Hi,
My husband has been seeing a rheumatologist for what we thought was chronic gout attacks. He has had gout attacks tor years and could stop eating red meat and take his med for it and it would go away.
We took him to the ER in March with severe abdominal pain that radiated to his back. They said it was a mild case of pancreatitis.
Then he started having gout attacks weekly that would move to various different joints. He would get the attacks while watching what he ate that could cause the attack. He was extremely tired, he would come home and lay down and take a nap everyday. A few times he would lay down in the bed with a low grade fever. We tried everything to see if some of his medicines were causing the attacks. Nothing would help.
He does have digestive problems.
We have had him tested for Lyme, rheumatoid arthritis, celiac, homochromatis. All tests came back negative. Then I did research and thought he may have leaky gut syndrome. I changed his diet to veggies, fruits, gluten free, organic. He is drinking a lot of water. He was eating a lot of sugary food; he does not eat the sugary foods anymore. He started feeling better by changing his food. Has not had but 2 gout attacks. The doctor put him on 2 gout medicines.
Then boom, we get a call last Monday with blood results:
Free Kappa S is at 712.8 mg/l
Free Lambda S is normal
Ratio is 90.23 mg/l
No monoclonal protein detected on a Immunofixation Serum test.
Low gamma globulins at 0.7 g/dl
Total Protein 6.8
Albumin 4.4
Alpha 1 0.3
Alpha 2 0.7
Beta 1 0.4
Beta 2 0.3
C-Reative Protein is 2.31
UPEP-Urine
Protein, Total, Urine 7.4
Alubumin, U 100.0
Alpha 1 0.0
Alpha 2 0.0
Beta Gl. 0.0
Gama Gl 0.0
M- Spike Not Observed
CBC are all normal
Uric Acid 7.0
Do these results suggest my husband has multiple myeloma or some related disease?
Thank you!
Forums
Re: High kappa-lambda ratio, no M-spike: is it myeloma?
Hi JK,
I'm sorry to hear about the health problems your husband has been having.
To me, when I read through your husband's lab results, there seems to be a disconnect between his serum free light chain results and his serum immunofixation results. It seems unlikely to me that both are correct.
The free light chain results show a very elevated kappa level, resulting in a high ratio (over 90). The lambda level is within the normal range, although, by my calculation, it's on the low end of normal (around 7.9, and the normal range is 5.71 to 26.3 mg/L).
With such a high kappa and kappa-lambda ratio, one would think the excess kappa free light chains are monoclonal, and therefore signs of a plasma cell disorder such as multiple myeloma or amyloidosis. It would be surprising with such a high kappa-lambda ratio for the elevated kappa result to be due to excess polyclonal (normal) kappa free light chain production.
Thus, with such an elevated kappa free light chain level, one would think that the serum immunofixation test would report back that at least monoclonal kappa proteins were found. (The immunofixation test usually checks for both monoclonal IgG, IgA, IgM, kappa, and lambda.) But your husband's serum immunofixation did not report any monoclonal proteins whatsoever.
So if I were in your shoes, I would double check the serum immunofixation results to make sure you read them right, and also that the test checked for monoclonal kappa and lambda free light chains. The same goes for the serum free light chain results.
If you read all the results correctly, and posted them correctly, then I would consider doing both tests over again, after checking with your husband's doctor to see if there is an explanation for how both sets of results could be correct.
Out of curiosity, what are your husband's hemoglobin, serum creatinine, and serum calcium levels?
Good luck!
I'm sorry to hear about the health problems your husband has been having.
To me, when I read through your husband's lab results, there seems to be a disconnect between his serum free light chain results and his serum immunofixation results. It seems unlikely to me that both are correct.
The free light chain results show a very elevated kappa level, resulting in a high ratio (over 90). The lambda level is within the normal range, although, by my calculation, it's on the low end of normal (around 7.9, and the normal range is 5.71 to 26.3 mg/L).
With such a high kappa and kappa-lambda ratio, one would think the excess kappa free light chains are monoclonal, and therefore signs of a plasma cell disorder such as multiple myeloma or amyloidosis. It would be surprising with such a high kappa-lambda ratio for the elevated kappa result to be due to excess polyclonal (normal) kappa free light chain production.
Thus, with such an elevated kappa free light chain level, one would think that the serum immunofixation test would report back that at least monoclonal kappa proteins were found. (The immunofixation test usually checks for both monoclonal IgG, IgA, IgM, kappa, and lambda.) But your husband's serum immunofixation did not report any monoclonal proteins whatsoever.
