I have googled and googled, but couldn't find an answer to this question. Any thoughts would be much appreciated!
My father has myeloma and is in treatment. His most recent tests indicate his M-spike has fallen (1.4 to 1.2), as have his free light chains – kappa 14.09 to 9.6, and lambda 0.62 to 0.07.
His kappa-lambda free light chain ratio, in turn, has increased markedly (22 to 137).
Question: Isn't it good to have the free light chains (FLCs) decrease? If this is so, then why would the FLC ratio rise, which is supposed to not be good? Am I missing something?
Thank you so much!
-Anna
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AnnaF - Name: AnnaF
- Who do you know with myeloma?: Father
- When were you/they diagnosed?: October 2014
- Age at diagnosis: 75
Re: Kappa & lambda free light chains down, but ratio up?
Hi Anna,
What are the units of measure and the reference ranges for these free light chain values?
Is he on Revlimid?
What are the units of measure and the reference ranges for these free light chain values?
Is he on Revlimid?
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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 down, but ratio up?
Hello!
The measurement for the FLCs is mg/dL; the M-spike (should it be relevant) is g/dL.
My dad is currently on Velcade / dex / melphalan, though they may switch to another combo as this one is not as effective as they had hoped (14% decrease in M-spike).
Thanks for any input! These FLCs are quite confusing.
Anna
The measurement for the FLCs is mg/dL; the M-spike (should it be relevant) is g/dL.
My dad is currently on Velcade / dex / melphalan, though they may switch to another combo as this one is not as effective as they had hoped (14% decrease in M-spike).
Thanks for any input! These FLCs are quite confusing.
Anna
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AnnaF - Name: AnnaF
- Who do you know with myeloma?: Father
- When were you/they diagnosed?: October 2014
- Age at diagnosis: 75
Re: Kappa & lambda free light chains down, but ratio up?
Interpreting free light chains is indeed confusing.
So, the reference ranges are:
• Kappa: 3.3-19.4 mg/L = 0.33-1.94 mg/dL
• Lambda: 5.71-26.3 mg/L = 0.571- 2.63 mg/dL
• Kappa / lambda ratio: 0.26–1.65
So, he therefore has a high kappa and a low lambda resulting in a high ratio.
This can means he has bone marrow suppression going on, which can be due to the treatment itself (my guess would be that the melphalan is the primary culprit, but I'm not a doc).
See the information at this page at the Binding Site website, which has this helpful table:
So, the reference ranges are:
• Kappa: 3.3-19.4 mg/L = 0.33-1.94 mg/dL
• Lambda: 5.71-26.3 mg/L = 0.571- 2.63 mg/dL
• Kappa / lambda ratio: 0.26–1.65
So, he therefore has a high kappa and a low lambda resulting in a high ratio.
This can means he has bone marrow suppression going on, which can be due to the treatment itself (my guess would be that the melphalan is the primary culprit, but I'm not a doc).
See the information at this page at the Binding Site website, which has this helpful table:
- FLC Cases.png (11.68 KiB) Viewed 5544 times
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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 down, but ratio up?
Thanks, that is a great link. I am surprised that I somehow missed it.
Do we want the FLC ratio to go down? I guess my confusion lies in that both the kappa and lambda have fallen (the kappa quite a bit), and the ratio has gone up. It would seem that, in this instance, two 'goods' have equaled one 'bad'. Or is it good for the ratio to go up?
Also, very interesting about the melphalan - his dose was doubled in the last round of treatments. You seem to have a knack for interpretation!
Again, thank you!
Anna
Do we want the FLC ratio to go down? I guess my confusion lies in that both the kappa and lambda have fallen (the kappa quite a bit), and the ratio has gone up. It would seem that, in this instance, two 'goods' have equaled one 'bad'. Or is it good for the ratio to go up?
Also, very interesting about the melphalan - his dose was doubled in the last round of treatments. You seem to have a knack for interpretation!
Again, thank you!
Anna
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AnnaF - Name: AnnaF
- Who do you know with myeloma?: Father
- When were you/they diagnosed?: October 2014
- Age at diagnosis: 75
Re: Kappa & lambda free light chains down, but ratio up?
Since your dad is kappa "involved", you generally do want to see this ratio go down and get into the normal range.
But, the bone marrow suppression due to the treatment is kind of throwing a wrench in all this and the high ratio is an artifact of the treatment itself. While I'm not a doc, I think that the primary metric in this situation would be to first see the kappa number down ... and it looks like it is coming down, along with a modest reduction in the M-spike.
