OK, for those of you with kappa light chain myeloma, please help me with numbers.
Should my mom have an M spike with a 24 hour urine test? She received her results back and they say:
No M-spike detected
No abnormal peaks are detected on protein electrophoresis.
No abnormal bands are detected on immunofixation.
No monoclonal proteins detected.
What exactly am I looking for with this test to monitor the disease?
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Re: Light chain myeloma - urine M-spike results of any value
Free light chains in the blood typically overflow in the urine. In general, the elevated blood free light chain in light chain myeloma patients can be picked up in the 24 hour urine sample and can be seen as an abnormal band or M-spike.
However, some patients with light chain myeloma produce only small amounts of free light chain, so very little of it passes through the kidneys and comes out unabsorbed in the urine. Such patients may have no detectable M proteins or bands in the 24-hour urine sample.
However, some patients with light chain myeloma produce only small amounts of free light chain, so very little of it passes through the kidneys and comes out unabsorbed in the urine. Such patients may have no detectable M proteins or bands in the 24-hour urine sample.
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Dr. Prashant Kapoor - Name: Prashant Kapoor, M.D.
Beacon Medical Advisor
Re: Light chain myeloma - urine M-spike results of any value
This is a topic that I've struggled to understand for quite awhile. Please help me with this. Here is my understanding. Tell me the incorrect parts.
In normal people (no disease), free light chains (FLC) are processed by the kidneys and don't make it into the blood. For a patient with light chain myeloma, a large number of monoclonal FLC (kappa or lamda) overwhelm the kidney and make it into the urine, detectable by UPEP or urine immunofixation (the former is less sensitive but quantitative, the latter sensitive but only qualitative).
For someone who has responded well to therapy, the serum FLC assay might show normal amounts of FLC in the blood and a normal kappa/lambda ratio. They might also show no evidence of monoclonal FLC in the blood. UPEP also measures nothing, but urine immunofixation shows a faint band of monoclonal Bence Jones (B-J) proteins.
If there is no evidence of kidney problems, how can FLC get into the urine and how can the very tiny number of monoclonal ones be detected? It would seem that there would be many more monoclonal FLC in the blood than urine. Why wouldn't these be seen by serum immunofixation?
In normal people (no disease), free light chains (FLC) are processed by the kidneys and don't make it into the blood. For a patient with light chain myeloma, a large number of monoclonal FLC (kappa or lamda) overwhelm the kidney and make it into the urine, detectable by UPEP or urine immunofixation (the former is less sensitive but quantitative, the latter sensitive but only qualitative).
For someone who has responded well to therapy, the serum FLC assay might show normal amounts of FLC in the blood and a normal kappa/lambda ratio. They might also show no evidence of monoclonal FLC in the blood. UPEP also measures nothing, but urine immunofixation shows a faint band of monoclonal Bence Jones (B-J) proteins.
If there is no evidence of kidney problems, how can FLC get into the urine and how can the very tiny number of monoclonal ones be detected? It would seem that there would be many more monoclonal FLC in the blood than urine. Why wouldn't these be seen by serum immunofixation?
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zephyrus - Name: Lee
- Who do you know with myeloma?: wife
- When were you/they diagnosed?: Feb, 2012
- Age at diagnosis: 64
Re: Light chain myeloma - urine M-spike results of any value
I've seen your other posts on this topic. Hopefully, though it's been a year, someone may be able to answer.
I too have a normal FLC ratio, B-J doesn't register UPEP, but does via immunofixation (proteineuria 162mg).
My local oncologist recently said that it is normal, everyone has light chains, but until this May it's never registered in my 24 hr urine immunofixation or UPEP, where now immunofixation reports kappa band B-J proteineuria.
BTW, I am borderline smoldering myeloma, high risk MGUS (10% plasma cells in marrow per immunochemistry of which 91% of all plasma cells are positive for CD56 & CD117, m-spike is on the lower side, still under 1.0 g/dL. Ten months prior (July 2013) my plasma cell % was 5% with no abberant cells noted.
A recent visit to my local oncologist only left me with more questions on this (immunofixation only B-J proteineuria).
Good luck with your wife's case.
