[Anonymous]

Free light chain ratio increased a lot the last month

by Anonymous on Tue Nov 26, 2013 11:54 am

Hello everybody.

My FLC ratio was 1.4 . During the last 4 weeks it increased continuously. I had to make every week the test to follow the changes.

First week the ratio became 2.08, second week 7, third week 8, and now 8.15 . I am out of treatment about 4 months and just a month before SCT. I did a bone marrow biopsy and the doctors have done and MRD assessment previous week. They say that I am in CR according to the histology and the flow cytometry with 4 colours. They did an 8 colour flow cytometry and they found a minimal residual disease of 0.1%.

Can the residual disease cause the ratio to increase? During that time the sFLC kappa is stable, which is the one that I follow the myeloma. The increase of the ratio is due to suppression of the lambda. Otherwise the kappa is always in the normal levels.

Thank you a lot. Any help is welcome.

Best regards,

Peter

[Wayne K]

Re: Free light chain ratio increased a lot the last month

by Wayne K on Tue Nov 26, 2013 11:57 am

Possibly they believe your light chains are coming from another source. As I understand it an increase in a light chain and the subsequent increase in ratio is not an indication of multiple myeloma by itself.

[Anonymous]

Re: Free light chain ratio increased a lot the last month

by Anonymous on Tue Nov 26, 2013 12:09 pm

Thank you very much for your answer Wayne. I really appreciate it. They don't know why it's happening, but when I searched about this topic on the net, everywhere I see that an FLC ratio increase, is associated with multiple myeloma progression.

Best regards
Peter

[Dr. Edward Libby]

Re: Free light chain ratio increased a lot the last month

by Dr. Edward Libby on Tue Nov 26, 2013 9:34 pm

Hello Peter,
A couple of possible explanations.
1. The ratio has two components kappa and lambda.....the production of both lambda and kappa free light chains is responsive to administration of chemotherapy. So even if you have a kappa light chain myeloma and the free kappa light chains normalize the free lambda light chains may fall as well. Sometimes the lambdas may fall below the normal range from treatment. Because the lambdas are in the denominator of the ratio this can make the ratio climb to abnormal levels.

2. If you have a lambda light chain myeloma the lambda free light chains will fall rapidly (usually) and outpace the normal kappas. As in the earlier scenario...if the lambdas have fallen and sometimes even into the "low" range this can make the ratio climb (because lambda is in the denominator of the ratio) into the abnormal elevated range even if you are in a remission.

If your lambda free light chains are low that is why the ratio may be "falsely" elevated.

[Niki]

Re: Free light chain ratio increased a lot the last month

by Niki on Tue Nov 26, 2013 10:00 pm

I am also interested in this topic.

Is there not a chance that the increase of the FLC ratio can be due to the residual myeloma cells that Peter talked about?

Also he told that he is out of treatment about 4 months. The increase cannot mean that the myeloma starts to be active again?

Thank you

Regards

Niki

[dnalex]

Re: Free light chain ratio increased a lot the last month

by dnalex on Wed Nov 27, 2013 5:12 pm

It looks to me that the FLC ratio is artificially inflated because you are having a drop in free lambdas, out of normal range, as opposed to an increase in either kappa or lambda. In conjunction with the other tests, I would think that it's not myeloma activating, or free light chain being produced anywhere else.

This is the reason when we look at FLCs we look at both numbers and ratios to get a clearer pic of what's going on.

Good luck with your SCT!

[Anonymous]

Re: Free light chain ratio increased a lot the last month

by Anonymous on Sat Nov 30, 2013 5:21 pm

thank you very much for your answers. I really appreciate it.