Hello,
I am new to the forum. I was diagnosed with MGUS a year ago, and IgG kappa smoldering multiple myeloma in June after a bone marrow biopsy showed 20%.
My first doc did a bone survey and it showed a lesion on the skull. Said the disease was Stage 1 multiple myeloma and recommended treatment with Velcade, Revlimid, and dexamethasone. However, another doctor ordered a CT scan of the skull, which showed no lesion, and so the diagnosis was determined to be smoldering multiple myeloma.
High risk smoldering, that is, as my kappa/lambda ratio is 25-33, and I have immunoparesis: uninvolved immunoglobulins IgA and IgM are low – half the lower margin and on declining trend.
My last test, however, showed a big jump in kappa/lambda free light chain ratio to 65 from 25 in 2 months. Kappa increased a bit, yet lambda got 2+ times lower, thus the jump in ratio.
I repeated the test 2 weeks later (after starting curcumin treatment) and the ratio was back to my "normal" range of 20+
Could the test with the high ratio (65) have been an error?
Thank you!
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7 posts
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Re: Jump in kappa-lambda light chain ratio - is it an error?
Yes, the free light chain lab results could easily have been due to a lab error. Most of us who have undergone a lot of testing over the years have suffered at least one or two "labomas". In fact, my specialist likes to say "if you don't like your labs, just repeat them." 
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Jump in kappa-lambda light chain ratio - is it an error?
Thanks, Multibilly! You are just tremendous with your knowledge, analytical skills and sharing your knowledge so generously.
Since they measure in g/dl, lambda dropped to 0.3 from 0.7. Perhaps smaller values (as opposed to measuring in g/L ) increase the chance for error?
My oncologist though said that the ratio is the key as, similar to immunoglobulins, kappa free light chains can suppress lambda ones, so these get too low while kappa is high.
I am also faced with the fact that on my last two 24- hour urine tests, immunofixation was not ordered (and that's what looks for Bence-Jones), so I had to repeat that and am waiting for results now. Unfortunately, the second hospital system I use has a faltering online system, so I just cannot see results online. Best bet is to call and have these printed.
So my M protein is 0.5 g/dl (5 g/l) and pretty steady over the last year, but high free light chain ratio and suppressed uninvolved immunoglobulins put me at high risk.
Since they measure in g/dl, lambda dropped to 0.3 from 0.7. Perhaps smaller values (as opposed to measuring in g/L ) increase the chance for error?
My oncologist though said that the ratio is the key as, similar to immunoglobulins, kappa free light chains can suppress lambda ones, so these get too low while kappa is high.
I am also faced with the fact that on my last two 24- hour urine tests, immunofixation was not ordered (and that's what looks for Bence-Jones), so I had to repeat that and am waiting for results now. Unfortunately, the second hospital system I use has a faltering online system, so I just cannot see results online. Best bet is to call and have these printed.
So my M protein is 0.5 g/dl (5 g/l) and pretty steady over the last year, but high free light chain ratio and suppressed uninvolved immunoglobulins put me at high risk.
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Dimamar - When were you/they diagnosed?: June, 2016
- Age at diagnosis: 54
Re: Jump in kappa-lambda light chain ratio - is it an error?
You may find this article of interest. It summarizes the new modern criteria for when to start treatment for multiple myeloma in absence of any of the classic "CRAB" features.
Rajkumar, SV, "New Criteria For The Diagnosis Of Multiple Myeloma And Related Disorders," The Myeloma Beacon, Oct 26, 2014
Nothing you mentioned so far would indicate numbers that are high enough to be considered "myeloma defining events" (MDEs), which would indicate treatable multiple myeloma.
Even a kappa-lambda ratio of 65 is well below the 100 or greater number mentioned in the article. Also, a 20% plasma cell percentage is far less the 60% mentioned. Even if a lesion is found, it must be 5 millimeter or greater.
Hope you remain smoldering for a long time like Multibilly.
Rajkumar, SV, "New Criteria For The Diagnosis Of Multiple Myeloma And Related Disorders," The Myeloma Beacon, Oct 26, 2014
Nothing you mentioned so far would indicate numbers that are high enough to be considered "myeloma defining events" (MDEs), which would indicate treatable multiple myeloma.
Even a kappa-lambda ratio of 65 is well below the 100 or greater number mentioned in the article. Also, a 20% plasma cell percentage is far less the 60% mentioned. Even if a lesion is found, it must be 5 millimeter or greater.
Hope you remain smoldering for a long time like Multibilly.