So if I were in your shoes, I would double check the serum immunofixation results to make sure you read them right, and also that the test checked for monoclonal kappa and lambda free light chains. The same goes for the serum free light chain results.
If you read all the results correctly, and posted them correctly, then I would consider doing both tests over again, after checking with your husband's doctor to see if there is an explanation for how both sets of results could be correct.
Out of curiosity, what are your husband's hemoglobin, serum creatinine, and serum calcium levels?
Good luck!
-
Jonah
Re: High kappa-lambda ratio, no M-spike: is it myeloma?
Hi JK,
To add to Jonah's comments, I wonder if you actually reported the free light chain numbers correctly? A free light chain ratio should not include any units of measure (i.e. mg/l) in the lab report.
To add to Jonah's comments, I wonder if you actually reported the free light chain numbers correctly? A free light chain ratio should not include any units of measure (i.e. mg/l) in the lab report.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: High kappa-lambda ratio, no M-spike: is it myeloma?
Thank you both for your responding. I went back and double checked. I put down the correct totals on all of the blood work.
The ratio does not have mg/l. It has nothing next to it.
I am scared so bad! I have been on this forum and can't ratios as high as mine. We went to an oncologist Thursday, he said that the levels make him nervous and the only way of knowing is doing a bone marrow biopsy. He performed one that very day. We go back this next Thursday for the results.
I have been so sick, I can't eat, and I have two kids to raise.
Thank you so much.
JK
The ratio does not have mg/l. It has nothing next to it.
I am scared so bad! I have been on this forum and can't ratios as high as mine. We went to an oncologist Thursday, he said that the levels make him nervous and the only way of knowing is doing a bone marrow biopsy. He performed one that very day. We go back this next Thursday for the results.
I have been so sick, I can't eat, and I have two kids to raise.
Thank you so much.
JK
Re: High kappa-lambda ratio, no M-spike: is it myeloma?
Hi JK,
The waiting can definitely be the worst. I will keep your husband in my prayers. Keep us updated on how things are going and what you find out.
The waiting can definitely be the worst. I will keep your husband in my prayers. Keep us updated on how things are going and what you find out.
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Eileenk - Name: Eileen
- Who do you know with myeloma?: me
- When were you/they diagnosed?: Smoldering, September 2017
- Age at diagnosis: 49
Re: High kappa-lambda ratio, no M-spike: is it myeloma?
Hi JK,
A kappa-lambda ratio of 90 is certainly high, but it's not anywhere near the highest kappa-lambda ratio ever seen. In some cases, for example, you would need a ratio higher than 100 for a diagnosis of multiple myeloma.
If the ratio really is 90, then I still feel that something isn't right. Either there was an error in the reporting of your husband's serum (blood) free light chain results, or there was an error with the serum immunofixation electrophoresis results. I can't see how the kappa-lambda ratio can be 90 and there not be any monoclonal proteins detected in by the serum immunofixation.
But I'm not a doctor, so this is something I think you'll need to sort out with your husband's doctors.
I still think it would be useful for you to check your husband's hemoglobin, creatinine, and calcium levels to see if they show any signs of myeloma (signs would be a low hemoglobin level, and/or elevated creatinine and calcium levels in the blood).
This post here in the forum gives an overview of the criteria for a multiple myeloma diagnosis,
https://myelomabeacon.org/forum/criteria-for-multiple-myeloma-diagnosis-t8505.html
This article explains the criteria in more detail:
https://myelomabeacon.org/news/2014/10/26/new-multiple-myeloma-diagnostic-criteria/
Good luck to you and your husband, and please let us know what you find out.
A kappa-lambda ratio of 90 is certainly high, but it's not anywhere near the highest kappa-lambda ratio ever seen. In some cases, for example, you would need a ratio higher than 100 for a diagnosis of multiple myeloma.
If the ratio really is 90, then I still feel that something isn't right. Either there was an error in the reporting of your husband's serum (blood) free light chain results, or there was an error with the serum immunofixation electrophoresis results. I can't see how the kappa-lambda ratio can be 90 and there not be any monoclonal proteins detected in by the serum immunofixation.
But I'm not a doctor, so this is something I think you'll need to sort out with your husband's doctors.
I still think it would be useful for you to check your husband's hemoglobin, creatinine, and calcium levels to see if they show any signs of myeloma (signs would be a low hemoglobin level, and/or elevated creatinine and calcium levels in the blood).
This post here in the forum gives an overview of the criteria for a multiple myeloma diagnosis,
https://myelomabeacon.org/forum/criteria-for-multiple-myeloma-diagnosis-t8505.html
This article explains the criteria in more detail:
https://myelomabeacon.org/news/2014/10/26/new-multiple-myeloma-diagnostic-criteria/
Good luck to you and your husband, and please let us know what you find out.
