In terms of kappa FLC, is a 30 with a low, abnormal beta-2 microglobulin anything to be concerned with as it pertains to MGUS or smoldering myeloma?
Thank you in advance. I also have a high IgA & a slight increase in Kappa over 6 months. Nothing on SPEP.
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Re: Level of kFLC for MGUS or smoldering myeloma diagnosis?
I'm sorry, the beta-2-microglobulin is slightly elevated too.
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rosa
Re: Level of kFLC for MGUS or smoldering myeloma diagnosis?
Not sure what you are really looking for here Rosa.
If you are MGUS or SMM, the big concern is whether you are becoming symptomatic by monitoring any CRAB issues (C = Calcium (elevated), R = Renal failure, A = Anemia, B = Bone lesions).
You have an elevated IgA and an elevated B2M, but no M-spike on your SPEP? That seems a bit peculiar to me. Your measured IgA is the sum of your normal IgA and the abnormal IgA (your abnormal IgA level = your M-spike). So, what is causing your overall IgA to be elevated if you don't have an M-spike?
Did you have an M-spike on an earlier test? Could it just be that this one SPEP test was off and should be repeated?
If you are MGUS or SMM, the big concern is whether you are becoming symptomatic by monitoring any CRAB issues (C = Calcium (elevated), R = Renal failure, A = Anemia, B = Bone lesions).
You have an elevated IgA and an elevated B2M, but no M-spike on your SPEP? That seems a bit peculiar to me. Your measured IgA is the sum of your normal IgA and the abnormal IgA (your abnormal IgA level = your M-spike). So, what is causing your overall IgA to be elevated if you don't have an M-spike?
Did you have an M-spike on an earlier test? Could it just be that this one SPEP test was off and should be repeated?
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Level of kFLC for MGUS or smoldering myeloma diagnosis?
Sometimes low-level IgA M-spikes can be difficult to pick up on the SPEP because they blend into the background of the other proteins. So the IgA level may be a better way to follow your particular myeloma protein.
The standard of care for smoldering myeloma remains close observation, so as long as you don't have the CRAB criteria you generally wouldn't need to start treatment.
In terms of the kappa FLC, what's more important than the absolute value is the ratio of the free kappa to the free lambda. There are data suggesting that patients with a very abnormal ratio (>8 or <0.125) have a higher risk of progressing to active myeloma (about 50% at 2 years). Patients in this high-risk category may be good candidates for clinical trials looking at novel therapies aimed at trying to delay or prevent progression.
The standard of care for smoldering myeloma remains close observation, so as long as you don't have the CRAB criteria you generally wouldn't need to start treatment.
In terms of the kappa FLC, what's more important than the absolute value is the ratio of the free kappa to the free lambda. There are data suggesting that patients with a very abnormal ratio (>8 or <0.125) have a higher risk of progressing to active myeloma (about 50% at 2 years). Patients in this high-risk category may be good candidates for clinical trials looking at novel therapies aimed at trying to delay or prevent progression.
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Dr. Adam Cohen - Name: Adam D. Cohen, M.D.
Beacon Medical Advisor
Re: Level of kFLC for MGUS or smoldering myeloma diagnosis?
Does the statement of 50% chance to progress in 2 years with an FLC ratio of < 0.125 apply regardless of other factors like % of plasma cells and Mspike value ?
Re: Level of kFLC for MGUS or smoldering myeloma diagnosis?
If you are talking about the study below, the answer is "yes, the FLC ratio was characterized in this study as being an independent marker".
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3629951/?report=classic
However, note the significant limitations of this study, especially the lack of correlating cytogenetic info, which is increasingly becoming a key metric for risk stratification of SMM patients.
"...The primary limitation of our study is the retrospective nature of its design. In addition, it was not statistically powered for further subgroup analysis by cytogenetics or other risk factors. An inherent advantage and disadvantage was the long period of patient eligibility spanning from 1970 to 2010, which allowed a larger study population but may have also introduced an increased number of confounders because of changes in imaging, physician practice styles and the less rigorous clinical documentation in previous decades. Despite these limitations, our findings show that patients with markedly high FLC ratio (≥100) are at high risk of progression to multiple myeloma or related disorder within 2 years of diagnosis and hence may be considered candidates for intervention, especially as the mode of progression in this subset is likely to be renal failure in a substantial proportion of patients."