In any case, you should really verify all this with the doc.
You can see some additional comments on this subject in this previous forum discussion:
"Interpreting results - light chain multiple myeloma" (started Nov 12, 2012)
But, the bone marrow suppression due to the treatment is kind of throwing a wrench in all this and the high ratio is an artifact of the treatment itself. While I'm not a doc, I think that the primary metric in this situation would be to first see the kappa number down ... and it looks like it is coming down, along with a modest reduction in the M-spike.
In any case, you should really verify all this with the doc.
You can see some additional comments on this subject in this previous forum discussion:
"Interpreting results - light chain multiple myeloma" (started Nov 12, 2012)
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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 down, but ratio up?
Hi Anna,
The feedback you've gotten from Multibilly basically answers your question, particularly what Dr. Libby said in the forum thread Multibilly linked to.
I just wanted to add that Dr. Hoffman also said something very similar, and perhaps even more specific to a situation such as your father's, in a recent forum discussion,
"Kappa FLC fluctuations in lambda light chain myeloma" (started May 5, 2015)
In the case Dr. Hoffman commented on, the patient has lambda as the "involved" free chain, and it is coming down. However, as is the case with your father, the ratio isn't always going in the right direction.
Dr. Hoffman basically says that treatment can suppress production of the uninvolved free light chains, which can make the ratio move in what seems to be the wrong way. So he recommends focusing on the level of the involved free light chain (kappa in your father's case).
I also agree that the melphalan, in particular, is probably what is causing the low level of the lambda free light chains.
I hope your father continues to respond to his treatment and that he doesn't experience too many side effects.
Good luck!
The feedback you've gotten from Multibilly basically answers your question, particularly what Dr. Libby said in the forum thread Multibilly linked to.
I just wanted to add that Dr. Hoffman also said something very similar, and perhaps even more specific to a situation such as your father's, in a recent forum discussion,
"Kappa FLC fluctuations in lambda light chain myeloma" (started May 5, 2015)
In the case Dr. Hoffman commented on, the patient has lambda as the "involved" free chain, and it is coming down. However, as is the case with your father, the ratio isn't always going in the right direction.
Dr. Hoffman basically says that treatment can suppress production of the uninvolved free light chains, which can make the ratio move in what seems to be the wrong way. So he recommends focusing on the level of the involved free light chain (kappa in your father's case).
I also agree that the melphalan, in particular, is probably what is causing the low level of the lambda free light chains.
I hope your father continues to respond to his treatment and that he doesn't experience too many side effects.
Good luck!
Re: Kappa & lambda free light chains down, but ratio up?
Hello, Cheryl and Mutibilly!
You are both fabulous. What useful info – that absolutely answered this FLC confusion. My dad's doctor is actually Dr. Libby, so it's always great seeing him referenced!
I just wanted to thank you both for your replies and kindness in answering my questions, as well as the helpful links. I passed your info along to my dad, and he sends his thanks, as well. You guys are such a wonderful resource, and it is helpful and comforting to have you out there.
Wish you all the best.
Thanks again,
Anna
You are both fabulous. What useful info – that absolutely answered this FLC confusion. My dad's doctor is actually Dr. Libby, so it's always great seeing him referenced!
I just wanted to thank you both for your replies and kindness in answering my questions, as well as the helpful links. I passed your info along to my dad, and he sends his thanks, as well. You guys are such a wonderful resource, and it is helpful and comforting to have you out there.
Wish you all the best.
Thanks again,
Anna
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AnnaF - Name: AnnaF
- Who do you know with myeloma?: Father
- When were you/they diagnosed?: October 2014
- Age at diagnosis: 75
Re: Kappa & lambda free light chains down, but ratio up?
I've been in complete remission, and my kappa and lambda levels are still in the normal range but have been gradually increasing the past few months. The kappa/lambda ratio has been just above the normal range for the past couple of months – currently up to 3.21.
When I referred to the binding site chart, it seemed to indicate that I have "monoclonal gammopathy" with bone marrow suppression. Is this an indication that the myeloma is becoming active again? I'm on Revlimid maintenance. Any thoughts would be appreciated!
When I referred to the binding site chart, it seemed to indicate that I have "monoclonal gammopathy" with bone marrow suppression. Is this an indication that the myeloma is becoming active again? I'm on Revlimid maintenance. Any thoughts would be appreciated!
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