Hi Susan,
What exactly were your most recent serum kappa and lambda free light chain values, including the units of measure? What were they just before the transplant?
Forums
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Kappa & lambda free light chains elevated (normal ratio)
Hi Multibilly,
At diagnosis I recall my kappa free light chain level being 6500 mg/dl. I don't know what my lambda level was, but was told it was within the normal range, but my ratio was elevated.
After one cycle of cyclophosphamide, thalidomide, and dexamethasone (CTD), my kappa had reduced to 2200, second cycle 890, third cycle 420 and fourth cycle 280. Lambda was never elevated nor below the normal range. Ratio was always abnormal.
Also, I was told I had free light chain disease. Three months after transplant I was told that serologically I had a stringent complete response (sCR) with a kappa free light chain level of 12. Normal lambda and 0 paraprotein. Last week I was told that my kappa free light chain level was 59 mg/dl, lambda 36, with a normal ratio, but a paraprotein of 0.6. I was also told that I have now IgG disease.
I hope this makes sense to you.
Kind regards.
At diagnosis I recall my kappa free light chain level being 6500 mg/dl. I don't know what my lambda level was, but was told it was within the normal range, but my ratio was elevated.
After one cycle of cyclophosphamide, thalidomide, and dexamethasone (CTD), my kappa had reduced to 2200, second cycle 890, third cycle 420 and fourth cycle 280. Lambda was never elevated nor below the normal range. Ratio was always abnormal.
Also, I was told I had free light chain disease. Three months after transplant I was told that serologically I had a stringent complete response (sCR) with a kappa free light chain level of 12. Normal lambda and 0 paraprotein. Last week I was told that my kappa free light chain level was 59 mg/dl, lambda 36, with a normal ratio, but a paraprotein of 0.6. I was also told that I have now IgG disease.
I hope this makes sense to you.
Kind regards.
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SusanTR1964 - Name: Susan
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 8th February 2016
- Age at diagnosis: 51
Re: Kappa & lambda free light chains elevated (normal ratio)
Hi Susan,
Hmmm, I'm not sure what to make of your elevated light chains. As mentioned earlier in the thread, the typical explanations for having both an elevated kappa and lambda number accompanied by a normal ratio is something like an infection or renal impairment. Are your kidney numbers (creatine, BUN, eGFR, etc) and sed rate (ESR) looking good?
Sometimes following a transplant, a person can develop an new M-spike as part of a phenomenon called oligoclonal banding. While it's not at all intuitive, oligoclonal banding is not generally considered to be a bad thing and sometimes has been shown to have positive consequences. You can use the advanced search function on the forum to look for threads containing "oligoclonal banding". Here is one such thread:
https://myelomabeacon.org/forum/oligoclonal-banding-stem-cell-transplant-t5871.html?hilit=oligoclonal#p34557
And here is a fairly recent article on the subject:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462372/
You might want to check with your doc to see if your situation represents a case of oligoclonal banding or not. Good luck and let us know what you find out at your next visits with your doc.
Hmmm, I'm not sure what to make of your elevated light chains. As mentioned earlier in the thread, the typical explanations for having both an elevated kappa and lambda number accompanied by a normal ratio is something like an infection or renal impairment. Are your kidney numbers (creatine, BUN, eGFR, etc) and sed rate (ESR) looking good?
Sometimes following a transplant, a person can develop an new M-spike as part of a phenomenon called oligoclonal banding. While it's not at all intuitive, oligoclonal banding is not generally considered to be a bad thing and sometimes has been shown to have positive consequences. You can use the advanced search function on the forum to look for threads containing "oligoclonal banding". Here is one such thread:
https://myelomabeacon.org/forum/oligoclonal-banding-stem-cell-transplant-t5871.html?hilit=oligoclonal#p34557
And here is a fairly recent article on the subject:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462372/
You might want to check with your doc to see if your situation represents a case of oligoclonal banding or not. Good luck and let us know what you find out at your next visits with your doc.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Kappa & lambda free light chains elevated (normal ratio)
Hi Multibilly,
Many thanks for your response. I saw my consultant last week, who confirmed I had relapsed and it could not be oligoclonal banding because I had already been diagnosed with myeloma, but I'm confused because articles I have read state that this happens in myeloma patients. My repeat bloods 2 weeks ago IFE showed a further change to 2 bands in IgG region, 1 in IgA and 1 in IgM. I'm really confused, but many thanks once again.
Regards
Many thanks for your response. I saw my consultant last week, who confirmed I had relapsed and it could not be oligoclonal banding because I had already been diagnosed with myeloma, but I'm confused because articles I have read state that this happens in myeloma patients. My repeat bloods 2 weeks ago IFE showed a further change to 2 bands in IgG region, 1 in IgA and 1 in IgM. I'm really confused, but many thanks once again.
