My husband's test results have remained quite stable over all areas for many years except for slowly increasing paraprotein levels which again only went up in slight increments to a high of 15.2 in September last year then down to 14.5 when he started Velcade and last level on 28/12 was 13.5. Hoping to get a further reading today or next week. However, the only thing that has been going all over the place is the free kappa. Readings were 24.9 on 12/3/10 then 41.4 in May, 46.7 in July, 41.6 in Feb 2010, 63.9 in May 2010, 47.1 in Nov 2011, 52.7 on 2/12/11, 42.8 9/12/11 then 68.7 28/12, 59.1 6/1/12, 54.4 on 13/1, 82.0 3rd Feb 2012 (after being off Velcade for two weeks as we went on vacation).. Free lambada is constant at 8.3 all the time but the kappa/lambada ratio is increasing. Last one 9.84. january it was 5.96.
Total kappa and total lambada have only had a slight increase. Overall not much difference moth to month in that area. So only thing is the free kappa really.
Does this mean that the Sq Velcade is not working and the myeloma is progressing ?
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laetetia - Who do you know with myeloma?: De facto
- When were you/they diagnosed?: 2001
- Age at diagnosis: 53
Re: increasing Free Kappa
Hello from cloudy and gray Seattle!
Generally your oncologist will primarily use only one of the markers as the main register for response. In current research studies the serum free light chains are often not accepted because of their variability and because their significance in determining response has yet to be defined. This is not because serum free light chains are not a wonderful additon to our ability to follow myeloma but because the free light chain assay is so new on the scene that we are still in the process of learning how to utilize them and because serum free light chain responses cannot be compared to older studies in which these tests were not available. If his SPEP m-spike was significantly elevated (> 1.0) when he started his current therapy I would tend to follow that primarily. Another test that can be used to follow his disease is the 24 hour urine for Bence Jones proteins.
It should be noted that in some patients (late in their disease course) the myeloma can stop secreting proteins and then the only way to monitor disease is by blood counts, calcium levels, kindey function, bone radiographs and bone marrow biopsies.
I am a little surprised that the levels are being checked so often over the past couple of months. Many oncologists find that checking these tests more than once per month is not valuable ( and is of course expensive $$$).
If his renal function is normal the ratio is the key. The bottom line is that your husbands climbing kappa levels and ratio could suggest recurrent disease.
Generally your oncologist will primarily use only one of the markers as the main register for response. In current research studies the serum free light chains are often not accepted because of their variability and because their significance in determining response has yet to be defined. This is not because serum free light chains are not a wonderful additon to our ability to follow myeloma but because the free light chain assay is so new on the scene that we are still in the process of learning how to utilize them and because serum free light chain responses cannot be compared to older studies in which these tests were not available. If his SPEP m-spike was significantly elevated (> 1.0) when he started his current therapy I would tend to follow that primarily. Another test that can be used to follow his disease is the 24 hour urine for Bence Jones proteins.
It should be noted that in some patients (late in their disease course) the myeloma can stop secreting proteins and then the only way to monitor disease is by blood counts, calcium levels, kindey function, bone radiographs and bone marrow biopsies.
I am a little surprised that the levels are being checked so often over the past couple of months. Many oncologists find that checking these tests more than once per month is not valuable ( and is of course expensive $$$).
If his renal function is normal the ratio is the key. The bottom line is that your husbands climbing kappa levels and ratio could suggest recurrent disease.
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Dr. Edward Libby - Name: Edward Libby, M.D.
Beacon Medical Advisor
Re: increasing Free Kappa
Dr. Libby,
My kidney function is poor (2.5 creatinine). My myeloma is a kappa variety. Is kappa light chains or kappa/lamda ratio a better indicator?
As usual, thanks for your help!
David
My kidney function is poor (2.5 creatinine). My myeloma is a kappa variety. Is kappa light chains or kappa/lamda ratio a better indicator?
As usual, thanks for your help!
David
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Arizonan - Name: Arizonan
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: April 2010
- Age at diagnosis: 54
Re: increasing Free Kappa
Cloudy and grey in Sydney too Dr Libby. Paraprotein (M spike) levels are only checked once a month but everything else on the blood test is checked weekly. I think they are mostly looking at platelets but sometimes his potassium level elevates too and he has to get it down. He has to do a blood test every week before he gets the sq Velcade. He hasn't had to do a urine test since July last year. Ur protein was0 .27 g/l protein excr 0.49 g/day. I'm thinking he might be better off trying the sq Velcade twice weekly instead of changing to IV to see if that gets his levels down.
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laetetia - Who do you know with myeloma?: De facto
- When were you/they diagnosed?: 2001
- Age at diagnosis: 53
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