When diagnosed, my mother's key lab results were:
Kappa free light chain level - 1150 mg/L
Lambda free light chain level - 7.12 Mg/l
Kappa-lambda ratio - 161.52
M-spike - 1.26 g/dL (12.6 g/l)
After CyBorD (cyclophosphamide, bortezomib, and dexamethasone) treatment for 6 cycles, her results were:
Kappa - 230 mg/ l
Lambda - 5.12 mg/l
Kappa-lambda ratio - 27.38
M-spike - none detected (doctor says it will be there in very small number)
She was put on maintenance with only cyclophosphamide and after 3 months her results are
Kappa - 545
Lambda - 23.50
Kappa-lambda ratio - 23.19
M-spike - 0.26 g/dL
(She was on antibiotics with a severe throat infection for 10 days before blood was drawn).
Which is more important here, the kappa level, or the kappa-lambda ratio? Could the elevated kappa level be due to the infection she had?
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Re: Increase in kappa, but decrease in kappa-lambda ratio?
Her beginning numbers on the serum free light chain test were high with a moderately high M-spike. She has responded well to the original treatment, with the involved kappa chain falling over 80%.The M spike fell to not measurable. You may need to run more labs to see if a trend has developed, but based on what you have posted, her numbers, both the "involved" kappa free light chain and the M-spike, have risen. That implies that the maintenance treatment may need to be modified.
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Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
Re: Increase in kappa, but decrease in kappa-lambda ratio?
Thank you so much for the reply Ron.
My mother isn’t a candidate for transplant because of her heart related issues. Her oncologist is a man of few words and it is hard to get information from him. This forum has provided me more knowledge than what I can get from him about all these myeloma things.
I feel it’s the absence of dexamethasone in the maintenance that might have caused her increase in kappa numbers again. But I am wondering why the lambda is increasing?
I did ask the oncologist about the kappa numbers, but he looked more interested in the ratio.
She has been off maintenance for a month now as she had to undergo a minor surgery. I just hope her numbers stay steady there. She had a broken humerus when she was diagnosed first and that still me a lot.
My mother isn’t a candidate for transplant because of her heart related issues. Her oncologist is a man of few words and it is hard to get information from him. This forum has provided me more knowledge than what I can get from him about all these myeloma things.
I feel it’s the absence of dexamethasone in the maintenance that might have caused her increase in kappa numbers again. But I am wondering why the lambda is increasing?
I did ask the oncologist about the kappa numbers, but he looked more interested in the ratio.
She has been off maintenance for a month now as she had to undergo a minor surgery. I just hope her numbers stay steady there. She had a broken humerus when she was diagnosed first and that still me a lot.
Re: Increase in kappa, but decrease in kappa-lambda ratio?
Hi bhagya,
Ron makes an important point about your mother's M-spike having reappeared. That could be a sign that there's been a change in the myeloma activity in her body.
That said, M-spike measurement can be imprecise, and that's particularly true if your mother has IgA myeloma (I'm not sure you mentioned what type she has).
Your mother's free light chain numbers are hard to interpret given her recent infection, but the ratio is certainly the most important number. Just keep in mind that free light chain results in general can bounce around.
Personally, I think it's far too early to conclude that it's time to change your mother's maintenance regimen, or even that her disease has become noticeably more active. Your doctor probably will want to wait until there are more definite signs the disease is progressing, and progressing at a fast pace, before he decides to change the regimen. People can be on maintenance with positive paraprotein (M-spike) levels and kappa-lambda ratios that plateau, or climb very slowly, over extended periods of time.
Cheers!
Ron makes an important point about your mother's M-spike having reappeared. That could be a sign that there's been a change in the myeloma activity in her body.
That said, M-spike measurement can be imprecise, and that's particularly true if your mother has IgA myeloma (I'm not sure you mentioned what type she has).
Your mother's free light chain numbers are hard to interpret given her recent infection, but the ratio is certainly the most important number. Just keep in mind that free light chain results in general can bounce around.
Personally, I think it's far too early to conclude that it's time to change your mother's maintenance regimen, or even that her disease has become noticeably more active. Your doctor probably will want to wait until there are more definite signs the disease is progressing, and progressing at a fast pace, before he decides to change the regimen. People can be on maintenance with positive paraprotein (M-spike) levels and kappa-lambda ratios that plateau, or climb very slowly, over extended periods of time.
Cheers!
Re: Increase in kappa, but decrease in kappa-lambda ratio?
Thanks for the reply Ian. Her oncologist said the same. He wants to wait for another month and retest again. He knows me for very long now and my level of anxiety. So he wants to reconfirm things before saying anything about relapse. All he said was "She had a bad infection and numbers do bounce when such things happen; we will wait for another month."‘
We do not have access to all the latest drugs here in India like the lucky folks in the U.S.