Regards
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SusanTR1964 - Name: Susan
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 8th February 2016
- Age at diagnosis: 51
Re: Kappa & lambda free light chains elevated (normal ratio)
Hi Susan,
Merry Christmas.
Your consultant's comments make no sense to me. Oligoclonal banding (OB) can definitely develop in patients already diagnosed with multiple myeloma and it is not that uncommon for OB to develop following treatments such as a transplant and/or induction therapy. There are many, many threads on this forum of myeloma patients that have experienced this phenomena post-treatment.
Could you have possibly misunderstood your consultant's comments? You might want to take copies of a couple of published articles on the subject when you next visit with your consultant just to make sure that everybody is on the same page.
Merry Christmas.
Your consultant's comments make no sense to me. Oligoclonal banding (OB) can definitely develop in patients already diagnosed with multiple myeloma and it is not that uncommon for OB to develop following treatments such as a transplant and/or induction therapy. There are many, many threads on this forum of myeloma patients that have experienced this phenomena post-treatment.
Could you have possibly misunderstood your consultant's comments? You might want to take copies of a couple of published articles on the subject when you next visit with your consultant just to make sure that everybody is on the same page.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Kappa & lambda free light chains elevated (normal ratio)
Hi Multibilly
Merry Christmas to you too. I hope you are having a great day.
I agree with you. The comments made no sense to me either. I expected (to be honest) that he would have said that oligoclonal banding may be a possibility, but he just dismissed it outright. I did email him the evening of the consultation and asked him to explain why he did not consider this to be oligoclonal banding (I also sent him the link from ASH 2012), and he replied that as I had a diagnosis of myeloma it was his interpretation of the IFE / SPEP that this was relapse.
So I have gone from lambda free light chain disease then had a stem cell transplant, was told I was in stringent complete remission / minimal residual disease (MRD) negative, told I had relapsed with a paraprotein band of 0.6 with IgG lambda, then 10 days later was told that I had the 2 bands in the IgG region, 1 in IgA and 1 in IgM. No mention of kappa or lambda. Maybe I am wrong, but I was under the impression that if you had free light chain disease, you relapsed with free light chain disease.
I'm having a further bone marrow biopsy on Thursday (don't know whether this is a late Christmas present or an early New Year gift!), so I suppose that will reveal all. I'll keep praying.
Many thanks for your reply. Much appreciated.
Sue
Merry Christmas to you too. I hope you are having a great day.
I agree with you. The comments made no sense to me either. I expected (to be honest) that he would have said that oligoclonal banding may be a possibility, but he just dismissed it outright. I did email him the evening of the consultation and asked him to explain why he did not consider this to be oligoclonal banding (I also sent him the link from ASH 2012), and he replied that as I had a diagnosis of myeloma it was his interpretation of the IFE / SPEP that this was relapse.
So I have gone from lambda free light chain disease then had a stem cell transplant, was told I was in stringent complete remission / minimal residual disease (MRD) negative, told I had relapsed with a paraprotein band of 0.6 with IgG lambda, then 10 days later was told that I had the 2 bands in the IgG region, 1 in IgA and 1 in IgM. No mention of kappa or lambda. Maybe I am wrong, but I was under the impression that if you had free light chain disease, you relapsed with free light chain disease.
I'm having a further bone marrow biopsy on Thursday (don't know whether this is a late Christmas present or an early New Year gift!), so I suppose that will reveal all. I'll keep praying.
Many thanks for your reply. Much appreciated.
Sue
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SusanTR1964 - Name: Susan
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 8th February 2016
- Age at diagnosis: 51
Re: Kappa & lambda free light chains elevated (normal ratio)
Hi Sue,
What did your paraprotein (m-spike), IgG, IgA, IgM, kappa and lambda levels do over the past 3 tests (from CR to your test where you had an m-spike of "0.6" to the test where you had two new bands)?
Also, it sounds like you are in the UK. If your paraprotein band (m-spike) was reported in g/L, a 0.6 g/L (0.06 g/dL) m-spike is a very small number. Note the definition of paraprotein relapse from http://www.bloodjournal.org/content/117/18/4691?sso-checked=true :
"In patients who do not have clinical relapse, a significant paraprotein relapse is defined as doubling of the M-component [total m-spikes] in 2 consecutive measurements separated by less than or equal to 2 months; or an increase in the absolute levels of serum M protein by more than or equal to 1 g/dL [10 g/dL], or urine M-protein by more than or equal to 500 mg/24 hours, or involved FLC level by more than or equal to 20 mg/dL (plus an abnormal FLC ratio) in 2 consecutive measurements separated by less than or equal to 2 months.
This definition of “paraprotein relapse” represents the rate of rise or absolute level of increase in M protein at which the panel considered that myeloma therapy should be restarted in relapsing patients in clinical practice, even if signs and symptoms of new end-organ damage are not yet apparent."
