I have just gotten the following results and don't quite understand them.
Free Kappa 83.13 mg. per liter.
Free lambda 16.07 mg. per liter
K/L ratio 5.17.
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Re: Interpreting free light chain assay results
What you are describing are results of the free light chain assay.
A normal FLC Assay
Kappa: 3.3-19.4
Lambda: 5.71-26.3
Ratio: .26-1.65
Based on your numbers, your kappa light chain is high and the ratio is high. This indicates that there is overproduction of the kappa light chains that has spilled out into your blood. It indicates the possibility of multiple myeloma. However other tests need to be run.
Although your numbers are high, they are not extremely high, and you may have MGUS or smoldering myeloma and not full blown multiple myeloma. You probably had other blood tests such as serum protein electrophoresis (SPEP) which combined with the free light chain assay would determine if you have multiple myeloma or not. You should discuss these results with your oncologist.
Generally a person with symptomatic multiple myeloma has to have one or more of the following features aka know as C.R.A.B.
C - elevated Calcium levels
R - Renal (kidney) impairment
A - Anemia
B - Bone lesions
Ron
A normal FLC Assay
Kappa: 3.3-19.4
Lambda: 5.71-26.3
Ratio: .26-1.65
Based on your numbers, your kappa light chain is high and the ratio is high. This indicates that there is overproduction of the kappa light chains that has spilled out into your blood. It indicates the possibility of multiple myeloma. However other tests need to be run.
Although your numbers are high, they are not extremely high, and you may have MGUS or smoldering myeloma and not full blown multiple myeloma. You probably had other blood tests such as serum protein electrophoresis (SPEP) which combined with the free light chain assay would determine if you have multiple myeloma or not. You should discuss these results with your oncologist.
Generally a person with symptomatic multiple myeloma has to have one or more of the following features aka know as C.R.A.B.
C - elevated Calcium levels
R - Renal (kidney) impairment
A - Anemia
B - Bone lesions
Ron
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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: Interpreting free light chain assay results
I have a question also about interpreting serum free light chain results. My lab results are within normal ranges for everything except a low level of 'M' protein. The serum free light chain results are normal, both in the amounts of free light chains present and also the ratio. How can this be?
I thought that the free light chain test was more sensitive than the SPEP test. Any thoughts on this?
I have had two lab tests since August with similar results. The 'm' proteins are rising slightly. The latest tests showed
Monoclonal #1 - 2.4
Monoclonal #2 - 1.6
(In US values I think these are 0.24 and 0.16)
(Of course, there are no 'normal' values for M protein)
Kappa free light chain level - 12.20 (normal values 3.30 - 19.40)
Lambda free light chain level - 10.10 (normal values 5.71 - 26.30)
Kappa / lambda free light chain ratio - 1.21 (normal values 0.26 - 1.65
Thanks for any insights on these results.
I thought that the free light chain test was more sensitive than the SPEP test. Any thoughts on this?
I have had two lab tests since August with similar results. The 'm' proteins are rising slightly. The latest tests showed
Monoclonal #1 - 2.4
Monoclonal #2 - 1.6
(In US values I think these are 0.24 and 0.16)
(Of course, there are no 'normal' values for M protein)
Kappa free light chain level - 12.20 (normal values 3.30 - 19.40)
Lambda free light chain level - 10.10 (normal values 5.71 - 26.30)
Kappa / lambda free light chain ratio - 1.21 (normal values 0.26 - 1.65
Thanks for any insights on these results.
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: Interpreting free light chain assay results
Dear Nancy,
The extent of free light chain production by someone's myeloma varies considerably from one person to the next. We see a lot of patients with intact immunoglobulin myeloma (IgG kappa, IgA lambda, etc) with residual M protein on SPEP testing, but normal serum free light chain testing. The fact that the light chain levels are normal is encouraging in that there does not appear to be immunoparesis (i.e. impairment of normal plasma cell antibody production). Additionally, you do not have evidence of free light chain escape, which means there is no emerging sub-clone of myeloma that is expressing light chains only.
The serum free light chain test is more sensitive for detecting free light chain (kappa or lambda) multiple myeloma, but is not more sensitive at picking up heavy chain myeloma (e.g. IgG kappa or IgA lambda myeloma). The FLC testing should still be done periodically to ensure there is no free light chain escape, as noted above.
Hope this helps. Take care!
Pete V.
