Hello all,
I am able to view my lab results online and my latest tests just came through.. I had an autologous stem cell transplant back in June, and my immunoglobulins have been low ever since. My CBC and CMP all look good including my WBC and RBC. But I noticed that my free light chain levels now are also low.
I am scheduled for a two-round treatment that is protocol after transplant with my transplant team. It will be Kyprolis, Pomalyst, and dexamethasone.
What is the meaning of the low immunoglobulin and free light chain levels? Are they a cause for concern?
Thank You,
George
IgA - 45 reference of 73-347
IgG - 418 reference of 657-1610
IgM - 10 reference of 46-304
Kappa, serum - 1.3 reference of 3.3-19.4 (last month was 4.6)
Lambda, serum - 1.3 reference of 5.7-26.3 (last month was 1.6)
Kappa-lambda ratio - 1.00 reference of 0.26-1.65.
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10 posts
• Page 1 of 1
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Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
Re: Low immunoglobulin & free light chain levels
George,
Discuss this with your oncologist but I believe that what you are seeing is likely a temporary result from the transplant. It takes time to rebuild the levels so the reason everything is low is likely due to the fact that is has been less than 6 months since your transplant.
Ron
Discuss this with your oncologist but I believe that what you are seeing is likely a temporary result from the transplant. It takes time to rebuild the levels so the reason everything is low is likely due to the fact that is has been less than 6 months since your transplant.
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: Low immunoglobulin & free light chain levels
Hi George,
Almost all myeloma therapies tend to suppress bone marrow function, which reduces the body's ability to produce immunoglobulins and free light chains. Generally, the more intensive the myeloma therapy, the more the marrow function will be reduced. That's why you'll often see posts here in the forum with people asking about low immunoglobulin or free light chain levels, whether it be post transplant, or simply during treatment.
See, for example, the thread mrozdav started during her initial myeloma treatment:
https://myelomabeacon.org/forum/all-immunoglobulins-suppressed-t6008.html
There's also the recent thread about free light chain levels that are almost zero after Darzalex treatment:
https://myelomabeacon.org/forum/no-detectable-free-light-chains-darzalex-t9385.html
I would think that the chances of your immunoglobulin levels recovering to normal levels would be higher if you had normal immunoglobulin levels prior to your transplant. But I don't think that's guaranteed. That could be a good topic to discuss with your doctor (let us know what you find out).
Good luck!
Almost all myeloma therapies tend to suppress bone marrow function, which reduces the body's ability to produce immunoglobulins and free light chains. Generally, the more intensive the myeloma therapy, the more the marrow function will be reduced. That's why you'll often see posts here in the forum with people asking about low immunoglobulin or free light chain levels, whether it be post transplant, or simply during treatment.
See, for example, the thread mrozdav started during her initial myeloma treatment:
https://myelomabeacon.org/forum/all-immunoglobulins-suppressed-t6008.html
There's also the recent thread about free light chain levels that are almost zero after Darzalex treatment:
https://myelomabeacon.org/forum/no-detectable-free-light-chains-darzalex-t9385.html
I would think that the chances of your immunoglobulin levels recovering to normal levels would be higher if you had normal immunoglobulin levels prior to your transplant. But I don't think that's guaranteed. That could be a good topic to discuss with your doctor (let us know what you find out).
Good luck!
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JimNY
Re: Low immunoglobulin & free light chain levels
Ron and JimNY,
Thank you both for the info. I spent two weeks inpatient for the transplant and two weeks near the transplant hospital to do labs several times per week. My IgG was in the 350 range the day I came home and I had to have an IVIG infusion. It helped and it came up to the high 500's. But it's still not in the range. I was given an order from my transplant hospital to do another IVIG if it dips under 400. I did have some leg and muscle pain and stopped cycling altogether to see if that might be the issue, but it didn't make a difference.
George
Thank you both for the info. I spent two weeks inpatient for the transplant and two weeks near the transplant hospital to do labs several times per week. My IgG was in the 350 range the day I came home and I had to have an IVIG infusion. It helped and it came up to the high 500's. But it's still not in the range. I was given an order from my transplant hospital to do another IVIG if it dips under 400. I did have some leg and muscle pain and stopped cycling altogether to see if that might be the issue, but it didn't make a difference.
George
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Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
Re: Low immunoglobulin & free light chain levels
Hi George,
I frequently see values reported as less than (<) the lower limit of the test for my serum free light chains. For instance, on 3 February, 2015 while being treated with Revlimid and dexamethasone, the kappa serum free light chain value was reported as < 0.0276 mg/dl, the lambda serum free light chain value was < 0.0236 mg/dl. The comment for the ratio was “unable to calculate due to low protein concentrations”. On 1 November, 2017, while being treated with Ninlaro, cyclophosphamide and dexamethasone, the kappa serum free light chain value was reported as < 0.0253 mg/dl, the lambda serum free light chain value was 0.7220 mg/dl, and the ratio reported as <0.0350.
This particular lab uses the following normal ranges:
Lambda serum free light chains 0.5700 - 2.63 mg/dl
Kappa serum free light chains 0.3300 - 1.94 mg/dl
Ratio (no units) 0.2600 - 1.65.
For this laboratory, if a serum free light chain is < 1.00 mg/dl, the result is reported to 4 places behind the decimal in the form 0.XXXX mg/dl. If the result is equal to or greater than 1, and less than 10 mg/dl, the result is reported in the form X.XX mg/dl. If the result is equal to or greater than 10, the result is reported in the form XX.X mg/dl.