If you were originally diagnosed with light-chain only disease, you can unfortunately relapse with non-light-chain disease via a process known as an "isotype switch". So, putting aside the confusion about whether this may be oligloclonal banding or not, that sort of a relapse is a possibility in light-chain-only patients.
What did your paraprotein (m-spike), IgG, IgA, IgM, kappa and lambda levels do over the past 3 tests (from CR to your test where you had an m-spike of "0.6" to the test where you had two new bands)?
Also, it sounds like you are in the UK. If your paraprotein band (m-spike) was reported in g/L, a 0.6 g/L (0.06 g/dL) m-spike is a very small number. Note the definition of paraprotein relapse from http://www.bloodjournal.org/content/117/18/4691?sso-checked=true :
"In patients who do not have clinical relapse, a significant paraprotein relapse is defined as doubling of the M-component [total m-spikes] in 2 consecutive measurements separated by less than or equal to 2 months; or an increase in the absolute levels of serum M protein by more than or equal to 1 g/dL [10 g/dL], or urine M-protein by more than or equal to 500 mg/24 hours, or involved FLC level by more than or equal to 20 mg/dL (plus an abnormal FLC ratio) in 2 consecutive measurements separated by less than or equal to 2 months.
This definition of “paraprotein relapse” represents the rate of rise or absolute level of increase in M protein at which the panel considered that myeloma therapy should be restarted in relapsing patients in clinical practice, even if signs and symptoms of new end-organ damage are not yet apparent."
If you were originally diagnosed with light-chain only disease, you can unfortunately relapse with non-light-chain disease via a process known as an "isotype switch". So, putting aside the confusion about whether this may be oligloclonal banding or not, that sort of a relapse is a possibility in light-chain-only patients.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Kappa & lambda free light chains elevated (normal ratio)
Hi Multibilly
Yes I am from the UK. I was told the paraprotein was 6 so I guess this is in g/dL. The first time a paraprotein showed up was from bloods done on 30th November and this was 6 IgG lambda. I had bloods done 10 days later and the paraprotein remained the same except IgG lambda had disappeared and IgG x 2 bands, IgA and IgM had appeared, each being 2. Up until then and from September serologically I was in stringent complete response (sCR).
Thank you for the information regarding isotype switching. I was unaware this could happen in free light chain disease.
King regards
Sue
Yes I am from the UK. I was told the paraprotein was 6 so I guess this is in g/dL. The first time a paraprotein showed up was from bloods done on 30th November and this was 6 IgG lambda. I had bloods done 10 days later and the paraprotein remained the same except IgG lambda had disappeared and IgG x 2 bands, IgA and IgM had appeared, each being 2. Up until then and from September serologically I was in stringent complete response (sCR).
Thank you for the information regarding isotype switching. I was unaware this could happen in free light chain disease.
King regards
Sue
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SusanTR1964 - Name: Susan
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 8th February 2016
- Age at diagnosis: 51
Re: Kappa & lambda free light chains elevated (normal ratio)
Hi Sue,
Note that an m-spike of 6 g/dL (60 g/L) is quite large and you aren't likely looking at such a large number.
If you are in the UK, your m-spike is most likely expressed in g/L, not g/dL. If your m-spike is 6 g/L and not 0.6 g/L, it is still not that large of a number, but it certainly is more significant and starts to get you into the realm of concern for a biochemical relapse based on the absolute increase in your m-spike from 0. In any case, you should really verify if your m-spike value is 6 or 0.6 and what the units of measure are.
Note that an m-spike of 6 g/dL (60 g/L) is quite large and you aren't likely looking at such a large number.
If you are in the UK, your m-spike is most likely expressed in g/L, not g/dL. If your m-spike is 6 g/L and not 0.6 g/L, it is still not that large of a number, but it certainly is more significant and starts to get you into the realm of concern for a biochemical relapse based on the absolute increase in your m-spike from 0. In any case, you should really verify if your m-spike value is 6 or 0.6 and what the units of measure are.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Kappa & lambda free light chains elevated (normal ratio)
Hi Multibilly
I've checked the unit of measure today and it is 6.0 g/l. So it does look like a biochemical relapse with triclonal banding and an isotype switch.
Interesting, my bloods showed an M-spike just 5 days after I underwent re-immunisation. Am wondering if there is any connection, but I'm probably just grasping at straws.
Many thanks for your expertise.
Regards,
Sue
I've checked the unit of measure today and it is 6.0 g/l. So it does look like a biochemical relapse with triclonal banding and an isotype switch.
Interesting, my bloods showed an M-spike just 5 days after I underwent re-immunisation. Am wondering if there is any connection, but I'm probably just grasping at straws.
Many thanks for your expertise.
Regards,
Sue
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SusanTR1964 - Name: Susan
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 8th February 2016
- Age at diagnosis: 51
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