This is my first post and I hope to learn from the experiences of others and contribute something worthwhile if possible.
I'm 67 years old and just received the results of my serum free light chain test. They're not good.
Free kappa light chains 699.1 mg/L HIGH
Free lambda light chains 4.2 mg/L
Kappa/lambda ratio 166.45 HIGH
Next week I'm scheduled for a bone marrow biopsy and have already had a bone scan, but am not sure how to interpret the bone scan results.
If anyone has any thoughts on these figures I'd certainly appreciate some input.
Thanks in advance!
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7 posts
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Robert33 - Name: Robert33
- Who do you know with myeloma?: Probably me.
- When were you/they diagnosed?: Lab results 4/13/2017
- Age at diagnosis: 67
Re: High kappa free light chain level & kappa-lambda ratio
Hi Robert,
Welcome to the forum, but sorry that you find yourself with out-of-whack free light chain numbers. These are fairly high kappa and free light chain ratio values and could very well suggest a disease such as multiple myeloma, smoldering multiple myeloma, or a related monoclonal gammopathy. But one really needs to know the results of other tests to make this call.
What caused your doctor to run these tests in the first place?
What did your other blood tests reveal? Specifically:
1. What was your M-spike (aka abnormal protein, paraprotein, m-protein, etc) from your serum electrophoresis test?
2. What did your serum immunofixation test say?
3. What were your calcium, hemoglobin, and creatinine levels from your CBC and metabolic panels?
It's important to understand all of the above values, not just your free light chain numbers.
Also, what kind of "bone scan" did you have (x-ray, PET/CT, MRI, etc)? Why don't you post the summary from the radiology report if you have questions on the results?
Note that bone marrow biopsy reports are very difficult for a layman to interpret and it is best that you walk through the report page-by- page with your doctor while taking notes. When going over the report, you are going to want to know what your bone marrow plasma cell percentage is, as well as any deleterious cytogenetics (i.e. genetic mutations such as "del 17p") that might impact your prognosis and treatment plan.
Welcome to the forum, but sorry that you find yourself with out-of-whack free light chain numbers. These are fairly high kappa and free light chain ratio values and could very well suggest a disease such as multiple myeloma, smoldering multiple myeloma, or a related monoclonal gammopathy. But one really needs to know the results of other tests to make this call.
What caused your doctor to run these tests in the first place?
What did your other blood tests reveal? Specifically:
1. What was your M-spike (aka abnormal protein, paraprotein, m-protein, etc) from your serum electrophoresis test?
2. What did your serum immunofixation test say?
3. What were your calcium, hemoglobin, and creatinine levels from your CBC and metabolic panels?
It's important to understand all of the above values, not just your free light chain numbers.
Also, what kind of "bone scan" did you have (x-ray, PET/CT, MRI, etc)? Why don't you post the summary from the radiology report if you have questions on the results?
Note that bone marrow biopsy reports are very difficult for a layman to interpret and it is best that you walk through the report page-by- page with your doctor while taking notes. When going over the report, you are going to want to know what your bone marrow plasma cell percentage is, as well as any deleterious cytogenetics (i.e. genetic mutations such as "del 17p") that might impact your prognosis and treatment plan.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: High kappa free light chain level & kappa-lambda ratio
Hi Multibilly,
Thanks for your response – I certainly do appreciate it.
It appears my M-spike is 1.5 g/dl, my hemoglobin is 13.2 g/dl, and my creatinine level is 139. I requested the VA send my serum immunofixation and calcium level, but the only response was to re-send the results I already have. I don't understand what every abbreviation in the cumulative lab report means, so those levels could very well be right in front of me. It's a lot of information to absorb, even for a technically oriented person such as myself.
As for the skeletal survey, it was done by x-ray and I'll quote the report given to me.
Bones:
Chronic fracture deformities of the right lower lateral ribs. No fracture or dislocation. No osteolytic or osteoblastic lesions identified. Multilevel degenerative disc disease throughout the cervical, thoracic, and upper lumbar spine. Lower lumbar spine facet arthropathy. Vertebral body heights are maintained. Bilateral AC joint degenerative changes. Mild degenerative changes in the bilateral hips. Cardiomediastinal silhouette is normal. Costophrenic angles are sharp. Heavily calcified aortic arch. Prominent central vascula effusion. Lungs are clear without focal airspace disease, effusion, or pneumothorax.
Abdomen:
No free intraperitoneal air on the upright film. Bowel gas pattern is normal without evidence of obstruction. Significant atherosclerotic disease in the abdominal aorta. No definite radiopaque renal calculi.