Like any marker, you shouldn't look at any given marker just by itself. You HAVE to consider all the other markers when gauging if you are likely to progress, IMHO.
In my case, I have a 0.04 FLC ratio, yet my other markers are pretty encouraging....and I'm still smoldering after 18 months. From just an FLC ratio point of view, I would think I was basically screwed from a progression point-of-view, which I (and my doctors) firmly believe is NOT the case.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3629951/?report=classic
However, note the significant limitations of this study, especially the lack of correlating cytogenetic info, which is increasingly becoming a key metric for risk stratification of SMM patients.
"...The primary limitation of our study is the retrospective nature of its design. In addition, it was not statistically powered for further subgroup analysis by cytogenetics or other risk factors. An inherent advantage and disadvantage was the long period of patient eligibility spanning from 1970 to 2010, which allowed a larger study population but may have also introduced an increased number of confounders because of changes in imaging, physician practice styles and the less rigorous clinical documentation in previous decades. Despite these limitations, our findings show that patients with markedly high FLC ratio (≥100) are at high risk of progression to multiple myeloma or related disorder within 2 years of diagnosis and hence may be considered candidates for intervention, especially as the mode of progression in this subset is likely to be renal failure in a substantial proportion of patients."
Like any marker, you shouldn't look at any given marker just by itself. You HAVE to consider all the other markers when gauging if you are likely to progress, IMHO.
In my case, I have a 0.04 FLC ratio, yet my other markers are pretty encouraging....and I'm still smoldering after 18 months. From just an FLC ratio point of view, I would think I was basically screwed from a progression point-of-view, which I (and my doctors) firmly believe is NOT the case.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Level of kFLC for MGUS or smoldering myeloma diagnosis?
Guess what confuses me is I have seen other reports that say if you have 2 out of 3 risk factors then your chances are about 40% over a 20 year span of progressing. The risk factors are:
- non-IgG type,
- abnormal FLC ratio (outside of 0.26-1.65), and
- M-spike >1.5 g/dl.
I am type IgA with an FLC of around 0.10, so I have 2/3. My M-spike is too small to record a number and my BMB plasma cell percentage was 2%.
To read that an FLC ratio below 0.125 all by itself yields a 50% chance in 2 years seems contradictory.
- non-IgG type,
- abnormal FLC ratio (outside of 0.26-1.65), and
- M-spike >1.5 g/dl.
I am type IgA with an FLC of around 0.10, so I have 2/3. My M-spike is too small to record a number and my BMB plasma cell percentage was 2%.
To read that an FLC ratio below 0.125 all by itself yields a 50% chance in 2 years seems contradictory.
Re: Level of kFLC for MGUS or smoldering myeloma diagnosis?
Confused:
Really, in your case, you seem to be in a great spot with your numbers.
I just gave up on trying to make sense out of these risk factors based on the lack of consensus in the medical industry. If I knew I was high risk or ultra high risk based on just my cytogenetics using the Mayo mSMART criteria, it would be a different matter. In that case, I might be investigating early treatment more carefully (but still not sure I would do it).
So, I just ignore my low FLC ratio, look at the general trends of all my numbers every 2-3 months, keep on the lookout for CRAB, eat exceptionally well, exercise harder every day, take lots of supplements and hope I will never progress.
Is non-IgG type multiple myeloma really a documented risk factor? I thought there was really no significance to the the type of involved immunoglobulin.
Really, in your case, you seem to be in a great spot with your numbers.
I just gave up on trying to make sense out of these risk factors based on the lack of consensus in the medical industry. If I knew I was high risk or ultra high risk based on just my cytogenetics using the Mayo mSMART criteria, it would be a different matter. In that case, I might be investigating early treatment more carefully (but still not sure I would do it).
So, I just ignore my low FLC ratio, look at the general trends of all my numbers every 2-3 months, keep on the lookout for CRAB, eat exceptionally well, exercise harder every day, take lots of supplements and hope I will never progress.
Is non-IgG type multiple myeloma really a documented risk factor? I thought there was really no significance to the the type of involved immunoglobulin.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Level of kFLC for MGUS or smoldering myeloma diagnosis?
Non IgG is a risk factor to progress from MGUS to multiple myeloma. Not sure of the significance after it progresses in terms of multiple myeloma risk.
Re: Level of kFLC for MGUS or smoldering myeloma diagnosis?
Ah, you are right. http://bloodjournal.hematologylibrary.org/content/117/21/5573.full
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
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