I remember the oncologist saying she has light chain disease. When diagnosed
IgG - 507 mg/l (ref 700 - 1600 mg/l)
IgA - 46 mg/l (70 - 400)
IgM - 24 mg/l (40-230)
All below range. Kappa was the only one that was high.
Sorry, but I still don’t get this whole myeloma thing.
We do not have access to all the latest drugs here in India like the lucky folks in the U.S.
I remember the oncologist saying she has light chain disease. When diagnosed
IgG - 507 mg/l (ref 700 - 1600 mg/l)
IgA - 46 mg/l (70 - 400)
IgM - 24 mg/l (40-230)
All below range. Kappa was the only one that was high.
Sorry, but I still don’t get this whole myeloma thing.
Re: Increase in kappa, but decrease in kappa-lambda ratio?
Based on the test results you posted, your mom's "involved" light chain is kappa.
The reference (normal) levels for the light chains are as follows:
Kappa - 3.3-19.4 mg/L
Lambda - 5.7 - 26.3 mg/L
Kappa-lambda ratio - 0.26-1.65
The involved chain is the one that is outside the norm, usually way above the top of the range. In your mom's case, that was the kappa chain, which was originally measured 1150 mg/L. The kappa-lambda ratio is simply dividing the kappa number by the lambda number. In her original diagnosis, that would be 1150/7.12 = 161.52 With light chain myeloma, the serum free light chain test is a better measure then the serum protein electrophoresis (SPEP) test (which measures the M-spike).
Results of the serum free light chain test can be impacted by infections and there are other discussion on this board that have gone into that. For example:
"Kappa & lambda light chain levels & colds and viruses" (started Sep 25, 2016)
In the U.S., maintenance is more common with Revlimid or Velcade, each either alone or with dexamethasone. Should she need to switch maintenance regimens, you might ask if a Revlimid or Velcade regimen would be an option.
The reference (normal) levels for the light chains are as follows:
Kappa - 3.3-19.4 mg/L
Lambda - 5.7 - 26.3 mg/L
Kappa-lambda ratio - 0.26-1.65
The involved chain is the one that is outside the norm, usually way above the top of the range. In your mom's case, that was the kappa chain, which was originally measured 1150 mg/L. The kappa-lambda ratio is simply dividing the kappa number by the lambda number. In her original diagnosis, that would be 1150/7.12 = 161.52 With light chain myeloma, the serum free light chain test is a better measure then the serum protein electrophoresis (SPEP) test (which measures the M-spike).
Results of the serum free light chain test can be impacted by infections and there are other discussion on this board that have gone into that. For example:
"Kappa & lambda light chain levels & colds and viruses" (started Sep 25, 2016)
In the U.S., maintenance is more common with Revlimid or Velcade, each either alone or with dexamethasone. Should she need to switch maintenance regimens, you might ask if a Revlimid or Velcade regimen would be an option.
-
Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
Re: Increase in kappa, but decrease in kappa-lambda ratio?
Thanks for the reply Ron. I always thought that there should be some heavy chain included with the light chain. so if so am not wrong, based on my mothers numbers, she has kappa light chain disease. Nothing like IgG lambda or IgA kappa.
I will surely ask the oncologist about Revlimid as it is available here, as is dexamethasone. My mother took cyclophosphamide, bortezomib (Velcade), and dexamethasone (CyBorD) treatment very well with no side effects except for constipation on the day of IV. That was solved with softeners. Hope she takes other medications well too.
With light chain I did read that kidneys can be affected. My mother's kidneys are perfect and creatinine levels too looking great. Only worry is the bone lesions which scare me a lot!
She is off maintenance for a month now and had a minor surgery 15 days back (haemorrhoidopexy). I need to ask her oncologist about restarting the maintenance. Hope the kappa numbers are not misbehaving without cyclophosphamide around for a month.
I have read a lot of your posts and I see that you too have not undergone a transplant. Your posts are so encouraging for people like my mother who can’t go for a transplant. Thank you.
I will surely ask the oncologist about Revlimid as it is available here, as is dexamethasone. My mother took cyclophosphamide, bortezomib (Velcade), and dexamethasone (CyBorD) treatment very well with no side effects except for constipation on the day of IV. That was solved with softeners. Hope she takes other medications well too.
With light chain I did read that kidneys can be affected. My mother's kidneys are perfect and creatinine levels too looking great. Only worry is the bone lesions which scare me a lot!
She is off maintenance for a month now and had a minor surgery 15 days back (haemorrhoidopexy). I need to ask her oncologist about restarting the maintenance. Hope the kappa numbers are not misbehaving without cyclophosphamide around for a month.
I have read a lot of your posts and I see that you too have not undergone a transplant. Your posts are so encouraging for people like my mother who can’t go for a transplant. Thank you.
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