So, I had a 24hr urine test done and just got the results.
Kappa within range
Lambda very low - 0.13
Ratio kappa/lambda - 46.92 (what do I make of this?) The range is 2.04-10.37. How am I 4x the upper limit?
U WBC - 2-5
I would appreciate a point of view on this.
Thank you.
Forums
Re: Kappa/Lambda ratio off the charts - 24 hr urine test
LM0516,
Welcome to the forum.
It would help if you let us know a bit about your situation, why you got a 24 hr urine test and if you got any other tests done.
Welcome to the forum.
It would help if you let us know a bit about your situation, why you got a 24 hr urine test and if you got any other tests done.
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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 ratio off the charts - 24 hr urine test
Thank you for the welcome note.
My mother passed away from multiple myeloma six years ago and I've been getting the electrophoresis blood test done every two years. It's been coming back with no issues. This year my doctor decided to do the 24 hr urine test instead, the results of which I posted. Besides the low WBC count, all other tests from the annual exam are within range. Trying to figure out how worried I should be about this.
My mother passed away from multiple myeloma six years ago and I've been getting the electrophoresis blood test done every two years. It's been coming back with no issues. This year my doctor decided to do the 24 hr urine test instead, the results of which I posted. Besides the low WBC count, all other tests from the annual exam are within range. Trying to figure out how worried I should be about this.
Re: Kappa/Lambda ratio off the charts - 24 hr urine test
Sorry to hear about your mom, but I'm glad you thought about getting periodically tested.
A lot of things can cause a low WBC count. Your FLC ratio is out of range.because your lambda FLC is low. Was your serum WBC count from your CBC test also low in addition to your low urine WBC count (a CBC test would be ordered for any annual checkup)?
A lot of things can cause a low WBC count. Your FLC ratio is out of range.because your lambda FLC is low. Was your serum WBC count from your CBC test also low in addition to your low urine WBC count (a CBC test would be ordered for any annual checkup)?
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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 ratio off the charts - 24 hr urine test
When it comes to looking at Free Light Chains the serum test (sFLC Assay) is considered much more realiable and accurate than the Urine test. Simple reason is the the FLC dump out into the blood first. As part of my ongoing testing I have the sFLC Assay run and have never had a urine test.
I would suggest that you discuss this with your doctor and have the sFLC test run and see if the numbers are comparable.
Ron
I would suggest that you discuss this with your doctor and have the sFLC test run and see if the numbers are comparable.
Ron
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Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
Re: Kappa/Lambda ratio off the charts - 24 hr urine test
Hi Ron, I also wondered about the 24 hr. urine test. I had them at dx, but I don't think that the SFLC test was in routine use then (at least I don't have a record of those tests.) Hadn't had that test done for several years, and when I did recently it basically mirrored the SFLC, which is a routine test for me. But if you read the comment by Dr. Voorhees, it seems that there are patients who can benefit from having both of those tests. Those patients have 'free light chain myeloma'. So it is another test to track their myeloma.
'Re: How important is 24 hour urine test?
by Dr. Peter Voorhees on Sun Oct 13, 2013 11:55 am
Dear Babs,
The 24 hour urine protein electrophoresis and immunofixation are most useful for those who have "free light chain" myeloma. In other words, their myeloma cells are either making a lot of free kappa light chain antibodies or free lambda light chain antibodies that are not complexed to a heavy chain (IgG, IgA, IgM, IgD, IgE). A patient's myeloma may make free light chain antibodies exclusively, none or hardly any at all, or a combination of intact antibodies (e.g. IgG kappa) and free light chains (e.g. free kappa light chains).
Free kappa and lambda light chains antibodies are not easily picked up by serum protein electrophoresis (at least not until they reach high levels). The 24 hour urine is much better at picking these up.
The serum free light chain test can also be used to measure free kappa and lambda light chain anibody levels and is even more sensitive than the 24-hour urine testing. The serum free light chain testing has allowed us to rely less heavily on the 24 hour urine tests for those with free light chain myeloma. It may be that your doctor is using this test in the place of the urine testing.
Even if your myeloma does not have a significant free light chain component (i.e. is not making much free kappa or lambda light chain antibodies), your physician should "spot check" the serum free light chain test periodically to assess for free light chain escape. This is a phenomenon in which a myeloma stops making an intact antibody and starts producing just the free light chain component of the antibody. For example, an IgG kappa myeloma may evolve into a free kappa light chain myeloma if the IgG portion of the antibody is no longer made. An SPEP alone would not pick this up until late in the game.
I hope this helps. Let me know if you have any other questions.
Take care!'
'Re: How important is 24 hour urine test?
by Dr. Peter Voorhees on Sun Oct 13, 2013 11:55 am
Dear Babs,
The 24 hour urine protein electrophoresis and immunofixation are most useful for those who have "free light chain" myeloma. In other words, their myeloma cells are either making a lot of free kappa light chain antibodies or free lambda light chain antibodies that are not complexed to a heavy chain (IgG, IgA, IgM, IgD, IgE). A patient's myeloma may make free light chain antibodies exclusively, none or hardly any at all, or a combination of intact antibodies (e.g. IgG kappa) and free light chains (e.g. free kappa light chains).
Free kappa and lambda light chains antibodies are not easily picked up by serum protein electrophoresis (at least not until they reach high levels). The 24 hour urine is much better at picking these up.
