Got some interesting lab results. I'm smoldering and have been for a couple of years, started with MGUS about 9 years ago. Recently, I've been seeing an increase in my lambda free light chain levels, now at 395. Not good. But my kappa free light chains have been increasing and are now in the normal range (for years, they have been low) 4.42.
Consequently, for years my involved/uninvolved ratio has been >100. Now the ratio is 89, down from 248 in January and down from over 400 in October.
Not sure what it means, if anything.
My M-spike continues to increase slightly, now at 1.9, and my immunoglobulin A continues to climb, now at 3500.
So not sure if the "improved" free light chain ratio means much or I'm just reaching for some good news.
Any thoughts?
Forums
7 posts
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Kebo - Name: Kebo
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2008
- Age at diagnosis: 51
Re: Improvement in involved / uninvolved FLC ratio
Hi Kebo,
It would be helpful if you posted the following, along with dates of the tests:
Lambda, kappa and FLC ratio values, including units of measure.
Your M-spike readings over time, including the units of measure.
It would be helpful if you posted the following, along with dates of the tests:
Lambda, kappa and FLC ratio values, including units of measure.
Your M-spike readings over time, including the units of measure.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Improvement in involved / uninvolved FLC ratio
Sure, I've had a long history of tests, but I'll summarize.
Lambda Free Light Chain Level (mg/L)
Aug 2009 250
Nov 2010 160
May 2011 155
Jun 2012 200
Jun 2013 225
Jun 2014 250
Sep 2014 250
Apr 2015 226
Jul 2015 222
Oct 2015 206
Feb 2016 335
Apr 2016 395
Kappa Free Light Chain Level (mg/L)
Aug 2009 3.0
Nov 2010 0.3
May 2011 1.4
Jun 2012 0.3
Jun 2013 1.4
Jun 2014 1.7
Sep 2014 1.2
Apr 2015 1.5
Jul 2015 0.3
Oct 2015 0.3
Feb 2016 1.4
Apr 2016 4.4
You can see the involved / uninvolved ratio has been well over 100 for the most part until recently.
M-spike
Only have a couple of tests on this
Apr 2015 0.8 g/dl
Feb 2016 1.4
Apr 2016 1.9
Lambda Free Light Chain Level (mg/L)
Aug 2009 250
Nov 2010 160
May 2011 155
Jun 2012 200
Jun 2013 225
Jun 2014 250
Sep 2014 250
Apr 2015 226
Jul 2015 222
Oct 2015 206
Feb 2016 335
Apr 2016 395
Kappa Free Light Chain Level (mg/L)
Aug 2009 3.0
Nov 2010 0.3
May 2011 1.4
Jun 2012 0.3
Jun 2013 1.4
Jun 2014 1.7
Sep 2014 1.2
Apr 2015 1.5
Jul 2015 0.3
Oct 2015 0.3
Feb 2016 1.4
Apr 2016 4.4
You can see the involved / uninvolved ratio has been well over 100 for the most part until recently.
M-spike
Only have a couple of tests on this
Apr 2015 0.8 g/dl
Feb 2016 1.4
Apr 2016 1.9
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Kebo - Name: Kebo
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2008
- Age at diagnosis: 51
Re: Improvement in involved / uninvolved FLC ratio
Hi Kebo,
A low kappa FLC reading, coupled by a high lambda FLC reading can suggest bone marrow suppression. See the table posted by Ron on this link:
https://myelomabeacon.org/forum/no-m-spike-abnormal-kappa-lambda-ratio-t4678-10.html
Bone marrow suppression is defined in the following link:
https://en.wikipedia.org/wiki/Bone_marrow_suppression
An involved/uninvolved FLC ratio of > 100 (with the involved FLC also being > 100 mg/L) is now termed as a Myeloma Defining Event (MDE). Some specialists may consider starting treatment based on a patient developing an MDE. I would add that not all specialists would automatically suggest starting treatment based on the finding of an MDE in the absence of a CRAB event (hypercalcemia, renal dysfunction, anemia, lytic bone lesions). See this link for a definition of an MDE:
https://myelomabeacon.org/news/2014/10/26/new-multiple-myeloma-diagnostic-criteria/
A low kappa FLC reading, coupled by a high lambda FLC reading can suggest bone marrow suppression. See the table posted by Ron on this link:
https://myelomabeacon.org/forum/no-m-spike-abnormal-kappa-lambda-ratio-t4678-10.html
Bone marrow suppression is defined in the following link:
https://en.wikipedia.org/wiki/Bone_marrow_suppression
An involved/uninvolved FLC ratio of > 100 (with the involved FLC also being > 100 mg/L) is now termed as a Myeloma Defining Event (MDE). Some specialists may consider starting treatment based on a patient developing an MDE. I would add that not all specialists would automatically suggest starting treatment based on the finding of an MDE in the absence of a CRAB event (hypercalcemia, renal dysfunction, anemia, lytic bone lesions). See this link for a definition of an MDE:
https://myelomabeacon.org/news/2014/10/26/new-multiple-myeloma-diagnostic-criteria/
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Improvement in involved / uninvolved FLC ratio
Thank you. My question was what could cause my ratio to move from >100 to less than <100.
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Kebo - Name: Kebo
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2008
- Age at diagnosis: 51
Re: Improvement in involved / uninvolved FLC ratio
My personal experience is that several of my markers fluctuate quite a bit and that is somewhat normal. But, I might suggest discussing the points I raised with your specialist the next time you see him/her. Also, these tests are not perfect, so your next test could show something quite different.
But in doing the math on some of your figures, your FLC ratio has been pretty darn high in the past, as is your lambda FLC. Are your kidney function markers (creatinine, eGFR, etc) doing well? How about your hemoglobin and calcium levels?
Are you being seen by a multiple myeloma specialist?
But in doing the math on some of your figures, your FLC ratio has been pretty darn high in the past, as is your lambda FLC. Are your kidney function markers (creatinine, eGFR, etc) doing well? How about your hemoglobin and calcium levels?
Are you being seen by a multiple myeloma specialist?
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Improvement in involved / uninvolved FLC ratio
All kidney tests are fine. Creatinine (0.96, scale = 0.53-1.20), GFR (86, scale >60) , BUN (14, scale 7-28 mg/dl). Hemoglobin a tad low (12 vs 12.5 g/dl lower end), same with hematocrit (35.5 vs 37 %) and RBC (3.84 vs 4 thou/com lower end). Calcium 8.9, scale 8.2-10.1
Other - Beta 2 actually improved from 3.4 mg/L to 2.5. So I continue to get a confusing mix of markers.
I'm scheduling an appointment with a myeloma specialist per request from the oncologist. I believe the oncologist was a bit perplexed also.
Other - Beta 2 actually improved from 3.4 mg/L to 2.5. So I continue to get a confusing mix of markers.
I'm scheduling an appointment with a myeloma specialist per request from the oncologist. I believe the oncologist was a bit perplexed also.
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Kebo - Name: Kebo
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2008
- Age at diagnosis: 51
7 posts
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