[Kj2737]

Increase in kappa & kappa / lambda light chain ratio

by Kj2737 on Wed Sep 23, 2015 3:21 pm

My mother in law was diagnosed 6 months ago with stage 3 multiple myeloma and end-stage kidney failure. She is doing peritoneal dialysis 3x per week. She did Velcade, Cytoxan, and steroid induction for two months and got very sick with a pseudo obstruction. We have been told by all doctors except the oncologist that the Cytoxan caused it, so she has only been doing the steroid and Velcade for the last three months.

Her kappa light chain has gone from 6000 to 7800 in the last month. Her ratio is 3800 and her lambda is low.

Of course the oncologist wants her to try Cytoxan, but she doesn't want to spend her end days sick. Her prognosis was broadly one to two years.

We are doing another biopsy next week, but I'm wondering what this increase in kappa means. Is her cancer not responding to the current chemo?

[Multibilly]

Re: Increase in kappa & kappa / lambda light chain ratio

by Multibilly on Wed Sep 23, 2015 5:39 pm

Sorry to hear about your mother in law.

One might consider discussing the use of doxorubicin instead of Cytoxan, given these circumstances. See this MB article and supporting study:

https://myelomabeacon.org/news/2010/11/05/experts-publish-treatment-recommendations-for-multiple-myeloma-patients-with-kidney-impairment/

http://www.ncbi.nlm.nih.gov/pubmed/20823423

A high kappa, low lambda with a high k/l ratio suggests bone marrow suppression, so that might also be something to also discuss with the oncologist. But you don't want to just look at the various free light chain values by themselves when judging a response to treatment. How's her M-spike doing and how have all these numbers been trending in general since she started treatment?

Also, is she working with a top multiple myeloma specialist or simply an oncologist that has some familiarity with multiple myeloma?

Lastly, you might want to consider anonymously registering and logging in when you post. It makes it a LOT easier to help folks if one can easily look at their earlier posts.

Take care.