Hello,
I was diagnosed with smoldering myeloma in October 2013; IgG lambda with 20% involvement. I've been monitored every six month since and have been relatively stable.
In September of 2017, I was diagnosed with Lyme disease ,which I got while camping in Northern California earlier the same year. I have just finished 4 months of intensive antibiotic treatment to kill the Lyme and I am feeling great; no more fatigue or aches and pains from Lyme at the moment.
However, I just went for my 6 month labs for myeloma, and things have changed.
My M-spike is still stable (2.3 g/dL), but my kappa-lambda free light chain ratio has changed.
My kappa free light chain level is 9.4 mg/L.
My lambda free light chain level is 736.1 mg/L.
My kappa-lambda ratio 0.01.
My hematologist says this indicates that my multiple myeloma is more active and we may need to consider starting treatment. Before we do that, though, she will run all labs again in two months considering I have just been battling Lyme disease. I am also anemic and beginning to supplement with iron.
I am trying to understand more about the kappa-lambda ratio and how it indicates the growth of my myeloma into a possible treatment phase. Can anyone help me understand more about this?
Thank you!
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Undine - Name: Undine
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Oct 2013
- Age at diagnosis: 43
Re: Kappa-lambda ratio & smoldering vs. active myeloma
Hi Undine,
Let me try to explain this the way I've always thought about this.
The free light chain ratio is useful since it's not always good to look at just one's involved free light chain value in isolation. While it's true that the "involved" free light chain (in your case the lambda free light chain) in smoldering myeloma patients is often elevated and it is key to track it, there are situations where the involved free light chain can be elevated while the uninvolved free light chain can be at a level which might suggest that something else is going on with you.
As an example, you can have situations where the involved free light chain is high, yet your accompanying free light chain ratio might suggest that you are experiencing a polyclonal gammopathy such as Lyme disease or renal insufficiency.
Also, these free light chain tests are imperfect and subject to lab error, and the results may change from day to day or even hour to hour.
Additionally, a good specialist is going to want to first see an established trend in your numbers before considering treatment.
It is likely a combination of all these reasons that you doctor wants to wait awhile and then retest you - especially since you have Lyme disease.
Now, having said all this, an involved/uninvolved free light chain ratio (in your case the lambda/kappa ratio as opposed to the kappa/lambda ratio given to you in your lab reports) greater than 100 accompanied by an involved free light chain value greater than 100 mg/L is now considered to be a "myeloma defining event" (MDE) by the International Myeloma Working Group (IMWG). Your lambda/kappa ratio is about 78, and your involved (lambda) free light chain level is clearly above 100 mg/L, so you have some overall free light chain values that are approaching an MDE threshold. But be clear that not all specialists would automatically consider initiating treatment based solely on meeting the free light chain MDE criteria. They would look at your overall situation as explained Dr. Rajkumar in his closing statement in this article about the criteria for a multiple myeloma diagnosis:
SV Rajkumar, "New Criteria For The Diagnosis Of Multiple Myeloma And Related Disorders," The Myeloma Beacon, Oct 26, 2014
Let me try to explain this the way I've always thought about this.
The free light chain ratio is useful since it's not always good to look at just one's involved free light chain value in isolation. While it's true that the "involved" free light chain (in your case the lambda free light chain) in smoldering myeloma patients is often elevated and it is key to track it, there are situations where the involved free light chain can be elevated while the uninvolved free light chain can be at a level which might suggest that something else is going on with you.
As an example, you can have situations where the involved free light chain is high, yet your accompanying free light chain ratio might suggest that you are experiencing a polyclonal gammopathy such as Lyme disease or renal insufficiency.
Also, these free light chain tests are imperfect and subject to lab error, and the results may change from day to day or even hour to hour.
Additionally, a good specialist is going to want to first see an established trend in your numbers before considering treatment.
It is likely a combination of all these reasons that you doctor wants to wait awhile and then retest you - especially since you have Lyme disease.
Now, having said all this, an involved/uninvolved free light chain ratio (in your case the lambda/kappa ratio as opposed to the kappa/lambda ratio given to you in your lab reports) greater than 100 accompanied by an involved free light chain value greater than 100 mg/L is now considered to be a "myeloma defining event" (MDE) by the International Myeloma Working Group (IMWG). Your lambda/kappa ratio is about 78, and your involved (lambda) free light chain level is clearly above 100 mg/L, so you have some overall free light chain values that are approaching an MDE threshold. But be clear that not all specialists would automatically consider initiating treatment based solely on meeting the free light chain MDE criteria. They would look at your overall situation as explained Dr. Rajkumar in his closing statement in this article about the criteria for a multiple myeloma diagnosis:
SV Rajkumar, "New Criteria For The Diagnosis Of Multiple Myeloma And Related Disorders," The Myeloma Beacon, Oct 26, 2014
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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 & smoldering vs. active myeloma
Undine,
Multibilly is correct, as always. Your lambda-kappa ratio is 736/9.4 = 78. still below the 100, or 0.01, threshold. What was it before, by the way? More importantly, what was lambda free light chain value?
I had one test where my kappa-lambda ratio jumped to 65 from 25-30 range in 2 months, and that scared me, but it was apparently a lab error, as the ratio returned to it's range on the next test. The fact that M-protein is stable is very important.
I am sure Lyme may have had to do with this and anemia as well. Hopefully the next test will be better.
Good luck!
Multibilly is correct, as always. Your lambda-kappa ratio is 736/9.4 = 78. still below the 100, or 0.01, threshold. What was it before, by the way? More importantly, what was lambda free light chain value?
I had one test where my kappa-lambda ratio jumped to 65 from 25-30 range in 2 months, and that scared me, but it was apparently a lab error, as the ratio returned to it's range on the next test. The fact that M-protein is stable is very important.
I am sure Lyme may have had to do with this and anemia as well. Hopefully the next test will be better.
Good luck!
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Dimamar - When were you/they diagnosed?: June, 2016
- Age at diagnosis: 54
Re: Kappa-lambda ratio & smoldering vs. active myeloma
Thank you both! That eases my mind and I will try to not worry between now and my next round of labs (May 30).
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Undine - Name: Undine
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Oct 2013
- Age at diagnosis: 43
4 posts
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