The extent of free light chain production by someone's myeloma varies considerably from one person to the next. We see a lot of patients with intact immunoglobulin myeloma (IgG kappa, IgA lambda, etc) with residual M protein on SPEP testing, but normal serum free light chain testing. The fact that the light chain levels are normal is encouraging in that there does not appear to be immunoparesis (i.e. impairment of normal plasma cell antibody production). Additionally, you do not have evidence of free light chain escape, which means there is no emerging sub-clone of myeloma that is expressing light chains only.
The serum free light chain test is more sensitive for detecting free light chain (kappa or lambda) multiple myeloma, but is not more sensitive at picking up heavy chain myeloma (e.g. IgG kappa or IgA lambda myeloma). The FLC testing should still be done periodically to ensure there is no free light chain escape, as noted above.
Hope this helps. Take care!
Pete V.
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Dr. Peter Voorhees - Name: Peter Voorhees, M.D.
Beacon Medical Advisor
Re: Interpreting free light chain assay results
Dear Dr. Voorhees,
Thanks so much for your detailed response. It was encouraging and you are kind to take the time to outline the background behind the interpretation of the free light chain vs. monoclonal SPEP tests. It seems that the 'heavy chains' and the 'light chains' are somewhat independent of each other. I do have both of these tests, as well as other blood tests, done for every appointment.
Thanks so much for your detailed response. It was encouraging and you are kind to take the time to outline the background behind the interpretation of the free light chain vs. monoclonal SPEP tests. It seems that the 'heavy chains' and the 'light chains' are somewhat independent of each other. I do have both of these tests, as well as other blood tests, done for every appointment.
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: Interpreting free light chain assay results
I also have a question on the light chains. I am newly diagnosed with MGUS but also have an elevated light chain ratio (2.03) and an elevated kappa light chain (37.96 ). At this time, I have no symptoms such as bone lesions or renal issues, and my other blood work has come back within the normal range. I also had a SPEP done which did not show any M spike. I do have abnormal bone marrow changes that were noted on an MRI that was done for a shoulder injury. At this time, the doctors are watching me carefully. I will get a repeat blood work done in November.
In the meantime I am trying to learn as much as I can. From what I understand, the elevated ratio is a concern. But everything I am reading says that if the ratio is abnormal, it indicates that the myeloma is active. Yet they gave me an MGUS diagnosis. Why?
Is it since my levels are just slightly over the typical and there was no M spike? From what I could find on light chain MGUS, I do fit in the categories. Did not have a bone marrow biopsy, but everything else fits.
I also read that the serum light chain tests can detect mildly increased levels of free light chains even when these levels are undetectable by SPEP and IFE. So doesn't this means that multiple myeloma could be detected earlier than might be possible with either SPEP or IFE, and it is particularly useful in instances when only small amounts of light chains are produced by the myeloma?
Also, a study from the Mayo Clinic showed that patients with monoclonal gammopathy of undetermined significance (MGUS) who also have an abnormal free light chain ratio are more likely to progress and develop active myeloma or a related malignant condition.
I also have other medical issues. I have diastolic dysfunction and pulmonary hypertension to name a few. I also have repeated sinus infections and inflammatory arthritis that is not yet diagnosed. A recent ANA tests came back positive and I will see the rheumatologist next month.
Am I understanding all of this correctly?
In the meantime I am trying to learn as much as I can. From what I understand, the elevated ratio is a concern. But everything I am reading says that if the ratio is abnormal, it indicates that the myeloma is active. Yet they gave me an MGUS diagnosis. Why?
Is it since my levels are just slightly over the typical and there was no M spike? From what I could find on light chain MGUS, I do fit in the categories. Did not have a bone marrow biopsy, but everything else fits.
I also read that the serum light chain tests can detect mildly increased levels of free light chains even when these levels are undetectable by SPEP and IFE. So doesn't this means that multiple myeloma could be detected earlier than might be possible with either SPEP or IFE, and it is particularly useful in instances when only small amounts of light chains are produced by the myeloma?
Also, a study from the Mayo Clinic showed that patients with monoclonal gammopathy of undetermined significance (MGUS) who also have an abnormal free light chain ratio are more likely to progress and develop active myeloma or a related malignant condition.
I also have other medical issues. I have diastolic dysfunction and pulmonary hypertension to name a few. I also have repeated sinus infections and inflammatory arthritis that is not yet diagnosed. A recent ANA tests came back positive and I will see the rheumatologist next month.
Am I understanding all of this correctly?