Impression:
1. No osteolytic or osteoblastic lesion identified.
That's pretty much the information I have right now. As to the skeletal survey, I think I understand the degenerative disease, considering my age. But I am concerned about my aorta.
Thank you for your encouragement, and I hope you're doing well.
Thanks for your response – I certainly do appreciate it.
It appears my M-spike is 1.5 g/dl, my hemoglobin is 13.2 g/dl, and my creatinine level is 139. I requested the VA send my serum immunofixation and calcium level, but the only response was to re-send the results I already have. I don't understand what every abbreviation in the cumulative lab report means, so those levels could very well be right in front of me. It's a lot of information to absorb, even for a technically oriented person such as myself.
As for the skeletal survey, it was done by x-ray and I'll quote the report given to me.
Bones:
Chronic fracture deformities of the right lower lateral ribs. No fracture or dislocation. No osteolytic or osteoblastic lesions identified. Multilevel degenerative disc disease throughout the cervical, thoracic, and upper lumbar spine. Lower lumbar spine facet arthropathy. Vertebral body heights are maintained. Bilateral AC joint degenerative changes. Mild degenerative changes in the bilateral hips. Cardiomediastinal silhouette is normal. Costophrenic angles are sharp. Heavily calcified aortic arch. Prominent central vascula effusion. Lungs are clear without focal airspace disease, effusion, or pneumothorax.
Abdomen:
No free intraperitoneal air on the upright film. Bowel gas pattern is normal without evidence of obstruction. Significant atherosclerotic disease in the abdominal aorta. No definite radiopaque renal calculi.
Impression:
1. No osteolytic or osteoblastic lesion identified.
That's pretty much the information I have right now. As to the skeletal survey, I think I understand the degenerative disease, considering my age. But I am concerned about my aorta.
Thank you for your encouragement, and I hope you're doing well.
-
Robert33 - Name: Robert33
- Who do you know with myeloma?: Probably me.
- When were you/they diagnosed?: Lab results 4/13/2017
- Age at diagnosis: 67
Re: High kappa free light chain level & kappa-lambda ratio
Hey Robert,
When evaluating a patient for suspected multiple myeloma, one looks to see if they meet any of the CRAB crtieria (hypercalcemia, renal impairment, anemia or bone damage) to determine if they are symptomatic or not.
I should have asked that you also include any reference ranges for your lab values, but your hemoglobin and creatinine levels appear to be at reasonable levels and don't meet any of the CRAB thresholds. This largely rules out the "A" and "R" in the CRAB criteria.
The key takeaway from your skeletal survey is that you have no osteolytic lesions. This largely rules out the "B" in the CRAB criteria. However, the recommendation by the International Myeloma Working Group (IMWG) is that newly diagnosed patients be screened with more accurate PET/CT scans or whole-body MRIs. So, you might want to discuss this with your doctor the next time you see him/her.
If you have your creatinine level results, you likely also have your calcium results. But it may be called "Ca" or something like that and will appear on the same lab report as your creatinine level.
Your M-spike is also not that high and could be in line with something like a smoldering multiple myeloma diagnosis.
However, you do have a high free light chain (FLC) ratio and a high kappa FLC number. Technically, the kappa FLC and FLC ratio taken together represent a "myeloma defining event" (MDE) and would peg you with a multiple myeloma diagnosis, depending on what the bone marrow biopsy reveals. See this article to better understand MDEs.
SV Rajkumar, "New Criteria For The Diagnosis Of Multiple Myeloma And Related Disorders," The Myeloma Beacon, Oct 26, 2014.
The key thing about MDEs is that not all multiple myeloma specialists will automatically suggest treating a patient with an MDE in the absence of meeting any of the CRAB criteria. This is where it pays to get a second opinion from a myeloma specialist before initiating any treatment.
Your bone marrow biopsy results will provide more insight as to what is going on with you and will indicate if you truly have multiple myeloma or some other sort of monoclonal gammopathy.
Lastly, since you have abnormal aorta findings on your x-ray, I would make sure that the doctor also runs a "Congo red stain test" as part of the bone marrow biopsy workup to help rule out amyloidosis.
Good luck and let us know how things turn out.
When evaluating a patient for suspected multiple myeloma, one looks to see if they meet any of the CRAB crtieria (hypercalcemia, renal impairment, anemia or bone damage) to determine if they are symptomatic or not.
I should have asked that you also include any reference ranges for your lab values, but your hemoglobin and creatinine levels appear to be at reasonable levels and don't meet any of the CRAB thresholds. This largely rules out the "A" and "R" in the CRAB criteria.
