Hi,
I am new to this forum and was diagnosed with MGUS in 2003. I have peripheral neuropathy also, but the doctor wasn't sure if it was related.
I never paid much attention to test results until recently and can see levels are going up. Here are my latest results.
I never knew about kappa-lambda ratio until very recently and was wondering if these results are okay.
I am going back this week as the doctor said to have more blood work done in a month instead of six months.
All of my regular bloodwork is in range, except calcium ionized has been low.
IgG 489 mg/dL 635-741 mg/dL L
IgA 18 mg/dL 66-433 mg/dL L
IgM <20 mg/dL 45-281 mg/dL L
Kappa Free Lt Chn 1580.00 mg/L 3.30-19.40 mg/L H
Verified by repeat analysis
Lamda Free Lt Chn 5.42 mg/L 5.71-26.30 mg/L L
Kappa Lamda Ratio 291.51 0.26-1.65 H
Total Protein SPE 6.4 g/dL 6.4-8.5 g/dL
Albumin SPE 3.8 g/dL 3.5-5.0 g/dL
Alpha 1 0.3 g/dL 0.1-0.4 g/dL
Alpha 2 0.9 g/dL 0.3-1.0 g/dL
Beta 1.0 g/dL 0.6-1.2 g/dL
Gamma 0.4 g/dL 0.5-1.7 g/dL L
SPE Comment: Hypogammaglobulinemia
Monoclonal Protein 0.00 g/dL 0 g/dL
Immunofixation No M component seen
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8 posts
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annekb1111 - Name: Anne
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: May 2018
- Age at diagnosis: 57
Re: High kappa-lambda ratio: has my MGUS progressed?
Hi Anne,
Welcome to the forum.
You appear to have light chain MGUS since you have no m-component (also known as an "M-spike").
You have quite a high free light chain ratio (high enough to indicate that you have a "myeloma defining event").
You might want to read through this recent thread to Jessi for what this all means.
https://myelomabeacon.org/forum/lambda-free-light-chain-high-mgus-t9919.html
You also have what is known as "immunoparesis" (the suppression of one or more of your IgG, IgA, and IgM immunoglobulin levels). Have you been getting sick, such as developing colds frequently?
With the combination of a high free light chain ratio, peripheral neuropathy and immunoparesis, I would strongly encourage you to seek out a hematologist that specializes in myeloma (not just one that may have a few myeloma patients, but one whose specialty is exclusively myeloma and related monoclonal gammopathies).
If you let us know what city you are in, folks on this forum can make some recommendations for treatment centers in your area that have myeloma specialists.
Welcome to the forum.
You appear to have light chain MGUS since you have no m-component (also known as an "M-spike").
You have quite a high free light chain ratio (high enough to indicate that you have a "myeloma defining event").
You might want to read through this recent thread to Jessi for what this all means.
https://myelomabeacon.org/forum/lambda-free-light-chain-high-mgus-t9919.html
You also have what is known as "immunoparesis" (the suppression of one or more of your IgG, IgA, and IgM immunoglobulin levels). Have you been getting sick, such as developing colds frequently?
With the combination of a high free light chain ratio, peripheral neuropathy and immunoparesis, I would strongly encourage you to seek out a hematologist that specializes in myeloma (not just one that may have a few myeloma patients, but one whose specialty is exclusively myeloma and related monoclonal gammopathies).
If you let us know what city you are in, folks on this forum can make some recommendations for treatment centers in your area that have myeloma specialists.
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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-lambda ratio: has my MGUS progressed?
Hello Anne,
I was drafting my reply when I saw Multibilly's post. Multibilly has given you scholarly feedback and I am posting a few items from my own experience because mine is a very similar case (kappa light chain only myeloma), except my IgG was high and my blood tests showed kappa around 1,200 mg/L and kappa-lambda ratio around 200 in late 2014. My skeletal x-ray survey showed multiple lesions all over the bones, but they were faint, and my oncologist started the induction therapy only after my bone marrow biopsy showed 30% plasma cells.
