Husband has been diagnosed with smoldering multiple myeloma and on the watch and wait treatment.
M spike 2.3 which resulted in more tests 3 weeks later:
Total Protein 8.7 G/DL (high) (6.5-8.2)
Alpha 1 .2 G/DL (0.1-0.3)
Alpha 2 .8 G/DL (0.5-1.0)
Beta .8 G/DL (0.6-1.4)
Gamma 2.9 G/DL (high) (0.8-1.7)
Two monoclonal bands were identified in the gamma region.
IgA 38 MG/DL (low) (82-453)
IgG 2850 MG/DL (high) (751-1560)
IgM 24.1 MG/DL (low) (43.0-304.0)
UR Kappa Free 9.82 mg/L (1.35-24.19)
UR Lambda Free 5.15 mg/L (0.24-6.66)
Free Kappa/Lamb 1.91 (low) (2.04-10.37)
Immunofixation studies show the presence of IgG kappa and IgG lambda paraprotein. I see the problem with the heavy chain IgG but what is confusing me is both light chains detected. Is this unusual?
Of the CRAB he has anemia which makes me wonder if he is really smoldering. He was diagnosed with hypothyroidism which we were told could be contributing to the anemia. Anemia is minor. No bone issues or organ damage at this time.
My husband is a Vietnam Veteran and Agent Orange seems to be the cause of all this.
Trying to understand this stuff. Any comments or suggestions would be greatly appreciated.
Thanks,
Cindy
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Re: Immunofixation shows IgG Kappa and IgG Lambda paraprotei
Hi Lsmo, Have you looked at the International Myeloma Foundation website to get online or paper copies of their publications about myeloma? They have a lot of information and I read and re-read those booklets when I was diagnosed and learned a lot about the disease! (In Canada, they are published by Myeloma Canada, but are basically the same…just the units of measurement are changed i think).
The kappa/lambda ratio is the measurement of free floating chains of light weight antibody type protein in the blood. Even normally, these protein chains are present, but during active myeloma the type of antibody produced protein, which is specific to the type of myeloma, is present in a larger quantity, and thus skews the ratio.
The kappa/lambda ratio is the measurement of free floating chains of light weight antibody type protein in the blood. Even normally, these protein chains are present, but during active myeloma the type of antibody produced protein, which is specific to the type of myeloma, is present in a larger quantity, and thus skews the ratio.
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: Immunofixation shows IgG Kappa and IgG Lambda paraprotei
Hi There LSMO,
It's a very anxious time when one first gets diagnosed. It will get easier for you two over time.
Regarding anemia, the IMWG defines anemia for the purpose of meeting or not meeting CRAB criteria as: Hemagloblin level lower than 2 g/dL below the normal limit or lower than 10 g/dL. You will find the HGB (Hb) level on the CBC chart. If he is truly anemic by this standard and not just "low", he would in fact not be smoldering...as you say.
Nancy is right on with her comments. Regarding the K/L ratio, with a low K/L ratio, your husband is likely Lambda light chain involved (you would have a high K/L ratio if Kappa involved). You want to watch both your K/L ratio and K and L values over time. Many believe that the K/L ratio is the most important indicator to watch regarding light chains, as opposed to the individual Lambda or Kappa values. When all is said and done, it doesn't really matter which of the heavy/light chain variations one has. But cytogenetics do play a role in one's prognosis and you should understand what these are.
BTW, don't know if you saw this regarding Agent Orange: https://myelomabeacon.org/forum/multiple-myeloma-and-military-medical-disability-t2478.html
Best of luck...many people smolder for their entire lives without becoming symptomatic.
It's a very anxious time when one first gets diagnosed. It will get easier for you two over time.
Regarding anemia, the IMWG defines anemia for the purpose of meeting or not meeting CRAB criteria as: Hemagloblin level lower than 2 g/dL below the normal limit or lower than 10 g/dL. You will find the HGB (Hb) level on the CBC chart. If he is truly anemic by this standard and not just "low", he would in fact not be smoldering...as you say.
Nancy is right on with her comments. Regarding the K/L ratio, with a low K/L ratio, your husband is likely Lambda light chain involved (you would have a high K/L ratio if Kappa involved). You want to watch both your K/L ratio and K and L values over time. Many believe that the K/L ratio is the most important indicator to watch regarding light chains, as opposed to the individual Lambda or Kappa values. When all is said and done, it doesn't really matter which of the heavy/light chain variations one has. But cytogenetics do play a role in one's prognosis and you should understand what these are.
BTW, don't know if you saw this regarding Agent Orange: https://myelomabeacon.org/forum/multiple-myeloma-and-military-medical-disability-t2478.html
Best of luck...many people smolder for their entire lives without becoming symptomatic.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Immunofixation shows IgG Kappa and IgG Lambda paraprotei
Thank you Nancy and Multibilly. I have 3 different tests results I'm working from. First from the VA who reported everything is fine. Then our family doctor by looking at the VA tests knew something was not right. He reordered same tests and then referred my husband to a hematologist who 3 weeks later reran some tests and some additional tests including a bone marrow biopsy and CT Scan. These 3 test results all have different reference ranges which is confusing to me. Where one says high another says normal.
His HGB within the last 11 months has been 11.8, 12.3 and last 13.1. So then according to the IMWG he is smoldering. That's been one of my concerns. It's been 6 months so retesting in a few weeks. This time I will be going and will be asking a lot of questions. Gosh hope it goes well.
My husband spent all of 1967 in Vietnam walking through and breathing Agent Orange. He basically lived in the jungle during that year and at times would be covered with Agent Orange. The VA knew this when they tested my husband and should have done more tests to determine what was wrong and should have told my husband that things were not fine.
Thanks for the links and Nancy I'm using the Myeloma Manager Personal Care Assistant to keep track of all the test results. It helps.
Prayers to everyone and thanks Myelomabeacon.com your site is awesome!
Cindy
His HGB within the last 11 months has been 11.8, 12.3 and last 13.1. So then according to the IMWG he is smoldering. That's been one of my concerns. It's been 6 months so retesting in a few weeks. This time I will be going and will be asking a lot of questions. Gosh hope it goes well.
My husband spent all of 1967 in Vietnam walking through and breathing Agent Orange. He basically lived in the jungle during that year and at times would be covered with Agent Orange. The VA knew this when they tested my husband and should have done more tests to determine what was wrong and should have told my husband that things were not fine.
Thanks for the links and Nancy I'm using the Myeloma Manager Personal Care Assistant to keep track of all the test results. It helps.
Prayers to everyone and thanks Myelomabeacon.com your site is awesome!
Cindy
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