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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: Jump in kappa-lambda light chain ratio - is it an error?
Thank you so much, Ron! Yes, that's the hope - to stay smoldering.
I did know about new MDEs, yet the article and comments by Dr. Rajkumar were very helpful.
I find these Beacon forums a tremendous resource.
I'm starting experimental turmeric treatment now. Started 1 g/day and increasing 1 g/ day to 8 g/day. Already feeling stomach upset (which has been the issue all my life), will see if I can tolerate it.
I did know about new MDEs, yet the article and comments by Dr. Rajkumar were very helpful.
I find these Beacon forums a tremendous resource.
I'm starting experimental turmeric treatment now. Started 1 g/day and increasing 1 g/ day to 8 g/day. Already feeling stomach upset (which has been the issue all my life), will see if I can tolerate it.
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Dimamar - When were you/they diagnosed?: June, 2016
- Age at diagnosis: 54
Re: Jump in kappa-lambda light chain ratio - is it an error?
Starting turmeric 8 g / day, but read some threads on this here, specifically "The dark side of curcumin" by MultiBilly, and starting to have second thoughts, especially given that lower back pain has intensified today.
Also, 24-hour urine is back, and a bit elevated creatinine and total protein, but appears like no Bence Jones, or so it seems?
Test Name Flags Units Ref Range
Collection period 24
Colume 3550
Creatinine H 2.62 0.87-2.4
Total protein, 24h H 180 mg/24h 0-149
Gamma globulin H 13.3 mg/L 0-12
Discrete bands none detected
Immunofixation interpretation: Normal[/normal]
Interesting that gamma globulin in serum is 0.3 g/dl and is low, used to be 0.9 a year ago.
If someone could comment on above, would really appreciate it.
Also, 24-hour urine is back, and a bit elevated creatinine and total protein, but appears like no Bence Jones, or so it seems?
Test Name Flags Units Ref Range
Collection period 24
Colume 3550
Creatinine H 2.62 0.87-2.4
Total protein, 24h H 180 mg/24h 0-149
Gamma globulin H 13.3 mg/L 0-12
Discrete bands none detected
Immunofixation interpretation: Normal[/normal]
Interesting that gamma globulin in serum is 0.3 g/dl and is low, used to be 0.9 a year ago.
If someone could comment on above, would really appreciate it.
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Dimamar - When were you/they diagnosed?: June, 2016
- Age at diagnosis: 54
Re: Jump in kappa-lambda light chain ratio - is it an error?
All I can add is that I've had major blood work quite a few times this year as well as two bone marrow biopsies since April, and I can see that free light chain results have varied quite a bit as well as several values.
Here are the values that have been consistent:
- Percentage of plasma cells and their morphology
- Immunoparesis – low IgM, near 25 (range of 35-243)
- IgG M-spike finally this year remains steady near 1.0 g/dL
- Immunofixation urine and UPEP indicate Bence Jones proteinuria IgG kappa
- Thankfully my H&H are at the low end of normal, so finally I'm not anemic
- Alpha 1, SPEP, is always high.
New lab values that have changed
- Folate is now high
- Reticulocyte count is a little higher than standard range
- GFR has dropped every time this year after always being at 100+; it's now 89
The latest GFR results of 89 is the high end of mild kidney impairment. Hopefully this is a one off and it returns to normal next tine
Guess what I wanted to point out is that my kappa and lambda free light chain levels vary quite a bit, so it's likely normal tot vary and just that most of us don't get tested very often.
Good luck.
Here are the values that have been consistent:
- Percentage of plasma cells and their morphology
- Immunoparesis – low IgM, near 25 (range of 35-243)
- IgG M-spike finally this year remains steady near 1.0 g/dL
- Immunofixation urine and UPEP indicate Bence Jones proteinuria IgG kappa
- Thankfully my H&H are at the low end of normal, so finally I'm not anemic
- Alpha 1, SPEP, is always high.
New lab values that have changed
- Folate is now high
- Reticulocyte count is a little higher than standard range
- GFR has dropped every time this year after always being at 100+; it's now 89
The latest GFR results of 89 is the high end of mild kidney impairment. Hopefully this is a one off and it returns to normal next tine
Guess what I wanted to point out is that my kappa and lambda free light chain levels vary quite a bit, so it's likely normal tot vary and just that most of us don't get tested very often.
Good luck.
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pinball - Who do you know with myeloma?: Myself
- When were you/they diagnosed?: 2010 MGUS, 2014 Smoldering
- Age at diagnosis: 39
7 posts
• Page 1 of 1