The article discusses the various criteria and "thresholds" for MGUS, smoldering myeloma, and multiple diagnoses:
SV Rajkumar, "New Criteria For The Diagnosis Of Multiple Myeloma And Related Disorders," The Myeloma Beacon, Oct 26, 2014
I am not a doctor and my interest has been focused on my kappa light-chain multiple myeloma. I have no detectable M-spike, either. The Beacon has been a source of a wealth of information and advice that has helped me manage many of my side effects of my treatment. Your IgM is high and one of my old colleagues was recently diagnosed with and is being treated for Waldenstrom's. I really don't know much about either, but it is similar to the IgM myeloma. mSMART.org has a lot of guidelines on this topic, too.
Your oncologist/(s) has been following your MGUS since 2003 and has ordered more blood work after seeing these results. Also the note "Verified by repeat analysis" next to your kappa reading seems to indicate a sudden jump in your kappa. It would be interesting to compare these results with a couple of your most recent test. Of course, the results of this week's blood tests would help your oncologist decide on the next course of action.
I was drafting my reply when I saw Multibilly's post. Multibilly has given you scholarly feedback and I am posting a few items from my own experience because mine is a very similar case (kappa light chain only myeloma), except my IgG was high and my blood tests showed kappa around 1,200 mg/L and kappa-lambda ratio around 200 in late 2014. My skeletal x-ray survey showed multiple lesions all over the bones, but they were faint, and my oncologist started the induction therapy only after my bone marrow biopsy showed 30% plasma cells.
The article discusses the various criteria and "thresholds" for MGUS, smoldering myeloma, and multiple diagnoses:
SV Rajkumar, "New Criteria For The Diagnosis Of Multiple Myeloma And Related Disorders," The Myeloma Beacon, Oct 26, 2014
I am not a doctor and my interest has been focused on my kappa light-chain multiple myeloma. I have no detectable M-spike, either. The Beacon has been a source of a wealth of information and advice that has helped me manage many of my side effects of my treatment. Your IgM is high and one of my old colleagues was recently diagnosed with and is being treated for Waldenstrom's. I really don't know much about either, but it is similar to the IgM myeloma. mSMART.org has a lot of guidelines on this topic, too.
Your oncologist/(s) has been following your MGUS since 2003 and has ordered more blood work after seeing these results. Also the note "Verified by repeat analysis" next to your kappa reading seems to indicate a sudden jump in your kappa. It would be interesting to compare these results with a couple of your most recent test. Of course, the results of this week's blood tests would help your oncologist decide on the next course of action.
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K_Shash - Name: K_Shash
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: November 2014
- Age at diagnosis: 67
Re: High kappa-lambda ratio: has my MGUS progressed?
I agree with the posts so far that have indicated that your latest test results, particularly your free light chain levels, are a concern.
I am sure your doctors will want to re-do many of these tests, particularly the serum free light chain test, to confirm the results you've shared with us. It seems odd to me that your kappa free light chain level is as high as it is, given that your immunofixation test says that no monoclonal proteins were found. That's why I would not be surprised if some of the tests you've had will be repeated.
When was your previous serum free light chain test, and what did it show?
Also, have you been having your hemoglobin level tested and, if so, what sort of results have you gotten for your last several tests (please include dates and units with the test results)?
Good luck!
I am sure your doctors will want to re-do many of these tests, particularly the serum free light chain test, to confirm the results you've shared with us. It seems odd to me that your kappa free light chain level is as high as it is, given that your immunofixation test says that no monoclonal proteins were found. That's why I would not be surprised if some of the tests you've had will be repeated.
When was your previous serum free light chain test, and what did it show?
Also, have you been having your hemoglobin level tested and, if so, what sort of results have you gotten for your last several tests (please include dates and units with the test results)?
Good luck!
Re: High kappa-lambda ratio: has my MGUS progressed?
