[Jer610]

Hypogammaglobulinemia and total light chain levels

by Jer610 on Mon Jun 27, 2016 11:24 am

When a person has hypo­gamma­globu­li­nemia, can their un­in­volved total light chain go to zero, or near zero, along with the uninvolved heavy chains?

My question here is not about the free light chain levels, but the levels of the uninvolved total light chain as shown on the immunofixation.

If, on every test, the uninvolved immunoglobulins, IgA and IgM, drop to new lows (currently 32 and 33 mg/dl), and the uninvolved Total Light Chain, Kappa (currently 41 mg/dl) is doing the same, with IgA losing an average of 6 mg/dl per year, IgM 5 mg/dl per year, and kappa 10 mg/dl per year, can my total kappa drop to zero in four years, leaving only very small amounts of lambda IgA and IgM.

With my lambda free light chain level rising an average of 12 mg/dl per year and currently at 225 mg/dl, am I looking at a FLC ratio of 275-1. It has me worried that I am looking at the slow destruction of my immune system.

[Ian]

Re: Hypogammaglobulinemia and total light chain levels

by Ian on Mon Jun 27, 2016 10:20 pm

Hi Jerry,

Anything that is measuring total (not just free) light chains – either kappa or lambda – is measuring the sum of two things:

1. The amount of free light chains, and
2. The amount of light chains bound to heavy chains in complete immunoglobulin molecules.

So the only way that you could have 0 (nil, zero) kappa or lambda total light chains is if your body were producing no immunoglobulins whatsoever of ANY type. No IgG,and no IgA and no IgM etc.

If the body were still producing immunoglobulins of any sort, then the light chains in those complete immunoglobulin molecules would be picked up in the total light chain test.

So, yes, if your kappa or lambda total light chain level were to hit 0, your immune system would be basically wiped out, given it would mean that you were not producing any immunoglobulins whatsoever.

Cheers!

[JPC]

Re: Hypogammaglobulinemia and total light chain levels

by JPC on Tue Jun 28, 2016 6:00 am

Hello Jer:

Treatment does suppress the immunoglobulins. I am not sure which drug does what, but I think the proteasome inhibitors have the biggest impact. I understand that they can go very low, and doctors will let it go until the point where the patient starts to experience more frequent infections. In that case, they will inject immunoglobulins, it's called IVIG support. My wife has very low immunoglobulin numbers; however, her cold / infections / illness situations is probably in the range of the normal person our age, maybe a little worse, but overall not too bad.

Remember, you still have your white blood cells. If you still have a healthy WBC count, that might be doing some of the work in place of the low immunoglobulin levels. We are transitioning from consolidation to maintenance, and the immunoglobulin levels are slowly coming up.

Are you comfortable that your doctor is a myeloma specialist, who is up to speed on these issues? Ask about IVIG. Like anything, the IVIG could cause other problems, so doctors would not give it if it were not necessary, but based on postings from other Beacon posters, it does seem to do its job in most cases.

[Jer610]

Re: Hypogammaglobulinemia and total light chain levels

by Jer610 on Mon Jul 18, 2016 11:44 am

Thank you for your responses, Ian and JPC. Your input is greatly appreciated. Next draw is in November and hopefully the trends will moderate or maybe even reverse. Have a great summer.