[Lacerta]

Kappa/lambda free light chain ratio stable but high

by Lacerta on Thu Jan 21, 2016 12:22 pm

Hi,

On behalf of my mother, I am trying to understand the kappa / lambda free light chain ratio, the results are given below.

The ratio fell sharply after the startup with the low-dose Velcade (bortezomib) treatment, but after that it has been stable at about 5.0. Is there any need to be concern about this high value, or should we interpret this as good results as it has stabilized at this level?

Units: mg/L

Before treatment:

Date: 26 October, 2015
Kappa free 4610 (reference 4.0-25.0)
Lambda free 1.4 (reference 6.0-27.0)
Kappa/lambda ratio 3414.8 (reference 0.5-1.6)

After low-dose treatment (Velcade):

Date: 3 November, 2015
Kappa free 77.7 (reference 4.0-25.0)
Lambda free 13.8 (reference 6.0-27.0)
Kappa/lambda ratio 5.6 (reference 0.5-1.6)

Date: 9 December, 2015
Kappa free 70.3 (reference 4.0-25.0)
Lambda free 13.0 (reference 6.0-27.0)
Kappa/lambda ratio 5.4 (reference 0.5-1.6)

Date: 15 January, 2016
Kappa free 83.8 (reference 4.0-25.0)
Lambda free 17.9 (reference 6.0-27.0)
Kappa/lambda ratio 4.68 (reference 0.5-1.6)

[Ron Harvot]

Re: Kappa/lambda free light chain ratio stable but high

by Ron Harvot on Thu Jan 21, 2016 1:58 pm

What I see is that there was a dramatic improvment that has held stable. Her numbers are above normal but not extremely high. Besides the Velcade is she also on low dose Dexamethazone? Dex enhances the effects of Velcade. The initial protocal now given by many oncologists is RVD (Revlimid, Velcade and Dex). That triplit has shown very good and sustainable results. It is often given as induction thearopy before an Autotougous Stem Cell transplant (ASCT).

I see your mom is relatively young 59, is she going the transplant route?

[Lacerta]

Re: Kappa/lambda free light chain ratio stable but high

by Lacerta on Thu Jan 21, 2016 2:10 pm

Hi Ron,

Thanks for answer.

Yes, she also get dexamethasone. But to my knowledge no Revlimid is given.

She will start with an autologous stem cell transplant (ASCT) in February. The doctors are satisfied with the treatment, but haven't explained which variables they are looking at in particular.

[Ron Harvot]

Re: Kappa/lambda free light chain ratio stable but high

by Ron Harvot on Thu Jan 21, 2016 2:50 pm

In some but not all patients, Revlimid can degrade the number of stem cells that are harvested. That could be the reason for not using it. After the ASCT as consolidation treatment, they may have her do a few rounds of Velcade, Revlimid, and dex (VRD) and then place her on a maintenance protocol of Revlimid and dex (RD). That seems to the be standard now.