I am an 83 yr. old male that discovered I had multiple myeloma in 2006.
Since that time, my oncologists have used the Kappa Light Chain (KLC) reading in my blood work as a marker for how my multiple myeloma is progressing.
I was first put on Revilimid plus 20 mg of DEX but when my KLC slowly moved up to 500, they decided to put me on Velcade plus DEX. It immediately went down to 5 and then 1.29. It stayed there for a couple months and the doctors took me off of the Velcade for four months with only half the dosage of the DEX. In time, the KLC started slowly going up. They then started me back on the Velcade plus DEX and now the KLC is around 70.
I'm hoping it won't go up but I'm wondering if the KLC marker is a good measurement for whether the multiple myeloma is progressing or not. What do other multiple myeloma patient's oncologists use as a standard measurement for determining how their multiple myeloma is progressing or not progressing and what constitutes "remission" when it comes to multiple myeloma?
Moderator note: This question originally was posted as a comment on this article,
https://myelomabeacon.org/news/2010/11/15/velcade-bortezomib-may-increase-bone-formation-in-multiple-myeloma-patients/
but was moved here so it might have a better chance of being answered.
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Re: Is KLC a good measure for disease progression?
Kappa light chain can be a manner in which to follow your disease.
As you may already know myeloma is a disease characterized (classically) by the clonal expression of a single antibody or part of an antibody by bone marrow resident plasama cells. Therefore, we can measure the amount of antibody in your serum (blood) or urine by several different methods. SPEP (serum protein electrophoresis) giving you a serum M-spike with immunofixation (tells you what kind of antibody and slightly more sensitive); UPEP and IFE (from your urine); quantitative immunoglobulins (non-specific measurement of immunoglobulin heavy chains (IgG or IgA predominantly); serum free light chains (measuring small aspects of the light chains). In most people with myeloma one can pick up the clonal antibody by all of these methods. However, in smaller percentages of individuals one only meaures protein in the urine and not the serum. In an even smaller percentage one can only find the clonal paraprotein by serum free light chains, because the myeloma cells only make a small amount and only a portion of the antibody. Prior to the utilization of SFLC analysis these people were referred to as non-secretory disease. Now we consider them oligosercretory disease, because we can meaure there disease in the serum with the more sensitive test. So, if this has always been the case with your disease, then it is perfectly appropriate to follow your disease this way. More typically, we actually follow the kappa to lambda ratio (should a a true representation of the tumor burden.
Merry Christmas and happy holidays.
As you may already know myeloma is a disease characterized (classically) by the clonal expression of a single antibody or part of an antibody by bone marrow resident plasama cells. Therefore, we can measure the amount of antibody in your serum (blood) or urine by several different methods. SPEP (serum protein electrophoresis) giving you a serum M-spike with immunofixation (tells you what kind of antibody and slightly more sensitive); UPEP and IFE (from your urine); quantitative immunoglobulins (non-specific measurement of immunoglobulin heavy chains (IgG or IgA predominantly); serum free light chains (measuring small aspects of the light chains). In most people with myeloma one can pick up the clonal antibody by all of these methods. However, in smaller percentages of individuals one only meaures protein in the urine and not the serum. In an even smaller percentage one can only find the clonal paraprotein by serum free light chains, because the myeloma cells only make a small amount and only a portion of the antibody. Prior to the utilization of SFLC analysis these people were referred to as non-secretory disease. Now we consider them oligosercretory disease, because we can meaure there disease in the serum with the more sensitive test. So, if this has always been the case with your disease, then it is perfectly appropriate to follow your disease this way. More typically, we actually follow the kappa to lambda ratio (should a a true representation of the tumor burden.
Merry Christmas and happy holidays.
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Dr. Ken Shain - Name: Ken Shain, M.D., Ph.D.
Beacon Medical Advisor
Re: Is KLC a good measure for disease progression?
Dr. Shain - Thanks for your inputs. Would you kindly clarify your last point--the one about using the K/L ratio. Are you saying that in light chain-only patients, you prefer using the K/L ratio to measure tumor burden instead of the absolute value of the involved light chain? If so, would you explain why? On a separate issue, might you be willing to provide your thoughts on using a normalized K/L ratio as part of the stringent CR criteria? There seems to be some skepticism about this criterion, especially in light of de Larrea's 2009 findings about the oligoclonal bands and abnormal rations. Thanks, and happy holidays to you.
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Glad200
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