I was diagnosed with standard risk multiple myeloma last July. I am 61 years old. Completed induction last fall with Revlimid and dexamethasone and then had an ASCT [autologous stem cell transplant] in February. I am IgA, and lambda in regard to free light chain. My free light chain ratio is below "normal" level (although I haven't had a FreeLite test in a number of months).
My question: Do most multiple myeloma folks have FLC ratios that are "out of normal range", or is this an exception? Does treatment benefit both our "heavy chain' numbers and our light chain numbers? Do folks like me who have below normal FLC numbers at diagnosis have poorer "prognoses" than those who have multiple myeloma but who have FLC in the normal range?
My Bence Jones proteins are in normal range - it is my kappa/lambda ratio that is "low.
In sum, while I think I have a handle on the "heavy chain" IgA situation, I am still confused about FLC as it relates to treatment and prognosis. Is the fact that I have both elevated IgA and a low FLC ratio unusual? Does it change the questions I need to ask at my upcoming 100 day follow up to my ASCT?
The complexity of this disease is incredible!
Thanks
Wesley
Forums
3 posts
• Page 1 of 1
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wesley - Who do you know with myeloma?: me
- When were you/they diagnosed?: July, 2013
- Age at diagnosis: 60
Re: Free light chain ratio - some basic questions
Dear Wesley,
To answer your questions:
1) Yes, most but not all active [symptomatic] multiple myeloma patients have an abnormal free light chain ratio at diagnosis. An abnormal FLC ratio at diagnosis does have prognostic importance in MGUS and smoldering myeloma, predicting for shorter time to progression to active myeloma. However, for patients who already have active myeloma, the baseline FLC ratio has not been shown to have a significant prognostic impact, and factors such as cytogenetics or ISS stage are much more important.
2) Treatment does benefit both heavy chain and light chain numbers, though the ratio can remain abnormal for some time, especially after a transplant, as it can take some time for the "uninvolved" light chain levels (in your case, the kappa levels) to recover.
3) If the FLC levels and ratio do eventually normalize after treatment, and all the other testing for residual myeloma is negative (i.e. SPEP, UPEP, serum and urine immunofixations, and bone marrow biopsy), then we call this a stringent complete remission (sCR). Achieving a sCR has been associated with longer time in remission compared with just a standard CR in some studies (e.g. Kapoor et al, Journal of Clinical Oncology, Dec. 2013; also, related Beacon news article), so this is a good milestone to achieve, and worth asking your oncologist about at your day 100 visit.
Hope this helps.
To answer your questions:
1) Yes, most but not all active [symptomatic] multiple myeloma patients have an abnormal free light chain ratio at diagnosis. An abnormal FLC ratio at diagnosis does have prognostic importance in MGUS and smoldering myeloma, predicting for shorter time to progression to active myeloma. However, for patients who already have active myeloma, the baseline FLC ratio has not been shown to have a significant prognostic impact, and factors such as cytogenetics or ISS stage are much more important.
2) Treatment does benefit both heavy chain and light chain numbers, though the ratio can remain abnormal for some time, especially after a transplant, as it can take some time for the "uninvolved" light chain levels (in your case, the kappa levels) to recover.
3) If the FLC levels and ratio do eventually normalize after treatment, and all the other testing for residual myeloma is negative (i.e. SPEP, UPEP, serum and urine immunofixations, and bone marrow biopsy), then we call this a stringent complete remission (sCR). Achieving a sCR has been associated with longer time in remission compared with just a standard CR in some studies (e.g. Kapoor et al, Journal of Clinical Oncology, Dec. 2013; also, related Beacon news article), so this is a good milestone to achieve, and worth asking your oncologist about at your day 100 visit.
Hope this helps.
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Dr. Adam Cohen - Name: Adam D. Cohen, M.D.
Beacon Medical Advisor
Re: Free light chain ratio - some basic questions
Many thanks to Dr. Adam Cohen and the many medical professionals who give unselfishly of their time to support the Beacon and Beacon forum! I am grateful for the clear and direct response Dr. Cohen provided to my questions about free light chains!
Wesley
Wesley
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wesley - Who do you know with myeloma?: me
- When were you/they diagnosed?: July, 2013
- Age at diagnosis: 60
3 posts
• Page 1 of 1