My husband's bloodwork has been all over the place and very concerned.
This last week his:
Kappa light chain, free went from the average of about 40 to 590 mg/L.
Lambda light chain, free) <5.70
(Free K/L ratio) 103.51
Immunoglobulin G measurement (IgG, quant) 1316 mg/dL
Immunoglobulin M measurement (IgM, quant) 24 mg/dL
Immunoglobulin A measurement (IgA, quant) <33
Last month these values were:
(Kappa light chain, free) 39.7 mg/L 3.3 || 19.4
(Lambda light chain, free) 6.69 mg/L 5.71 || 26.3
(Free K/L ratio) 5.93
Immunoglobulin G measurement (IgG, quant) 1794 mg/dL 650.0 || 1500.0
Immunoglobulin M measurement (IgM, quant) 25 mg/dL 60.0 || 280.0
Immunoglobulin A measurement (IgA, quant) 33 mg/dL
What does all this mean?
He was off any treatment for 7 months due to side effects and other problems. Failed on Velcade after it did work with the IV, sided effects for that were neuropathy and severe weight loss and other problems. He went on the subcutaneous Velcade, which didn't work.
He then went on Revlimid and that brought his M spike down and was stable. When he went off it for a few months, it started climbing again and then started back a few months ago on it. It didn't go down the first month, went down to 1.2, then the next month to 1.4. We are awaiting that result for last Friday. His beta 2 was 4.68 and goes up and down. The doctor said that isn't of concern and they really don't go by that.
His doctor said that he might change him to Pomalyst if the M spike went higher again.
He was diagnosed in Aug 2011 and had a plasmacytoma on his spine and had 2 weeks of radiation for that. He had an MRI last month and he now has an acute compression fracture in that area. He is 'glowing' in a lot of places on the PET scan, with new lesions in some areas, including his pelvic area.
He had prostate cancer in 2000, was treated with both external radiation for 5 weeks and high dose temporary bracytherapy, too. His PSA came down gradually to 0.01, but several years ago started going up and the last year has gone up a point every month, now at 11. We are getting very little info from the doctor if the prostate cancer could be back or what is causing it. Could it just be inflammation from the tumors in the area or irritation from the severe diarrhea he has?
If anyone can explain all this, simply, I would appreciate it.
Thank You
Chris
Forums
4 posts
• Page 1 of 1
Re: High kappa light chain & K/L ratio - what does it mean?
Hi there Chrisbo,
Is the doctor you are working with a multiple myeloma specialist? This is the question most on this forum will ask first. We can't emphasize this point enough.
What kind of cytogenetics (genetic abnormalities) are you working with? That would also have a bearing on which drugs would work best in your husband's case.
To summarize, in one month:
IgG went from 1316 to 1794
Kappa went from 39.7 to 590
This is a pretty big swing in one month. Obviously, you will get more data very soon, but it seems like you should be prepared for a bump in the M-Spike....or to get re-tested.
Your husband went from using IV Velcade to subq Velcade to Revlimid (I assume all with a steroid like dex or prednisone, right?)
Before talking about Pomalyst (which is in the IMID family of drugs with other drugs like Revlimid), did your doctor discuss the combination of Velcade (subcutaneous) & Revlimid and a low dose of a steroid like Dex (that combo is referred to as VRd)?
While Velcade and Revlimid may not work as sole agents in some patients, they can often produce good results when combined together, along with a steroid (this is true of many multiple myeloma drugs and many "triplet" combinations of drugs are available). Also, if neuropathy is a concern, there are other new drugs such as Carfilzomib (aka Kyprolis, which is in the proteasome inhibitor family with other drugs like Velcade) that has low incidences of peripheral neuropathy.
A multiple myeloma specialist is best prepared to recommend which combo would likely work best in your hubby's particular situation, with an eye to what might be best if he were to also relapse again in the future (you need to think this through a couple of steps down the road as you choose your drugs). But the point here is that there are a lot of options.
I am totally unqualified to comment on the prostate cancer question ... sorry.
Hope this helps a little bit. Let us know how things go on Friday.
Is the doctor you are working with a multiple myeloma specialist? This is the question most on this forum will ask first. We can't emphasize this point enough.
What kind of cytogenetics (genetic abnormalities) are you working with? That would also have a bearing on which drugs would work best in your husband's case.
To summarize, in one month:
IgG went from 1316 to 1794
Kappa went from 39.7 to 590
This is a pretty big swing in one month. Obviously, you will get more data very soon, but it seems like you should be prepared for a bump in the M-Spike....or to get re-tested.
Your husband went from using IV Velcade to subq Velcade to Revlimid (I assume all with a steroid like dex or prednisone, right?)
Before talking about Pomalyst (which is in the IMID family of drugs with other drugs like Revlimid), did your doctor discuss the combination of Velcade (subcutaneous) & Revlimid and a low dose of a steroid like Dex (that combo is referred to as VRd)?
While Velcade and Revlimid may not work as sole agents in some patients, they can often produce good results when combined together, along with a steroid (this is true of many multiple myeloma drugs and many "triplet" combinations of drugs are available). Also, if neuropathy is a concern, there are other new drugs such as Carfilzomib (aka Kyprolis, which is in the proteasome inhibitor family with other drugs like Velcade) that has low incidences of peripheral neuropathy.
A multiple myeloma specialist is best prepared to recommend which combo would likely work best in your hubby's particular situation, with an eye to what might be best if he were to also relapse again in the future (you need to think this through a couple of steps down the road as you choose your drugs). But the point here is that there are a lot of options.
I am totally unqualified to comment on the prostate cancer question ... sorry.
