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Elevated kappa FLC & kappa-lambda FLC ratio - meaning?

by Christina on Wed Jan 14, 2015 2:12 pm

Just got my new labs. M protein is the same at 0.4 g/dL.

But I haven't had a kappa light chain in a while, so I was surprised

Kappa 788.24 mg/l
Lambda 15.26 mg/l
Kappa / lambda 51.65

What does this mean? I'm sure my doctor has the results from before, but that would be maybe 6 months ago. He doesn't normally do the light chain tests.

Any ideas, since these are way out of range (not the lambda ).

Thanks

Christina
Name: Christina
When were you/they diagnosed?: June2005
Age at diagnosis: 52

Re: Elevated kappa FLC & kappa-lambda FLC ratio - meaning?

by blustein on Wed Jan 14, 2015 2:19 pm

All I can say is my lab results had the same results last week. When I saw the m-spike was stable, I figured everything was fine. Then my myeloma doctor said that the kappa light chains had increased significantly and I need to get on new drugs ASAP. He said I could not use the m-spike anymore to measure the myeloma.

blustein
Name: Richard Blustein
Who do you know with myeloma?: Self
When were you/they diagnosed?: July 2009
Age at diagnosis: 58

Re: Elevated kappa FLC & kappa-lambda FLC ratio - meaning?

by Multibilly on Wed Jan 14, 2015 2:45 pm

Christina,

Serum free light chain values "can" sometimes be a leading indicator of a change in your monoclonal activity, or it can be the only indicator of a change in one's condition. What were your free light values from your last test?

I'm not a doc and you should never look at just one lab value without considering all the other lab values. Suggest you follow up with your doc on what he/she thinks.

Multibilly
Name: Multibilly
Who do you know with myeloma?: Me
When were you/they diagnosed?: Smoldering, Nov, 2012

Re: Elevated kappa FLC & kappa-lambda FLC ratio - meaning?

by Christina on Wed Jan 14, 2015 3:45 pm

I don't get the free light chain test done often, I'll have to check my records. But I have had a tooth infection for a while. Also, I've been on Revlimid now 20 cycles, and my m protein stays within the 0.2 - 0.4 g/dL range.

I am a bit baffled by this. Does this mean I need to change drugs? I guess I'll know soon enough.

Christina
Name: Christina
When were you/they diagnosed?: June2005
Age at diagnosis: 52

Re: Elevated kappa FLC & kappa-lambda FLC ratio - meaning?

by Multibilly on Wed Jan 14, 2015 4:04 pm

Christina,

You've got a couple of things going on here. Revlimid can sometimes cause liver inflammation, which can in turn raise your FLCs. So can an infection. Best that you consult with your doc.

Hope that helps a bit.

Multibilly
Name: Multibilly
Who do you know with myeloma?: Me
When were you/they diagnosed?: Smoldering, Nov, 2012

Re: Elevated kappa FLC & kappa-lambda FLC ratio - meaning?

by Christina on Wed Jan 14, 2015 11:57 pm

Okay, so after some responses to my earlier post (thank you those that responded), here is where I am at.

My m-protein is stable at 0.4, I have no other symptoms, blood work good.

With this kappa being at 788, lambda at 15, and kappa-lambda ratio at 51, do I start a new treatment plan?

I'm currently on Revlimid 25 mg, dex 16 mg weekly.

Of course, I realize this is a medical question, and I'm not looking for a medical answer. I just so happen to see my doctor tomorrow, but I'm after OPINIONS of others.

I would ask, should I add Velcade to the mix?

Christina
Name: Christina
When were you/they diagnosed?: June2005
Age at diagnosis: 52

Re: Elevated kappa FLC & kappa-lambda FLC ratio - meaning?

by blair77 on Thu Jan 15, 2015 1:05 am

I have read that when the involved free light chain is elevated to over 100 that treatment should be restarted. As you are already on treatment, adding a third drug might be a good idea. However, without CRAB symptoms, your doctor might tell you to wait.

blair77
Who do you know with myeloma?: My husband
When were you/they diagnosed?: April 2013
Age at diagnosis: 43

Re: Elevated kappa FLC & kappa-lambda FLC ratio - meaning?

by K_Shash on Thu Jan 15, 2015 6:15 pm

Hello Christina,

I just completed my first 4-week cycle on RVD (Revlimid, Velcade and dex). My lab work after the first cycle showed that my kappa free light chain level dropped from the mid December high of 1,070 (rose from 854 in late November) by almost 90%.

I had researched a fair bit about this subject before my chemotherapy started, and even my oncologist was in favor of the RVD rather that the 2-drug combo.

Please refer to PeggyB's experience in her Introductory post in the thread "How did you decide whether to have a SCT or not?" (started Dec 31, 2014). There are some posts that have seen good results with Velcade or Revlimid, but many others had to go to the RVD route after some 'trial and error'.

K_Shash

K_Shash
Name: K_Shash
Who do you know with myeloma?: Self
When were you/they diagnosed?: November 2014
Age at diagnosis: 67

Re: Elevated kappa FLC & kappa-lambda FLC ratio - meaning?

by Christina on Wed Feb 11, 2015 11:34 am

So, all the tests are in, including the BMB.

Overall, it looks good. IgG test normal. 24-hour urine normal (surprised at that). X-rays show lytic lesions, but nothing new and alarming from 2 years ago, so good. I have no pain anywhere, so that's good!

The biopsy shows 6.8 plasma cells, which is a little higher than what it was 5 years ago.

There are higher kappa light chains, but only mildly so, says the pathologist.

So, why did my kappa light chains last month come back at 788??

I see my doctor tomorrow but I'd like anyone's 2 cents on this. I'm pleased, of course, but also con­fused. I will ask for a new SPEP test and the light chain (is that the immunoflxation?). Not sure is that the right test?

But if anyone sees something here let me know.

Otherwise, it sounds like he's going to keep me on Revlimid / dex. I'm going to ask for the dex to go down to 12 mg.

Christina
Name: Christina
When were you/they diagnosed?: June2005
Age at diagnosis: 52

Re: Elevated kappa FLC & kappa-lambda FLC ratio - meaning?

by Cheryl G on Wed Feb 11, 2015 12:24 pm

Hi Christina,

Glad your latest results look as good as they do.

This may help clear things up a bit. When you reported these results at the beginning of this thread,

Kappa 788.24 mg/l
Lambda 15.26 mg/l
Kappa / lambda 51.65

were those results from a blood test or a urine test?

Also, was the test looking at FREE light chains, or TOTAL light chains?

Separately, in the new lab work you had done, did they test the calcium, hemoglobin, and creatinine levels in your blood? If so, how did those results compare to previous ones that you have?

Cheryl G

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