I just realized that Cheryl makes a very good point and I might have been in error regarding your "M-component" (i.e. monoclonal protein, whether it be monoclonal free light chains or monoclonal heavy chains such as monoclonal IgG, IgA or IgM).
Your immunofixaiton test should have registered an M-component even if you have no M-spike. Put another way, the serum immunofixation test should have picked up the fact that you have monoclonal free light chains even though you may not have any monoclonal protein as measured by your SPE test (i.e. you have no monoclonal IgG, IgA or IgM).
It is peculiar that you have a diagnosis of MGUS and a high kappa free light chain value, yet your immunofixation test did not pick up any M-component whatsoever.
Your immunofixaiton test should have registered an M-component even if you have no M-spike. Put another way, the serum immunofixation test should have picked up the fact that you have monoclonal free light chains even though you may not have any monoclonal protein as measured by your SPE test (i.e. you have no monoclonal IgG, IgA or IgM).
It is peculiar that you have a diagnosis of MGUS and a high kappa free light chain value, yet your immunofixation test did not pick up any M-component whatsoever.
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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-lambda ratio: has my MGUS progressed?
Thanks to all who have replied to my post.
Here are the results prior to latest set. They are dated October 13, 2017.
IgG 596 mg/dL 635-1741 mg/dL L
IgA 20 mg/dL 66-433 mg/dL L
IgM 26 mg/dL 45-281 mg/dL L
Kappa Free Lt Chn 1080.00 mg/L 3.30-19.40 mg/L H
Verified by repeat analysis.
Lamda Free Lt Chn 8.84 mg/L 5.71-26.30 mg/L
Kappa Lamda Ratio 122.17 0.26-1.65 H
Total Protein SPE 6.5 gm/dL 6.4-8.5 gm/dL
Albumin SPE 3.7 gm/dL 3.5-5.0 gm/dL
Alpha 1 0.3 gm/dL 0.1-0.4 gm/dL
Alpha 2 1.0 gm/dL 0.3-1.0 gm/dL
Beta 1.0 gm/dL 0.6-1.2 gm/dL
Gamma 0.5 gm/dL 0.5-1.7 gm/dL
SPE Comment:
Essentially normal pattern on serum electrophoresis.
No M-component seen.
Monoclonal Protein 0.00 gm/dL 0 gm/dL
Immunofixation No M component seen.
Here are the results prior to latest set. They are dated October 13, 2017.
IgG 596 mg/dL 635-1741 mg/dL L
IgA 20 mg/dL 66-433 mg/dL L
IgM 26 mg/dL 45-281 mg/dL L
Kappa Free Lt Chn 1080.00 mg/L 3.30-19.40 mg/L H
Verified by repeat analysis.
Lamda Free Lt Chn 8.84 mg/L 5.71-26.30 mg/L
Kappa Lamda Ratio 122.17 0.26-1.65 H
Total Protein SPE 6.5 gm/dL 6.4-8.5 gm/dL
Albumin SPE 3.7 gm/dL 3.5-5.0 gm/dL
Alpha 1 0.3 gm/dL 0.1-0.4 gm/dL
Alpha 2 1.0 gm/dL 0.3-1.0 gm/dL
Beta 1.0 gm/dL 0.6-1.2 gm/dL
Gamma 0.5 gm/dL 0.5-1.7 gm/dL
SPE Comment:
Essentially normal pattern on serum electrophoresis.
No M-component seen.
Monoclonal Protein 0.00 gm/dL 0 gm/dL
Immunofixation No M component seen.
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annekb1111 - Name: Anne
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: May 2018
- Age at diagnosis: 57
Re: High kappa-lambda ratio: has my MGUS progressed?
Hmmm. Your kappa free light chain is on the rise, as is your free light chain ratio. Your immunogloblulin levels are deteriorating. You are repeatedly not registering any monoclonal protein of any type in your blood. Lastly, your latest serum protein electrophoresis (SPEP) suggests hypogammaglobulinemia (which is a reduction in all types of gamma globulins).