Hope this helps a little bit. Let us know how things go on Friday.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: High kappa light chain & K/L ratio - what does it mean?
Dear chrisbo,
The kappa light chain and FLC ratio results are very suspicious for rapidly relapsing disease. I would go see your doctor as soon as possible to go over the results. If what you have posted is accurate, a change in therapy sooner rather than later is warranted, especially with numerous "hot spots" on PET-CT.
Hang in there!
Pete V.
The kappa light chain and FLC ratio results are very suspicious for rapidly relapsing disease. I would go see your doctor as soon as possible to go over the results. If what you have posted is accurate, a change in therapy sooner rather than later is warranted, especially with numerous "hot spots" on PET-CT.
Hang in there!
Pete V.
-
Dr. Peter Voorhees - Name: Peter Voorhees, M.D.
Beacon Medical Advisor
Re: High kappa light chain & K/L ratio - what does it mean?
Thank you Multibilly and Dr Pete for your responses,
My husband was supposed to see the doctor last Friday and we were hoping for answers to all that is going on, BUT again he was out of town and we saw the Nurse Practitioner. She is good, but can't change or do anything more, except put notes in for the doctor to address. We wait and wait and no one calls back. AND this is the best center in Vegas. Traveling, even to California, is an impossibility, so we have to deal with things here.
His M spike DID go down to 1.1 from 1.4 last time, not much but at least it didn't go up.
Also the beta 2 went down to 2.8. That one really goes all over the place as it was 4.68 last time. Now reading up on this, it's really not an indication of anything now, just at original diagnosis. IS that right? His doctor before said it comes out of the kidneys so maybe dehydrated? He did start drinking spring water and keeping better track of it.
His tests are all over the place, ones showing better, but that kappa was really was out of left field. This happened a while back with it going up past 800, but then went back to the 40ish range where it usually stays. I HOPE they will retest next time and see if it is still up.
There was no answer on the PSA going up to now almost 11, no answers if the lesions in his pelvic area could be pressing down there causing inflammation, but it had slowly gone up for a few years before his multiple myeloma diagnosis. I think he should have a biopsy to see if the prostate cancer is back. It is going up at least a point a month now.
No answer about the compression fracture and how bad it is. His diarrhea doesn't to be controlled and he was off his Revlimid this last week, thought it would help and the pills all again today. What a vicious circle this is.
Multibilly - Yes, he was on the dex for a while with the high dose 10 at a time several days of the cycle. He had severe side effects and couldn't control his blood sugar and the doc was concerned it would cause more problems then help. This last year it's been only the first day of the 3 week cycle and 5 dex's with the Revlimid.
I asked last time after seeing others protocol if he should add more to maybe boost the Revlimid and the doc upped it to once a week 5 dex's for the three weeks of Revlimid, so 3 days of it a cycle. He's tolerating it, it even helps slow down the diarrhea for a couple of days.
He's a diabetic, but that is one thing that has been OK except when he does take the dex's and then it's the only days he has to take his diabetic meds, so maybe multiple myeloma cures diabetes??
I'm wondering if the dex's did bring down the M spike this time. He did so badly on Velcade that I doubt if they would put him back on it. He has only been on only one chemo at a time, never combined.
Thanks for any info or insight into all this.
Chris
My husband was supposed to see the doctor last Friday and we were hoping for answers to all that is going on, BUT again he was out of town and we saw the Nurse Practitioner. She is good, but can't change or do anything more, except put notes in for the doctor to address. We wait and wait and no one calls back. AND this is the best center in Vegas. Traveling, even to California, is an impossibility, so we have to deal with things here.
His M spike DID go down to 1.1 from 1.4 last time, not much but at least it didn't go up.
Also the beta 2 went down to 2.8. That one really goes all over the place as it was 4.68 last time. Now reading up on this, it's really not an indication of anything now, just at original diagnosis. IS that right? His doctor before said it comes out of the kidneys so maybe dehydrated? He did start drinking spring water and keeping better track of it.
His tests are all over the place, ones showing better, but that kappa was really was out of left field. This happened a while back with it going up past 800, but then went back to the 40ish range where it usually stays. I HOPE they will retest next time and see if it is still up.
There was no answer on the PSA going up to now almost 11, no answers if the lesions in his pelvic area could be pressing down there causing inflammation, but it had slowly gone up for a few years before his multiple myeloma diagnosis. I think he should have a biopsy to see if the prostate cancer is back. It is going up at least a point a month now.
No answer about the compression fracture and how bad it is. His diarrhea doesn't to be controlled and he was off his Revlimid this last week, thought it would help and the pills all again today. What a vicious circle this is.
Multibilly - Yes, he was on the dex for a while with the high dose 10 at a time several days of the cycle. He had severe side effects and couldn't control his blood sugar and the doc was concerned it would cause more problems then help. This last year it's been only the first day of the 3 week cycle and 5 dex's with the Revlimid.
I asked last time after seeing others protocol if he should add more to maybe boost the Revlimid and the doc upped it to once a week 5 dex's for the three weeks of Revlimid, so 3 days of it a cycle. He's tolerating it, it even helps slow down the diarrhea for a couple of days.
He's a diabetic, but that is one thing that has been OK except when he does take the dex's and then it's the only days he has to take his diabetic meds, so maybe multiple myeloma cures diabetes??
I'm wondering if the dex's did bring down the M spike this time. He did so badly on Velcade that I doubt if they would put him back on it. He has only been on only one chemo at a time, never combined.
Thanks for any info or insight into all this.
Chris
-
chrisbo
4 posts
• Page 1 of 1