-
Jonah
Re: High kappa-lambda ratio, no M-spike: is it myeloma?
Thank you Jonah.
All of his other blood work, creatinine and hemoglobin, etc., were in range. However, that blood test was done on August 29th. Not sure if that length of time would make a big difference. They could be really off by now. He has been feeling so much better since I changed his diet to eating healthy foods and taking away his sugar intake. He has not had a gout attack for a good while. That is why I am so shocked over all of this.
His lower back hurts him really bad. This is why I am so nervous that it is active. He has to go to the bathroom 3 or 4 times at night. Praying his kidneys are not affected. I noticed today he didn't feel good.
We go back to the doctor this Thursday for the bone marrow results.
Again, thank you for responding and sharing your advice. It helps. I feel so alone.
All of his other blood work, creatinine and hemoglobin, etc., were in range. However, that blood test was done on August 29th. Not sure if that length of time would make a big difference. They could be really off by now. He has been feeling so much better since I changed his diet to eating healthy foods and taking away his sugar intake. He has not had a gout attack for a good while. That is why I am so shocked over all of this.
His lower back hurts him really bad. This is why I am so nervous that it is active. He has to go to the bathroom 3 or 4 times at night. Praying his kidneys are not affected. I noticed today he didn't feel good.
We go back to the doctor this Thursday for the bone marrow results.
Again, thank you for responding and sharing your advice. It helps. I feel so alone.
Re: High kappa-lambda ratio, no M-spike: is it myeloma?
Bone marrow test came back with 15% plasma cells. Awaiting the FISH results. He had a full body x-ray to check for lesions. He will have a PET scan as well. The doctor said he will decide about treatment after he gets the scan results. We go back in two weeks.
Wow, how your life can change in the blink of an eye.
JK
Wow, how your life can change in the blink of an eye.
JK
Re: High kappa-lambda ratio, no M-spike: is it myeloma?
With a 15 percent bone marrow plasma cell percentage and a kappa-lambda ratio under 100, your husband most likely will be diagnosed with smoldering multiple myeloma, rather than active (symptomatic) multiple myeloma.
The exact diagnosis will depend on whether or not your husband has any of the myeloma-defining events (MDEs) listed in the links I posted earlier. One of those MDEs is having a kappa-lambda ratio of 100 or greater. With a previously measured ratio of 90, your husband is close to that cutoff, but I believe many doctors will be hesitant to classify your husband's disease as symptomatic myeloma without signs that the disease is extensive and having a negative impact on your husband's body (for example, bone lesions, kidney damage, or anemia).
The distinction between smoldering and symptomatic (active) multiple myeloma is important. Symptomatic multiple myeloma is almost always treated. There are few exceptions. The "standard of care" when it comes to smoldering multiple myeloma, however, is not to treat it. This is because not all people diagnosed with smoldering myeloma see their disease progress to symptomatic myeloma within their lifetimes. Also, myeloma therapies have side effects, and they sometimes can be serious and long-lasting side effects. So the thinking is that only those patients should be treated who really, really need to be treated.
One of the hardest things for people new to myeloma to wrap their heads around is the fact that myeloma is not like the cancers most people are used to. With a "typical" cancer, like breast cancer or stomach cancer, the disease is often in a defined location, so cutting it out and hitting it hard with chemo and/or radiation can completely get rid of the cancer.
That's not true with multiple myeloma. Unlike the cancers most people are used to, multiple myeloma is not curable (except in some cases via donor stem cell transplants, also called allogeneic, or allo, stem cell transplants). Current treatments for multiple myeloma reduce the disease's presence in the body, but they don't get rid of the disease. So the idea that people carry over from typical cancers, which is that there is always a positive payoff to hitting the cancer hard, and hitting it early, and hitting it for a long time, doesn't necessarily apply when it comes to multiple myeloma. With myeloma, all the "hard / early / long" strategy may do is reduce a patient's quality of life for the time they do live with the disease (which, thankfully, is getting longer and longer). (For those more versed in these issues, please note that I used the word "may" in the last sentence. I realize I'm touching on some controversies here.)
Please keep us updated on what you find out about your husband's case, including what is found on additional blood tests and imaging. It also would be helpful for everyone here to understand what the disconnect was, if any, between the free light chain results and serum immunofixation results that you posted initially.
Good luck!
