[goldmine848]

Kappa & lambda FLCs significantly elevated, but ratio ok

by goldmine848 on Tue Jan 13, 2015 4:44 pm

This month, both my kappa and lambda serum free light chains were elevated out of the normal range for the first time since early in my treatment.

Kappa 3.72 mg/dl (37.2 mg/L)
Lambda 2.94 mg/dl (29.4 mg/L)
Ratio 1.27

The prior month:

Kappa was 1.72 mg/dl (17.2 mg/L)
Lambda was 1.59 mg/dl (15.9 mg/L)
Ratio was 0.08

These are some serious increases, but the ratio is in the normal range.

I have read conflicting explanations, with some saying only the ratio is important, and others saying that, after initial diagnosis, the emphasis should be on the "involved" one - in my case lambda.

As for my M-spike, it is 0.3 g/dL (3 g/L) kappa, while at diagnosis the involved protein was lambda, meaning that my current M-spike is arguably secondary MGUS and thus nothing to worry about.

I wonder if someone can help me make sense of this.

[blair77]

Re: Kappa & lambda FLCs significantly elevated, but ratio ok

by blair77 on Tue Jan 13, 2015 6:43 pm

My husband (IgA lambda) has this in reference to the free light chains also: At our latest appointment, the NP mentioned the K/L ratio first, and our "myeloma specialist" stated, "I don't need the ratio, just the lambda number," implying that ratio wasn't important, just the involved number.

September 2, 2014

Kappa/ Lambda Ratio - 1.08 (RR 0.26-1.65)
Kappa - 24.9 mg/L ( 3.3-19.4)
Lambda - 23 mg/L ( 5.7-26.3)

September 25, 2014

Ratio - 1.36
Kappa - 34.9
Lambda - 25.7

January 6, 2015

Ratio - 1.02
Kappa - 32.6
Lambda - 32.0

I have read that when both are increased and the ratio is normal, that it is a sign of inflammation. However, most of what I read in reference to myeloma has a flipside that totally contradicts the article I read 5 minutes before!!

[Multibilly]

Re: Kappa & lambda FLCs significantly elevated, but ratio ok

by Multibilly on Tue Jan 13, 2015 6:55 pm

Hey Andrew,

Building a bit off what Blair stated earlier.

Well, you are right in that one does get somewhat conflicting messages regarding this subject.

D Siegel et al, "Serum Free Light Chain Analysis for Diagnosis, Monitoring, and Prognosis of Monoclonal Gammopathies," Lab Medicine, 2009 (full text).

The involved free light chain concentration or the difference between clonal and nonclonal light chain is recommended for serial evaluation of treatment response rather than the ratio"

But if you read this article,

N Kroeger et al, "Questionable role of free light chain assay ratio to determine stringent complete remission in multiple myeloma patients," Blood, April 22, 2010 (full text).

you will find:

These results confirm that the free light chain assay ratio is, due to its shorter half-life, a useful marker for faster detection of remission or progression in myeloma patients, but these results do not support additional value of free light chain ratio to determine the depth of remission in immunofixation-negative patients"

I notice that both your kappa and lambda values increased, not just the involved FLC. I understand that this can also sometimes caused by impaired kidney function, where both of the free light chain types are retained in the blood. Has your BUN or creatinine level deteriorated between now and your last test? It's been about a year since your transplant, right?

As always, I'm just a layman guessing in the dark here.

[goldmine848]

Re: Kappa & lambda FLCs significantly elevated, but ratio ok

by goldmine848 on Tue Jan 13, 2015 8:22 pm

In fact, my creatinine has always been in the normal range and BUN, although elevated, actually went down.

I am guessing this is the result of a virus that I had about a week before the latest blood test. I will see what the doc says.

[Multibilly]

Re: Kappa & lambda FLCs significantly elevated, but ratio ok

by Multibilly on Tue Jan 13, 2015 8:35 pm

Ah, a virus... Blair might be on the money regarding her statement that inflammation may be behind the rise in the two FLCs values. Inflammation can raise the polyclonal sFLCs levels, which in turn could raise the overall values from your SFLC assay?

Also, see Blair's earlier post and Dr. Valent's comments:

"Kappa & lambda free light chains elevated (but normal ratio)," forum discussion started June 23, 2014.

[JBarnes]

Re: Kappa & lambda FLCs significantly elevated, but ratio ok

by JBarnes on Tue Jan 13, 2015 11:25 pm

My kappa had never been below 8 dl in two years. Yours sounds great.

[goldmine848]

Re: Kappa & lambda FLCs significantly elevated, but ratio ok

by goldmine848 on Wed Jan 14, 2015 8:38 am

Of course, that's the other issue: They may be elevated out of range, but are they elevated enough to be a concern? I will see the doc today and see what he has to say.

[Christina]

Re: Kappa & lambda FLCs significantly elevated, but ratio ok

by Christina on Wed Jan 14, 2015 4:05 pm

Blair,

Why would the doctor look only at the lambda number? Does that indicate something rather than the kappa?

My kappa appears quite high (relative to the normal range), but my lambda is normal??

[blair77]

Re: Kappa & lambda FLCs significantly elevated, but ratio ok

by blair77 on Wed Jan 14, 2015 4:20 pm

Christina,

My husband's diseases is lambda subtype, which is why the doctor is only concerned with his lambda number. If his subtype was kappa, then that would be the number he would be watching.

So it depends on which subtype you are.

[goldmine848]

Re: Kappa & lambda FLCs significantly elevated, but ratio ok

by goldmine848 on Wed Jan 14, 2015 10:16 pm

Update:

The doc said not to be concerned. The elevation is likely due to a recent virus. The light chain levels can be elevated in response to a virus or infection for up to three weeks after the symptoms disappear. Normal creatinine and GFR made it unlikely that there is a kidney issue.

He also said that he would only be concerned if the involved free light chain was over 10 mg/dl (100 mg/l).