I too have a normal FLC ratio, B-J doesn't register UPEP, but does via immunofixation (proteineuria 162mg).
My local oncologist recently said that it is normal, everyone has light chains, but until this May it's never registered in my 24 hr urine immunofixation or UPEP, where now immunofixation reports kappa band B-J proteineuria.
BTW, I am borderline smoldering myeloma, high risk MGUS (10% plasma cells in marrow per immunochemistry of which 91% of all plasma cells are positive for CD56 & CD117, m-spike is on the lower side, still under 1.0 g/dL. Ten months prior (July 2013) my plasma cell % was 5% with no abberant cells noted.
A recent visit to my local oncologist only left me with more questions on this (immunofixation only B-J proteineuria).
Good luck with your wife's case.
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pinball - Who do you know with myeloma?: Myself
- When were you/they diagnosed?: 2010 MGUS, 2014 Smoldering
- Age at diagnosis: 39
Re: Light chain myeloma - urine M-spike results of any value
Lee (zephyrus):
Regarding:
"In normal people (no disease), free light chains (FLCs) are processed by the kidneys and don't make it into the blood. For a patient with light chain myeloma, a large number of monoclonal FLC (kappa or lamda) overwhelm the kidney and make it into the urine, detectable by UPEP or urine immunofixation (the former is less sensitive but quantitative, the latter sensitive but only qualitative).
For someone who has responded well to therapy, the serum FLC assay might show normal amounts of FLC in the blood and a normal kappa/lambda ratio. They might also show no evidence of monoclonal FLC in the blood. UPEP also measures nothing, but urine immunofixation shows a faint band of monoclonal Bence Jones (B-J) proteins.
If there is no evidence of kidney problems, how can FLC get into the urine and how can the very tiny number of monoclonal ones be detected? It would seem that there would be many more monoclonal FLC in the blood than urine. Why wouldn't these be seen by serum immunofixation?"
Lee: Your assumptions aren't quite right here.
"Normal people" absolutely DO have free light chains in their blood (that's why there are "normal" serum levels for kappa and lambda free light chains. Free light chains are in fact continually processed by most people's kidneys (mine happen to reject them even though I don't have kidney disease, but that's another story). But even with the kidneys working perfectly in someone without multiple myeloma, there are FLCs present in the blood serum at any given time.
Monoclonal protein molecules (heavy chains) are too big to make it through one's kidneys and are therefore only found in the blood, bone marrow, etc.
Regarding:
"In normal people (no disease), free light chains (FLCs) are processed by the kidneys and don't make it into the blood. For a patient with light chain myeloma, a large number of monoclonal FLC (kappa or lamda) overwhelm the kidney and make it into the urine, detectable by UPEP or urine immunofixation (the former is less sensitive but quantitative, the latter sensitive but only qualitative).
For someone who has responded well to therapy, the serum FLC assay might show normal amounts of FLC in the blood and a normal kappa/lambda ratio. They might also show no evidence of monoclonal FLC in the blood. UPEP also measures nothing, but urine immunofixation shows a faint band of monoclonal Bence Jones (B-J) proteins.
If there is no evidence of kidney problems, how can FLC get into the urine and how can the very tiny number of monoclonal ones be detected? It would seem that there would be many more monoclonal FLC in the blood than urine. Why wouldn't these be seen by serum immunofixation?"
Lee: Your assumptions aren't quite right here.
"Normal people" absolutely DO have free light chains in their blood (that's why there are "normal" serum levels for kappa and lambda free light chains. Free light chains are in fact continually processed by most people's kidneys (mine happen to reject them even though I don't have kidney disease, but that's another story). But even with the kidneys working perfectly in someone without multiple myeloma, there are FLCs present in the blood serum at any given time.
Monoclonal protein molecules (heavy chains) are too big to make it through one's kidneys and are therefore only found in the blood, bone marrow, etc.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Light chain myeloma - urine M-spike results of any value
Of course, Multibilly, you are right. I meant to say "into the urine" not "into the blood" (which doesn't make any sense).
Thanks for your input.
Thanks for your input.
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zephyrus - Name: Lee
- Who do you know with myeloma?: wife
- When were you/they diagnosed?: Feb, 2012
- Age at diagnosis: 64
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