The exact diagnosis will depend on whether or not your husband has any of the myeloma-defining events (MDEs) listed in the links I posted earlier. One of those MDEs is having a kappa-lambda ratio of 100 or greater. With a previously measured ratio of 90, your husband is close to that cutoff, but I believe many doctors will be hesitant to classify your husband's disease as symptomatic myeloma without signs that the disease is extensive and having a negative impact on your husband's body (for example, bone lesions, kidney damage, or anemia).
The distinction between smoldering and symptomatic (active) multiple myeloma is important. Symptomatic multiple myeloma is almost always treated. There are few exceptions. The "standard of care" when it comes to smoldering multiple myeloma, however, is not to treat it. This is because not all people diagnosed with smoldering myeloma see their disease progress to symptomatic myeloma within their lifetimes. Also, myeloma therapies have side effects, and they sometimes can be serious and long-lasting side effects. So the thinking is that only those patients should be treated who really, really need to be treated.
One of the hardest things for people new to myeloma to wrap their heads around is the fact that myeloma is not like the cancers most people are used to. With a "typical" cancer, like breast cancer or stomach cancer, the disease is often in a defined location, so cutting it out and hitting it hard with chemo and/or radiation can completely get rid of the cancer.
That's not true with multiple myeloma. Unlike the cancers most people are used to, multiple myeloma is not curable (except in some cases via donor stem cell transplants, also called allogeneic, or allo, stem cell transplants). Current treatments for multiple myeloma reduce the disease's presence in the body, but they don't get rid of the disease. So the idea that people carry over from typical cancers, which is that there is always a positive payoff to hitting the cancer hard, and hitting it early, and hitting it for a long time, doesn't necessarily apply when it comes to multiple myeloma. With myeloma, all the "hard / early / long" strategy may do is reduce a patient's quality of life for the time they do live with the disease (which, thankfully, is getting longer and longer). (For those more versed in these issues, please note that I used the word "may" in the last sentence. I realize I'm touching on some controversies here.)
Please keep us updated on what you find out about your husband's case, including what is found on additional blood tests and imaging. It also would be helpful for everyone here to understand what the disconnect was, if any, between the free light chain results and serum immunofixation results that you posted initially.
Good luck!
-
Jonah
Re: High kappa-lambda ratio, no M-spike: is it myeloma?
Hello JK540.
Somebody else may have commented on this earlier, but I could not find it readily.
I think all of your husband's myeloma-related symptoms are very similar to mine when my multiple myeloma was first diagnosed 3 years ago. I have the kappa light chain-only multiple myeloma, and I, too, do not have any measurable M-spike.
My oncologist considered me to be a 'borderline' case and my Induction therapy was started only after my bone marrow biopsy showed 30% plasma cells. For comparison, my kappa was 1,070 mg/L (normal range 3.3 - 19.4 mg/L) and my lambda was 'normal at 5.75 mg/L (normal 5.71 - 26.3 mg/L) and the kappa-lambda ratio therefore was 186.09. I did not compare all the other parameters from your husband's blood tests to mine.
As Jonah has pointed out, the kappa-lambda ratio of under 100, the kappa free light chain level at 712.8, and the 15% bone marrow plasma cell percentage would quite likely be in the smoldering myeloma category, and your husband's myeloma team would watch these numbers at least once a month. All I can relate to you is that my oncologist had indicated that, even with my much higher kappa-lambda ratio, the 30% plasma cells in my bone marrow was the key deciding factor in starting my treatment.
Wish your husband all the best and hope his FISH tests and the skeletal x-rays do not show any cause for concern.
Somebody else may have commented on this earlier, but I could not find it readily.
I think all of your husband's myeloma-related symptoms are very similar to mine when my multiple myeloma was first diagnosed 3 years ago. I have the kappa light chain-only multiple myeloma, and I, too, do not have any measurable M-spike.
My oncologist considered me to be a 'borderline' case and my Induction therapy was started only after my bone marrow biopsy showed 30% plasma cells. For comparison, my kappa was 1,070 mg/L (normal range 3.3 - 19.4 mg/L) and my lambda was 'normal at 5.75 mg/L (normal 5.71 - 26.3 mg/L) and the kappa-lambda ratio therefore was 186.09. I did not compare all the other parameters from your husband's blood tests to mine.
As Jonah has pointed out, the kappa-lambda ratio of under 100, the kappa free light chain level at 712.8, and the 15% bone marrow plasma cell percentage would quite likely be in the smoldering myeloma category, and your husband's myeloma team would watch these numbers at least once a month. All I can relate to you is that my oncologist had indicated that, even with my much higher kappa-lambda ratio, the 30% plasma cells in my bone marrow was the key deciding factor in starting my treatment.
Wish your husband all the best and hope his FISH tests and the skeletal x-rays do not show any cause for concern.
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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
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