At diagnosis it was determined that my myeloma was IgG kappa. I think I have a pretty good understanding of the role free light chains [FLCs] play in multiple myeloma. However, I have not seen or heard any discussion regarding the clinical significance of having kappa vs lambda free light chain with regard to PFS, OS or prognosis.
Does the disease manifest itself differently depending upon the dominant free light chain involved?
Thanks to everyone on The Beacon Forum for all of your support and information.
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Re: Clinical significance of kappa or lambda FLCs?
From what I've learned since being diagnosed, this disease tends to manifest itself differently in everyone regardless of the type. I have non-secretory (no discernible M spike) kappa light chain multiple myeloma and I have had no instances of bone lesions while others have.
Am I just lucky? Or did I get diagnosed early, before it had a chance to affect my skeletal structure? (Given my light chain numbers prior to treatment and the effect on my one and only kidney, I think that it had been going on for a while. Then, again, I'm not sure how early "early" is when it comes to multiple myeloma diagnosis.) Or did it just manifest itself differently in me?
Who knows? The doctors don't seem to, and that is no disrespect to them. It's a strange disease.
Am I just lucky? Or did I get diagnosed early, before it had a chance to affect my skeletal structure? (Given my light chain numbers prior to treatment and the effect on my one and only kidney, I think that it had been going on for a while. Then, again, I'm not sure how early "early" is when it comes to multiple myeloma diagnosis.) Or did it just manifest itself differently in me?
Who knows? The doctors don't seem to, and that is no disrespect to them. It's a strange disease.
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Blackbird - Name: Rick Crow
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Feb, 2013
- Age at diagnosis: 53
Re: Clinical significance of kappa or lambda FLCs?
Excellent question Dano!
While heavy chain usage in multiple myeloma (ie. IgG, IgA, IgM, IgD) is associated with certain disease characteristics – IgG with bony disease, IgA with younger age and aggressive course, IgD with kidney disease, IgM with hyperviscosity (thick, sluggish blood flow) – the same is not necessarily true for the light chains.
With one notable exception. Lambda light chains are more capable of forming amyloid deposits - as is seen in a related condition called "Primary systemic light chain amyloidosis." In this disorder, the light chain (typically lambda, but not exclusively) misfolds and deposits in certain organs (heart, GI tract, kidney, nervous system) and causes organ damage.
Otherwise the available data on this topic is scant ... but ripe for study!
Best!
P.S. - See my posting in the discussion thread "Is IgA multiple myeloma more aggressive" for additional information on this topic.
While heavy chain usage in multiple myeloma (ie. IgG, IgA, IgM, IgD) is associated with certain disease characteristics – IgG with bony disease, IgA with younger age and aggressive course, IgD with kidney disease, IgM with hyperviscosity (thick, sluggish blood flow) – the same is not necessarily true for the light chains.
With one notable exception. Lambda light chains are more capable of forming amyloid deposits - as is seen in a related condition called "Primary systemic light chain amyloidosis." In this disorder, the light chain (typically lambda, but not exclusively) misfolds and deposits in certain organs (heart, GI tract, kidney, nervous system) and causes organ damage.
Otherwise the available data on this topic is scant ... but ripe for study!
Best!
P.S. - See my posting in the discussion thread "Is IgA multiple myeloma more aggressive" for additional information on this topic.
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Dr. Heather Landau - Name: Heather Landau, M.D.
Beacon Medical Advisor
Re: Clinical significance of kappa or lambda FLCs?
This is a great and useful summary Dr. Landau. I've never seen this info laid out in such clear, simple terms.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Clinical significance of kappa or lambda FLCs?
Thank you Dr. Landau for this terrific reference!
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DanaH - Who do you know with myeloma?: Myself, SMM as of 1/2012
- When were you/they diagnosed?: 1/2012
- Age at diagnosis: 54
Re: Clinical significance of kappa or lambda FLCs?
