[jet]

When do free light chain increases become an issue?

by jet on Mon Dec 22, 2014 3:28 pm

When I first got diagnosed, my very first light chains blood test that my local doctor took was lambda 7025. Three days later I was hospitalized, where they of course did more bloods. Lambda was 3470. I didn't have any treatment in between. That's quite a fluctuation, yes?

After 9 months treatment and a few months of feeling pretty good, I found out yesterday my lambda is creeping up again, now at 900, which is sending me right back into anxious-land.

At which point do increases become an issue? Is it when there's kidney involvement? Or?

Thanks, I appreciate any insight.

[JBarnes]

Re: When do free light chain increases become an issue?

by JBarnes on Tue Dec 23, 2014 1:26 am

Never heard of numbers that high. You sure you are reading the blood tests correctly? 900 is way too high. What's the rest of your blood tests show? Can you copy your latest blood tests results in here so we can see them?

[Ian]

Re: When do free light chain increases become an issue?

by Ian on Tue Dec 23, 2014 2:01 am

A couple of things.

First, what are the units for your test results? Different countries use different units, and even within a country, the units can be different between testing laboratories.

Second, are you sure you are looking at results for your FREE light chain numbers, rather than TOTAL light chain numbers? There's a difference. It's the free light chain numbers that matter when tracking multiple myeloma.

Finally, are these results from blood (serum) or urine testing?

You can find a lot of discussions here in the forum about light chain levels and ratios and their meaning by searching from the forum search box on keywords like "kappa", "lambda", "light", or "FLC". It's best to use just a single keyword at a time, though.

[Ian]

Re: When do free light chain increases become an issue?

by Ian on Tue Dec 23, 2014 2:04 am

Also, for what it's worth, here are the normal (reference) ranges for the serum free light chain test:

Kappa free light chain level 3.3 - 19.4 mg/L
Lambda free light chain level 5.7 - 26.3 mg/L
Kappa/lambda ratio (without renal impairment) 0.26 - 1.65
Kappa/lambda ratio (with renal impairment) 0.37 - 3.1

http://labmed.ascpjournals.org/content/40/6/363/T1.expansion.html

[jet]

Re: When do free light chain increases become an issue?

by jet on Tue Dec 23, 2014 3:54 am

Hi Jerry

I'm in New Zealand. Maybe the measure is different?

10th December my bloodtest said :

Free light chains - lambda 905.1 mg/L (5.7-26.3) H
Free light chains - kappa 1.0 mg/L (3.3-19.4) L
Free light chains - k/l ratio <0.01

[jet]

Re: When do free light chain increases become an issue?

by jet on Tue Dec 23, 2014 4:08 am

Hi Ian,

Thanks for that. Its all very confusing. I have posted exactly what my blood test said in reply to JBarnes. Yes, it's FREE light chains and serum (blood).

At my last follow up appointment, my haemotologist said they are checking my monthly bloods and contacting me if there's any cause for concern.

[Melanie]

Re: When do free light chain increases become an issue?

by Melanie on Tue Dec 23, 2014 8:39 am

My husband's free lambda light chains at diagnosis were 7700, so I have no doubt in my mind that Jet is the test correctly. The concern with light chains that high is that they can interfere with kidney function. My husband's oncologist was amazed that my husband's kidney function had not been affected, therefore she worked very hard to get those numbers down quickly.

[Multibilly]

Re: When do free light chain increases become an issue?

by Multibilly on Tue Dec 23, 2014 9:53 am

Jet,

Your latest numbers indicate an involved/uninvolved free light chain ratio of 905 That's quite a high ratio and a Lambda FLC value of 905 mg/L is also quite high just by itself. I'm not a doc, but I would think that you would want to seriously discuss with your doc the idea of reinstating some sort of treatment to bring it under control prior to it causing any end-organ issues like kidney damage.

Do you know your creatinine levels over this period of time?

What has your M-Spike been doing over this same period of time? (or is your multiple myeloma light-chain restricted and you have no M-spike?)

[Ron Harvot]

Re: When do free light chain increases become an issue?

by Ron Harvot on Tue Dec 23, 2014 11:08 am

Based on the new diagnostic standards you have active multiple myeloma and should be modifying your treatment.

Here are the new standards:

Updated Definition of Multiple Myeloma

The revised IMWG criteria will allow, in addition to the classic CRAB features, the following three markers as “myeloma defining events” (MDEs).

1. Sixty percent or greater clonal plasma cells on bone marrow examination
    
2. Serum involved / uninvolved free light chain ratio of 100 or greater, provided the absolute level of the involved free light chain is at least 100 mg/L (a patient’s “involved” free light chain – either kappa or lambda – is the one that is above the normal reference range; the uninvolved light chain is the one that typically is in, or below, the normal range)
    
3. More than one focal lesion on MRI that is at least 5 multiple myeloma or greater in size.

The presence of at least one of these markers will be considered sufficient for a diagnosis of multiple myeloma, regardless of the presence or absence of symptoms or CRAB features. Each of these markers has been shown in two or more independent studies to be associated with an approximately 80 percent or higher risk of developing myeloma-related organ damage within two years."

Meeting any of these three or meeting the older CRAB markers alone means your multiple myeloma is active.

(Quote from S Vincent Rajkumar, "New Criteria For The Diagnosis Of Multiple Myeloma And Related Disorders," The Myeloma Beacon, Oct 26, 2014.)

In your case you have a ratio of 905 and the tipping point is 100, so your numbers are well over the tipping point.

Sorry but based on your sFLC the multiple myeloma is active. it would appear that your treatment needs to be modified to get your numbers down. The goal would be to get them down to the normal range.

[Multibilly]

Re: When do free light chain increases become an issue?

by Multibilly on Tue Dec 23, 2014 11:44 am

Hey Ron,

I was considering mentioning the new MDE definitions and specifically the one your referenced. But I wasn't clear if these new criteria pertained to previously treated multiple myeloma patients or not, or just for NDMM patients? I would tend to think that they would apply to all multiple myeloma patients under all circumstances, as you imply.