The serum free light chain test can also be used to measure free kappa and lambda light chain anibody levels and is even more sensitive than the 24-hour urine testing. The serum free light chain testing has allowed us to rely less heavily on the 24 hour urine tests for those with free light chain myeloma. It may be that your doctor is using this test in the place of the urine testing.
Even if your myeloma does not have a significant free light chain component (i.e. is not making much free kappa or lambda light chain antibodies), your physician should "spot check" the serum free light chain test periodically to assess for free light chain escape. This is a phenomenon in which a myeloma stops making an intact antibody and starts producing just the free light chain component of the antibody. For example, an IgG kappa myeloma may evolve into a free kappa light chain myeloma if the IgG portion of the antibody is no longer made. An SPEP alone would not pick this up until late in the game.
I hope this helps. Let me know if you have any other questions.
Take care!'
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: Kappa/Lambda ratio off the charts - 24 hr urine test
Hello,
My kappa/lambda light chains are also very high. You folks seem to have a lot of information about myeloma. I have just started treatment v/d/r; had one spot on rib. I am 71 and was working at the time in construction. I have low energy so I can't do much around home. Tomorrow will be my 8th treatment. The numbers didn't change with the first three treatments.
Am I on the right track with this treatment? Kidney function was good. I started treatment in July. I am trying to understand all the numbers of this disease. Any feedback appreciated.
Thanks, Jim.
My kappa/lambda light chains are also very high. You folks seem to have a lot of information about myeloma. I have just started treatment v/d/r; had one spot on rib. I am 71 and was working at the time in construction. I have low energy so I can't do much around home. Tomorrow will be my 8th treatment. The numbers didn't change with the first three treatments.
Am I on the right track with this treatment? Kidney function was good. I started treatment in July. I am trying to understand all the numbers of this disease. Any feedback appreciated.
Thanks, Jim.
Re: Kappa/Lambda ratio off the charts - 24 hr urine test
I would not get too excited about a 46.94 kappa/lambda light chain ratio unless your oncologist has concerns about it. Like others have said the serum test is more meaningful unless you have the conditions that Nancy pointed out above. The ratio is high because of low lambda, not sky high total kappa. If my math is correct your kappa level is 360? That is bit above the normal range and I can see why you and your oncologist would take interest in that. Is the lambda level low because of drug treatment?
When I was on Velcade, my lambda levels dropped to the levels you have and even one test showed no detectable level. So looking that this from a mathematical perspective, any time you start dividing really small numbers into to larger numbers you get a much larger number still, even if the kappa number may not have risen that much. In my case, one time I had a total kappa number greater than 3000, and if you have myeloma with kappa light chain numbers that is the number that matters. My lambda level was 1. So my kappa/light chain ratio was over 3000, which makes 46.92 look pretty good in comparison, if just looking at these numbers alone. At the time I had a lambda of none detectable, I had no kappa/lambda ratio, you cannot divide a number by zero. But again this is all mathematical play and what is necessary to draw anything meaningful as what it means for you is your oncologist’s assessment of lab results.
Best wishes,
Eric
When I was on Velcade, my lambda levels dropped to the levels you have and even one test showed no detectable level. So looking that this from a mathematical perspective, any time you start dividing really small numbers into to larger numbers you get a much larger number still, even if the kappa number may not have risen that much. In my case, one time I had a total kappa number greater than 3000, and if you have myeloma with kappa light chain numbers that is the number that matters. My lambda level was 1. So my kappa/light chain ratio was over 3000, which makes 46.92 look pretty good in comparison, if just looking at these numbers alone. At the time I had a lambda of none detectable, I had no kappa/lambda ratio, you cannot divide a number by zero. But again this is all mathematical play and what is necessary to draw anything meaningful as what it means for you is your oncologist’s assessment of lab results.
Best wishes,
Eric
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Eric Hofacket - Name: Eric H
- When were you/they diagnosed?: 01 April 2011
- Age at diagnosis: 44
Re: Kappa/Lambda ratio off the charts - 24 hr urine test
Eric,
My kappa is 5500 and the lambda 422. Of course, I have been concerned because they are very high. My other blood work was good. What am I up against with these high numbers?
Thanks again, Jim
My kappa is 5500 and the lambda 422. Of course, I have been concerned because they are very high. My other blood work was good. What am I up against with these high numbers?
Thanks again, Jim
Re: Kappa/Lambda ratio off the charts - 24 hr urine test
Wvjim,
I am not a doctor much less an oncologist and I am in no position to answer such a question as to what you are up against from a light chains lab test. I also feel it would be irresponsible for me to do so. And I believe an oncologist would not be able to answer that question with just those numbers alone.
In my post I was trying to say that we should not get wrapped up in the mathematical nuances and number play of lab results numbers and should focus what or oncologist have to say about what they mean for us. If you do not have an oncologist that is doing this you can trust that then maybe you should seek a second opinion or seek a new oncologist.
I am not a doctor much less an oncologist and I am in no position to answer such a question as to what you are up against from a light chains lab test. I also feel it would be irresponsible for me to do so. And I believe an oncologist would not be able to answer that question with just those numbers alone.
In my post I was trying to say that we should not get wrapped up in the mathematical nuances and number play of lab results numbers and should focus what or oncologist have to say about what they mean for us. If you do not have an oncologist that is doing this you can trust that then maybe you should seek a second opinion or seek a new oncologist.
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Eric Hofacket - Name: Eric H
- When were you/they diagnosed?: 01 April 2011
- Age at diagnosis: 44
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