I'm wondering if you have a nonsecretory form of MGUS, along with hypogammaglobulinemia? Nonsecretory myeloma is where the your bone marrow doesn't produce any monoclonal proteins (M-components) that are measurable in your blood or urine, yet you can (in some cases) still have free light chain numbers that are out of whack.
You might want to see this article for a discussion on nonsecretory myeloma and free light chains.
Drayson, M, et al, "Serum free light-chain measurements for identifying and monitoring patients with nonsecretory multiple myeloma," Blood, 2001 (full text of article)
When you see your doctor, you may want to discuss getting a 24-hour urine protein electrophoresis test as well as a bone marrow biopsy to get to the bottom of all this.
Good luck and let us know what you find out.
I'm wondering if you have a nonsecretory form of MGUS, along with hypogammaglobulinemia? Nonsecretory myeloma is where the your bone marrow doesn't produce any monoclonal proteins (M-components) that are measurable in your blood or urine, yet you can (in some cases) still have free light chain numbers that are out of whack.
You might want to see this article for a discussion on nonsecretory myeloma and free light chains.
Drayson, M, et al, "Serum free light-chain measurements for identifying and monitoring patients with nonsecretory multiple myeloma," Blood, 2001 (full text of article)
When you see your doctor, you may want to discuss getting a 24-hour urine protein electrophoresis test as well as a bone marrow biopsy to get to the bottom of all this.
Good luck and let us know what you find out.
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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-lambda ratio: has my MGUS progressed?
As Multibilly notes, the results of the last blood test look like they are part of a trend, rather than an error. It looks like you have had what these days would be called light chain MGUS, and that your disease (technically) may have progressed to light chain myeloma.
Back in 2001 when the article Multibilly mentioned was published, this all might have been called nonsecretory disease, because the plasma cell "secretions" (monoclonal proteins) couldn't be detected using conventional testing. These days, with the availability of serum free light chain testing, I believe the term nonsecretory is usually reserved for cases where there is no evidence of monoclonal proteins on either SPEP, IFE, or serum free light chain laboratory tests.
I'm surprised that kappa free light chain levels such as yours, which are almost certainly due to monoclonal free light chains, don't show up on a serum immunofixation test, but the data in Table 1 of the paper Multibilly cited suggests that's not unheard of.
I agree that a bone marrow biopsy will be a likely next step, and probably also imaging (x-rays, MRI, or PET/CT) to see if you have developed any bone lesions.
Having said all that, I think it will be important to discuss with your doctor(s) why they have proceeded the way they have, and the rationale for whatever plans they have for you going forward. They know your disease history and what impact the disease is having on you, and they have ready access to the diagnostic criteria for MGUS, smoldering myeloma, and symptomatic myeloma. So just ask them to explain to you how they would like to proceed, and why. And then run it by us, if you want to.
Good luck!
Back in 2001 when the article Multibilly mentioned was published, this all might have been called nonsecretory disease, because the plasma cell "secretions" (monoclonal proteins) couldn't be detected using conventional testing. These days, with the availability of serum free light chain testing, I believe the term nonsecretory is usually reserved for cases where there is no evidence of monoclonal proteins on either SPEP, IFE, or serum free light chain laboratory tests.
I'm surprised that kappa free light chain levels such as yours, which are almost certainly due to monoclonal free light chains, don't show up on a serum immunofixation test, but the data in Table 1 of the paper Multibilly cited suggests that's not unheard of.
I agree that a bone marrow biopsy will be a likely next step, and probably also imaging (x-rays, MRI, or PET/CT) to see if you have developed any bone lesions.
Having said all that, I think it will be important to discuss with your doctor(s) why they have proceeded the way they have, and the rationale for whatever plans they have for you going forward. They know your disease history and what impact the disease is having on you, and they have ready access to the diagnostic criteria for MGUS, smoldering myeloma, and symptomatic myeloma. So just ask them to explain to you how they would like to proceed, and why. And then run it by us, if you want to.
Good luck!
8 posts
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