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patti1963 - Name: Patti1963
- When were you/they diagnosed?: MGUS
- Age at diagnosis: 51
Re: Interpreting free light chain assay results
Hi Patty,
I think some of your confusion here is based on what you think the various test results indicate.
The IFE and SPEP don't indicate the presence of monoclonal free light chains. Those tests instead indicate the presence of monoclonal immunoglobulins (heavy chains) and measure the amount of those mononclonal heavy chains, respectively. On the other hand, the free light chain assay instead measures the presence of free light chains (light chains that are basically floating around in your blood unattached from a heavy chain).
So, your serum tests are indicating that you have no monoclonal heavy chains present in your blood, but you do have a slightly elevated amount of kappa free light chains. But, the elevation in the kappa is quite small, as is your free light chain ratio (one starts to worry when the ratio gets up in the range of 100, so you have a very enviable free light chain ratio at 2.03). So, it sounds like you could have light chain MGUS (which is fairly rare), where your myeloma cells are only throwing off monoclonal free light chains ... and then only at a very low rate.
You also say that you are surprised that your tests are showing that your multiple myeloma is "active", yet you have a diagnosis of MGUS. Both stages of early multiple myeloma (MGUS and smoldering multiple myeloma) have some amount of active monoclonal protein production going on. After all, if you had no detectable monoclonal proteins in your body (heavy or light), you wouldn't have a diagnosis of MGUS at all. So, it's all a question of degree of monoclonal protein production and if there is any organ damage that separates a diagnosis from MGUS from smoldering multiple myeloma from symptomatic multiple myeloma.
I'm not a doc, but since you haven't had a bone marrow biopsy to confirm if you actually have myeloma cells in your bone marrow, I think there might also be the possibility that none of this is being caused by a monoclonal gammopathy and that you may just have a blip in your free light chain numbers due to infection, etc. Getting re-tested will help confirm this.
If it does end up being MGUS, remember that the risk of it turning into symptomatic multiple myeloma is only about 1% per year. Many, many people cruise through life with MGUS and are never any the worse for it ... or even know that they have it.
Hope this helps.
I think some of your confusion here is based on what you think the various test results indicate.
The IFE and SPEP don't indicate the presence of monoclonal free light chains. Those tests instead indicate the presence of monoclonal immunoglobulins (heavy chains) and measure the amount of those mononclonal heavy chains, respectively. On the other hand, the free light chain assay instead measures the presence of free light chains (light chains that are basically floating around in your blood unattached from a heavy chain).
So, your serum tests are indicating that you have no monoclonal heavy chains present in your blood, but you do have a slightly elevated amount of kappa free light chains. But, the elevation in the kappa is quite small, as is your free light chain ratio (one starts to worry when the ratio gets up in the range of 100, so you have a very enviable free light chain ratio at 2.03). So, it sounds like you could have light chain MGUS (which is fairly rare), where your myeloma cells are only throwing off monoclonal free light chains ... and then only at a very low rate.
You also say that you are surprised that your tests are showing that your multiple myeloma is "active", yet you have a diagnosis of MGUS. Both stages of early multiple myeloma (MGUS and smoldering multiple myeloma) have some amount of active monoclonal protein production going on. After all, if you had no detectable monoclonal proteins in your body (heavy or light), you wouldn't have a diagnosis of MGUS at all. So, it's all a question of degree of monoclonal protein production and if there is any organ damage that separates a diagnosis from MGUS from smoldering multiple myeloma from symptomatic multiple myeloma.
I'm not a doc, but since you haven't had a bone marrow biopsy to confirm if you actually have myeloma cells in your bone marrow, I think there might also be the possibility that none of this is being caused by a monoclonal gammopathy and that you may just have a blip in your free light chain numbers due to infection, etc. Getting re-tested will help confirm this.
If it does end up being MGUS, remember that the risk of it turning into symptomatic multiple myeloma is only about 1% per year. Many, many people cruise through life with MGUS and are never any the worse for it ... or even know that they have it.
Hope this helps.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Interpreting free light chain assay results
Thank you for taking the time to explain things.
I did receive the doctors note and he gave me the diagnosis of IgA kappa MGUS, but since there is no M spike, they will just monitor me every 6 months. I guess we shall know more in November.
Thank you again.
I did receive the doctors note and he gave me the diagnosis of IgA kappa MGUS, but since there is no M spike, they will just monitor me every 6 months. I guess we shall know more in November.
Thank you again.
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patti1963 - Name: Patti1963
- When were you/they diagnosed?: MGUS
- Age at diagnosis: 51
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