Thank you for explaining this! I am lambda light chain IgA. Stage 3. I have lesions across the sacral ala and all down my spine. I also have compression from the mid spine to the small of my back. I have lymphatic tumors at the base of my spine. So, it's concentrating mostly in my spine. I am starting to show some liver involvement as well. I also have hypothyroidism and congestive heart disease and intracranial atherosclerosis and costochondritis.
Yep. I'm an overachiever. haha.
I was diagnosed a year ago and have never known what the importance of being lambda light chain was. It always sounded so much like a sorority that I just joked around about my body taking me back to college again. I have to admit this disease does cause you to freshen up on your deductive skills and research abilities. Heh, I'm a college student again at 53! woohoo! So, when is the toga party?
Yep. I'm an overachiever. haha.
I was diagnosed a year ago and have never known what the importance of being lambda light chain was. It always sounded so much like a sorority that I just joked around about my body taking me back to college again. I have to admit this disease does cause you to freshen up on your deductive skills and research abilities. Heh, I'm a college student again at 53! woohoo! So, when is the toga party?
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Obayan
Re: Clinical significance of kappa or lambda FLCs?
Interesting and clear response. I have kappa disease and amyloid deposits. At diagnosis first week of May, light chains were 5136 kappa. After 1st round of RVD, dropped to 1300 and subsequent rounds have dropped only slightly to 1220 and 1043. Have bone marrow biopsy on the 18th to see how that is responding. Was 80% plasma cells at diagnosis.
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CindyBrown - Name: Cindy Brown
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: 4/26/14
- Age at diagnosis: 48
Re: Clinical significance of kappa or lambda FLCs?
There are always exceptions to the rule - and when it is you, a single individual, you feel like the rule even if you are the exception!
In "our" case, IgA has not been aggressive or high risk and was not at a younger age. I've wondered, however, if Velcade is (as in our case) more effective against lambda light chain disease characteristic than Revlimid. And if those who respond well to Velcade also respond well to curcumin.
Just a sample of one, however, which proves nothing ...
In "our" case, IgA has not been aggressive or high risk and was not at a younger age. I've wondered, however, if Velcade is (as in our case) more effective against lambda light chain disease characteristic than Revlimid. And if those who respond well to Velcade also respond well to curcumin.
Just a sample of one, however, which proves nothing ...
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julie Z
Re: Clinical significance of kappa or lambda FLCs?
Thank you Dr. Landau for your input and expansion on this topic.
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Dano - Who do you know with myeloma?: Me
- When were you/they diagnosed?: Jan 2014
- Age at diagnosis: 65
Re: Clinical significance of kappa or lambda FLCs?
My related question is whether the type of myeloma you have can change over time.
When I was first diagnosed five years ago, I had classic symptoms -- multiple bone lesions, high M spike, and high lambda light chains. I am IgG lambda. After induction treatment and a SCT, I was in complete remission.
Two years ago, I came out of remission, but just with an incremental M spike in the MGUS range. Everything else, including my light and heavy light chains, were normal. Two months ago, my lambda light chains spiked, and my IgA and IgM dropped. But my M spike is still at the incremental level.
So is this a different version of myeloma and what is the significance of the symptom mainly being high lambda light chains?
I just had three cycles of dexa/Velcade and will meet with my oncologist again in three weeks.
Dana A
When I was first diagnosed five years ago, I had classic symptoms -- multiple bone lesions, high M spike, and high lambda light chains. I am IgG lambda. After induction treatment and a SCT, I was in complete remission.
Two years ago, I came out of remission, but just with an incremental M spike in the MGUS range. Everything else, including my light and heavy light chains, were normal. Two months ago, my lambda light chains spiked, and my IgA and IgM dropped. But my M spike is still at the incremental level.
So is this a different version of myeloma and what is the significance of the symptom mainly being high lambda light chains?
I just had three cycles of dexa/Velcade and will meet with my oncologist again in three weeks.
Dana A
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darnold - Name: Dana Arnold
- Who do you know with myeloma?: self
- When were you/they diagnosed?: May 2009
- Age at diagnosis: 52
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