This is what I look like.
November 2014
Routine electrophoresis and immunofixation studies identify an IgA Lambda monclonal protein
spike (1.00 g/dl) within the gamma region
A second IgA Lambda spike is also noted within the gamma region at levels too low to quantitate (gamma + spike #2 = 0.50 g/dl).
IgA serum 68-359 mg/dL 1870 high
IgG serum 681-1513 mg/dL 655 low
IgM serum 31-257 mg/dL 43 normal
April 29th 2015
M-spike 1.3
IGA 2050 H
IGG 658 L
IGM 50 Normal
Kappa, Lambda Free Light Chains (FLCs) w Ratio, Serum
Kappa FLC 7.6 Range 3.3-19.4 mg/l
Lambda FLC 58.5*H Range 5.7-26.3 mg/l
Kappa/Lambda Ratio 0.13*L Range 0.26-1.65 ratio
May 14th 2015
Kappa, Lambda Free Light Chains (FLCs) w Ratio, Serum
Kappa FLC 8.4 Range 3.3-19.4 mg/l
Lambda FLC 60.28*H Range 5.7-26.3 mg/l
Kappa/Lambda Ratio 0.14*L Range 0.26-1.65 ratio
My hematocrit goes up and down at just over normal and my lymphocytes has increased from 36%-45.20% but, other than that, all other blood work is normal.
My main question is on my free light chains. Are these numbers high by a lot or just a little?
Bone marrow biopsy (BMB) done and will have those back on Tuesday (waiting is driving me nuts), but on that I did show having a "dry tap" when they were trying to get a sample (as posted in previous post)
Any insight would be helpful.
Forums
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Re: Are my free light chain numbers high?
Your involved / uninvolved FLC ratio (lambda / kappa) would be ~7.3. If your BMB shows you are smoldering, then this ratio would put you in the "non-high" risk-of-progression category. For smoldering patients, an FLC ratio > 8 and a bone marrow plasma % > 10 is now considered to be "high risk", at least in the eyes of the folks who wrote the article referenced in this thread:
"Review article - smoldering multiple myeloma" (started May 27, 2015)
Note that the authors of the above article reference the paper below when they state that "the risk of progression associated with an abnormal FLC ratio is a continuum":
A Dispenzieri et al, "Immunoglobulin free light chain ratio is an independent risk factor for progression of smoldering (asymptomatic) multiple myeloma," Blood, Jan 2008 (full text of article)
I think my own specialist would still refer to my FLC ratio of 20 as "fairly low", but different doctors and groups clearly have different interpretations of what is now considered to be an FLC ratio that might signal a high risk of progression. And remember that when looking at what your disease is doing, you can't just look at the FLC numbers, but you also need to consider all the other key markers as well.
Good luck on your BMB results. Make sure to ask your doc lots of questions about the BMB report and go through it page by page since those reports are a real bear to try to interpret on you own.
"Review article - smoldering multiple myeloma" (started May 27, 2015)
Note that the authors of the above article reference the paper below when they state that "the risk of progression associated with an abnormal FLC ratio is a continuum":
A Dispenzieri et al, "Immunoglobulin free light chain ratio is an independent risk factor for progression of smoldering (asymptomatic) multiple myeloma," Blood, Jan 2008 (full text of article)
I think my own specialist would still refer to my FLC ratio of 20 as "fairly low", but different doctors and groups clearly have different interpretations of what is now considered to be an FLC ratio that might signal a high risk of progression. And remember that when looking at what your disease is doing, you can't just look at the FLC numbers, but you also need to consider all the other key markers as well.
Good luck on your BMB results. Make sure to ask your doc lots of questions about the BMB report and go through it page by page since those reports are a real bear to try to interpret on you own.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Are my free light chain numbers high?
Thanks Multibilly for the reply. But I have a question:
How did you figure out my FLC ratio is 7.3? I have tried reading on this and it is just not making sense to me. Can you show me a break down on how to get that ratio?
Thank you!
How did you figure out my FLC ratio is 7.3? I have tried reading on this and it is just not making sense to me. Can you show me a break down on how to get that ratio?
Thank you!
Re: Are my free light chain numbers high?
Your involved / uninvolved FLC ratio (lambda / kappa) = 60.28 / 8.4 = 7.3. What is reported on your lab report is the standard FLC lab ratio of the inverse of this number. Kappa / lambda (0.14 in your case) is always used in lab reports, regardless of the type of multiple myeloma that one might have.
The reason YOU need to use the inverse of the reported lab number is because the "involved" free light chain (the one that is high and being produced in excess by your abnormal plasma cells) happens to be the lambda number. Other people may have kappa-involved multiple myeloma and they can just use the ratio straight off the lab report. But you have to flip the reported FLC lab ratio to get to the ratio that is used in most of the literature (involved / uninvolved).
This seems to really confuse a lot of people new to multiple myeloma, so you aren't alone.
The reason YOU need to use the inverse of the reported lab number is because the "involved" free light chain (the one that is high and being produced in excess by your abnormal plasma cells) happens to be the lambda number. Other people may have kappa-involved multiple myeloma and they can just use the ratio straight off the lab report. But you have to flip the reported FLC lab ratio to get to the ratio that is used in most of the literature (involved / uninvolved).
This seems to really confuse a lot of people new to multiple myeloma, so you aren't alone.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
4 posts
• Page 1 of 1