulin fibres: Slight diffuse increase. Grade II
Comments: There was no evidence of amyloid deposition either on the H&E stained specimen or the Congo-red stained specimen.
Diagnosis: Plasma cell myeloma.

Cancer registry notified
WHO ICD-O Code: 9732/3

Bone Marrow Biopsy-Aspirate

Indication: IgG lambda paraprotein / MGUS / myeloma.
Hb 141, MCV 96, Plts 307, WCC 7.7
Blood Film: Blood film not available for review.
Site: Left posterior iliac crest.
Ease of aspiration:Easy.
Cellularity: Normal.
Megakaryocytes: Normal.
Granulopoiesis: Normal.
Lymphopoiesis: Lymphocytes normal. There is an excess of plasma cells, some of which are binucleate. Some plasma cells contain Russell bodies.
Erythropoiesis: Normal.
Iron stores: Normal.
Sideroblasts: Occasional non-ring sideroblasts present.
Differential:
Blast cells 1 %
Promyelocytes 1 %
Myelocytes 20 %
Neutrophils 31 %
Lymphocytes 21 %
Monocytes 1 %
Eosinophils 1 %
Plasma cells 4 %
Erythroblasts 20 %
M/E Ratio: 4.0:1
Sample sent to: Surface markers.
Comments: See trephine result.
Diagnosis: Plasma cell myeloma (based on composite of biochemistry, aspirate, trephine and immuno­phenotyping).

[Multibilly]

Re: Elevated lambda free light chain level - meaning?

by Multibilly on Wed Jul 13, 2016 11:18 am

A key thing to understand is what your CLONAL bone marrow plasma cell percentage is. It's not clear to me what that figure is from the report you posted. It's also important to understand what kind of lesion you have (focal or lytic), as well as its size.

Technically, to have a diagnosis of smoldering multiple myeloma, you would need to have an M-spike > 3.0 g/dL (30 g/L) or a clonal bone marrow plasma cell percentage > 10%, with no CRAB symptoms ("no CRAB" also means the presence of no cancerous lytic lesions).

You don't say what your M-spike level is, but it can't be > 3.0 g/dL (30 g/L) given your total IgG level is 11.8 g/L (an IgG M-spike makes up a fraction of one's total IgG) . Again, it's not clear what your clonal bone marrow plasma cell percentage is.

But let's assume that you have a clonal bone marrow plasma cell percentage that is < 10% and one cancerous lytic lesion. I'm not a doc, but given they are considering treating the lesion with radiation (provided the PET/CT shows that the lesion is cancerous), the diagnosis actually sounds more like a "solitary plasmacytoma plus MGUS". You might want to read through this article to better understand that potential diagnosis:

https://myelomabeacon.org/news/2012/05/04/solitary-bone-plasmacytoma/

On the other hand, if your clonal bone marrow plasma cell percentage is > 10% and you have a cancerous lytic lesion (to be verified by PET/CT), then you would instead be diagnosed with stage 1 multiple myeloma.

In any case, the presence of a cancerous lytic lesion would rule out a diagnosis of smoldering multiple myeloma.

Again, it will be key to understand from your doctor just what your clonal bone marrow plasma cell percentage is, as well as the details about your lesion, and why he/she thinks you have a diagnosis of smoldering multiple myeloma.

I hope this isn't too confusing. Let us know if you have any questions.