The key takeaway from your skeletal survey is that you have no osteolytic lesions. This largely rules out the "B" in the CRAB criteria. However, the recommendation by the International Myeloma Working Group (IMWG) is that newly diagnosed patients be screened with more accurate PET/CT scans or whole-body MRIs. So, you might want to discuss this with your doctor the next time you see him/her.
If you have your creatinine level results, you likely also have your calcium results. But it may be called "Ca" or something like that and will appear on the same lab report as your creatinine level.
Your M-spike is also not that high and could be in line with something like a smoldering multiple myeloma diagnosis.
However, you do have a high free light chain (FLC) ratio and a high kappa FLC number. Technically, the kappa FLC and FLC ratio taken together represent a "myeloma defining event" (MDE) and would peg you with a multiple myeloma diagnosis, depending on what the bone marrow biopsy reveals. See this article to better understand MDEs.
SV Rajkumar, "New Criteria For The Diagnosis Of Multiple Myeloma And Related Disorders," The Myeloma Beacon, Oct 26, 2014.
The key thing about MDEs is that not all multiple myeloma specialists will automatically suggest treating a patient with an MDE in the absence of meeting any of the CRAB criteria. This is where it pays to get a second opinion from a myeloma specialist before initiating any treatment.
Your bone marrow biopsy results will provide more insight as to what is going on with you and will indicate if you truly have multiple myeloma or some other sort of monoclonal gammopathy.
Lastly, since you have abnormal aorta findings on your x-ray, I would make sure that the doctor also runs a "Congo red stain test" as part of the bone marrow biopsy workup to help rule out amyloidosis.
Good luck and let us know how things turn out.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: High kappa free light chain level & kappa-lambda ratio
Hey Multibilly,
I should have mentioned that my initial lab work was part of the annual workup given all veterans enrolled in the VA health care system. I was experiencing no pain or other symptoms. The recent follow-up was due to the M-spike.
I found the Ca value, which I should have noticed earlier. It's 9.0 mg/dL and the range is 8.5 to 10.1.
Getting a second opinion could be difficult because I'm limited to using the VA system; due to financial constraints I have no other option. But I'll try.
When I have a chance I can send you ranges for the figures I previously gave you, and I'll review your posts so I can write down the tests you recommend and pass them on to my oncologist.
Again, thank you.
I should have mentioned that my initial lab work was part of the annual workup given all veterans enrolled in the VA health care system. I was experiencing no pain or other symptoms. The recent follow-up was due to the M-spike.
I found the Ca value, which I should have noticed earlier. It's 9.0 mg/dL and the range is 8.5 to 10.1.
Getting a second opinion could be difficult because I'm limited to using the VA system; due to financial constraints I have no other option. But I'll try.
When I have a chance I can send you ranges for the figures I previously gave you, and I'll review your posts so I can write down the tests you recommend and pass them on to my oncologist.
Again, thank you.
-
Robert33 - Name: Robert33
- Who do you know with myeloma?: Probably me.
- When were you/they diagnosed?: Lab results 4/13/2017
- Age at diagnosis: 67
Re: High kappa free light chain level & kappa-lambda ratio
Your calcium level looks good, so that's good news as well. I'm not a doc, but it doesn't seem like you meet any of the CRAB criteria.
Since you are in the VA system and are 67, were you exposed to agent orange during military service in Vietnam? If so, the VA system would potentially fully cover your myeloma treatment and provide disability compensation.
Since you are in the VA system and are 67, were you exposed to agent orange during military service in Vietnam? If so, the VA system would potentially fully cover your myeloma treatment and provide disability compensation.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: High kappa free light chain level & kappa-lambda ratio
I could have been exposed to a very small quantity of dioxin when I was stationed in Thailand during the war, but since I was not assigned to the base perimeter or exhibited any symptoms of exposure within the required amount of time after exposure, there is no option for filing a claim. I really don't think that's a factor.
I was exposed to lead fumes when I worked at a foundry in 1977 before OSHA shut the place down, but I've never been tested for heavy metals or exhibited any symptoms of lead poisoning.
My mother died of pancreatic cancer three years ago and her sister of blood cancer last month, so heredity could be a factor contributing to my current condition.
I was exposed to lead fumes when I worked at a foundry in 1977 before OSHA shut the place down, but I've never been tested for heavy metals or exhibited any symptoms of lead poisoning.
My mother died of pancreatic cancer three years ago and her sister of blood cancer last month, so heredity could be a factor contributing to my current condition.
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Robert33 - Name: Robert33
- Who do you know with myeloma?: Probably me.
- When were you/they diagnosed?: Lab results 4/13/2017
- Age at diagnosis: 67
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