[Canoz]

Increasing kappa-lambda ratio with smoldering myeloma

by Canoz on Fri Oct 19, 2018 4:17 pm

My husband (42) has had smoldering multiple myeloma for 4 years now, and his numbers have remained steady so far, with an M-spike of between 16 and 20 g/L (1.6 and 2.0 g/dl).

However, his last two readings have been concerning, and we are having repeat bloods in 10 weeks.

May-2016
Free Kappa - 91.2 mg/L
Free Lambda - 9.1 mg/L
Kappa/Lambda ratio - 10

Sep-2016
Free Kappa - 308
Free Lambda - 11.4 mg/L
Kappa/Lambda ratio - 27

I don't have copies of blood results when he was first diagnosed, but the kappa-lambda ratio was around 3 or 4.

Is it possible that the ratio will stop going up, and my husband will be able to continue to be smoldering for a long time? Or does a jump like this usually lead to further increases?

We are concerned the disease is sneaking up on us.

[Arizonan]

Re: Increasing kappa-lambda ratio with smoldering myeloma

by Arizonan on Fri Oct 19, 2018 10:45 pm

Canoz,

It’s likely those numbers will continue to go up, hopefully at a slow rate. What’s most important is not having high calcium, high creatinine, low hemoglobin, bone damage, or frequent infections. If these are not happening, and your husband's kappa-lambda ratio is under 100, it’s not likely a doctor will recommend treatment.

It’s important to remember your husband has a great advantage, the myeloma was discovered at an early stage. If and when your husband requires treatment, the myeloma will be at a relatively low level, and there are a lot of effective drugs (some with few side effects) to push his numbers back down. As a contrast, when my myeloma was discovered, my kappa-lambda ratio was around 1000!

Good luck,

David

[Dimamar]

Re: Increasing kappa-lambda ratio with smoldering myeloma

by Dimamar on Sun Oct 21, 2018 11:49 pm

Canoz,

Did you mean May and September of 2018, not 2016?

Anyway, one should not be too concerned about one lab test. When I was just being diagnosed (MGUS first), the kappa free light chain result the first time was 80, and the next reading was 260. Later, my new doctor told me that they were getting new machines / recalibrating that time, so everyone's readings went up a few times. However, the ratio stayed close around 30, but still, I would watch it and repeat, but not get concerned yet.

I also had a situation (with different clinic) when lambda reading one test was very low, bringing ratio up to 65 from 25-30. That was apparently a lab error.

And just few days ago, my new test came, and it was clearly not my blood. Ratio of 0.7, normal or high IgA/IgM (that I have very low), etc.

So, watch it closely and hopefully the trend will stop or slow down.

As David said, you are still far from requiring a treatment, provided no CRAB symptoms.

Good luck!

[DonnaMarie]

Re: Increasing kappa-lambda ratio with smoldering myeloma

by DonnaMarie on Mon Oct 29, 2018 1:52 pm

Good afternoon Canoz:

I was recently diagnosed with smoldering myeloma so I can certainly understand your concern about the increase in your kappa-lambda ratio.

I suppose all we can really do is continue to move forward in life, in the most positive way, enjoy the moments we have, the memories that we make and hope for a cure or better treatment options so that we are around for a very long time.

I just had my follow up appointment with my oncologist, I had my most recent blood test early in October and got free light chain and M-spike results, but the lab forgot to run my IgG, IgA, IgM, so I had to go back last week to get that blood drawn. I should have results by this week.

David, I do not know how I would have handled being told that my kappa-lambda ratio was 1000

As others have stated, you need to keep an eye on trends and not just one set of lab results, and you are not even close to a "myeloma defining event" as far as the kappa-lambda ratio goes, but as stated by Dimamar, you also have to watch out for C.R.A.B.

Try and have a nice week.

Donna Marie