The hematologist has never expressed concern about the low light chain values. In cases they have been quite low for consecutive months. Also note the lower limit of the tests changes slightly through time as the lab sets up a new standard curve.
Best Regards
I frequently see values reported as less than (<) the lower limit of the test for my serum free light chains. For instance, on 3 February, 2015 while being treated with Revlimid and dexamethasone, the kappa serum free light chain value was reported as < 0.0276 mg/dl, the lambda serum free light chain value was < 0.0236 mg/dl. The comment for the ratio was “unable to calculate due to low protein concentrations”. On 1 November, 2017, while being treated with Ninlaro, cyclophosphamide and dexamethasone, the kappa serum free light chain value was reported as < 0.0253 mg/dl, the lambda serum free light chain value was 0.7220 mg/dl, and the ratio reported as <0.0350.
This particular lab uses the following normal ranges:
Lambda serum free light chains 0.5700 - 2.63 mg/dl
Kappa serum free light chains 0.3300 - 1.94 mg/dl
Ratio (no units) 0.2600 - 1.65.
For this laboratory, if a serum free light chain is < 1.00 mg/dl, the result is reported to 4 places behind the decimal in the form 0.XXXX mg/dl. If the result is equal to or greater than 1, and less than 10 mg/dl, the result is reported in the form X.XX mg/dl. If the result is equal to or greater than 10, the result is reported in the form XX.X mg/dl.
The hematologist has never expressed concern about the low light chain values. In cases they have been quite low for consecutive months. Also note the lower limit of the tests changes slightly through time as the lab sets up a new standard curve.
Best Regards
Re: Low immunoglobulin & free light chain levels
George,
My immunoglobulin levels have been consistently below normal due to the continued treatments I have been on (as JimNY has indicated is common). I get IVIG infusions monthly that keeps them up higher than they would otherwise be and has helped me avoid any serious infections. That does not stop me from bike riding and hope you can get back to it.
My immunoglobulin levels have been consistently below normal due to the continued treatments I have been on (as JimNY has indicated is common). I get IVIG infusions monthly that keeps them up higher than they would otherwise be and has helped me avoid any serious infections. That does not stop me from bike riding and hope you can get back to it.
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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: Low immunoglobulin & free light chain levels
Anon25 & Ron,
Thanks for your input. I just started 2 rounds of Kyprolis, Pomalyst, and dex (KPD) yesterday. When I was first diagnosed back in January 2014, my IgA was 4500. I also meet with my oncologist today. My oncologist told me that he had several patients that receive the IVIG treatment monthly.
Ron, I do need to start riding again. I want to train for some rides that start on New Year's day. They are short. First one is only 40 miles. Just a fun ride. Then there are several rides all through 2018. I just need to train better than I have in the past.
Thank You, George
Thanks for your input. I just started 2 rounds of Kyprolis, Pomalyst, and dex (KPD) yesterday. When I was first diagnosed back in January 2014, my IgA was 4500. I also meet with my oncologist today. My oncologist told me that he had several patients that receive the IVIG treatment monthly.
Ron, I do need to start riding again. I want to train for some rides that start on New Year's day. They are short. First one is only 40 miles. Just a fun ride. Then there are several rides all through 2018. I just need to train better than I have in the past.
Thank You, George
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Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
Re: Low immunoglobulin & free light chain levels
I started Velcade, Revlimid and dexamathasone (VRD) about 6 weeks ago, and am just beginning my 3rd 21-day regimen. I didn’t start Revlimid until my 2nd rotation.
My IgG dropped from 1940 (high) to 430 (low). My free light chain levels and kappa/lambda ratio are now all in the normal range (my k/l ratio started at 0.04). I’m feeling great, and my oncologist thinks the IgG drop is probably associated with my Revlimid.
My IgG dropped from 1940 (high) to 430 (low). My free light chain levels and kappa/lambda ratio are now all in the normal range (my k/l ratio started at 0.04). I’m feeling great, and my oncologist thinks the IgG drop is probably associated with my Revlimid.
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michaelgreer - Who do you know with myeloma?: Self
- When were you/they diagnosed?: 10/25/17
- Age at diagnosis: 68
Re: Low immunoglobulin & free light chain levels
Hi folks,
Let's remember that those immunoglobulin numbers include both the many normal and good polyclonal immunoglobulins as well as the monoclonal IgA, IgG, or IgMs that are the problem. The ranges quoted by the labs are for the "typical" population of people. When a number climbs out of the range dramatically, the excess is considered to be exclusively the monoclonal immunoglobulin shows up as the M-spike. You only have half the story if the M-spike is missing. For example, one person posted in another thread about having elevated IgG, but no M spike, and it turned out that he had a significant infection that his body was fighting off by producing a lot of polyclonal IgG. There are other exceptions, but you should be getting M-spike info any time you get immunoglobulin info.
Let's remember that those immunoglobulin numbers include both the many normal and good polyclonal immunoglobulins as well as the monoclonal IgA, IgG, or IgMs that are the problem. The ranges quoted by the labs are for the "typical" population of people. When a number climbs out of the range dramatically, the excess is considered to be exclusively the monoclonal immunoglobulin shows up as the M-spike. You only have half the story if the M-spike is missing. For example, one person posted in another thread about having elevated IgG, but no M spike, and it turned out that he had a significant infection that his body was fighting off by producing a lot of polyclonal IgG. There are other exceptions, but you should be getting M-spike info any time you get immunoglobulin info.
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Foundry738 - Name: Biclonal
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 2016
- Age at diagnosis: 67
Re: Low immunoglobulin & free light chain levels
I don’t think I’ve received any M-spike info, but I thought I read that with kappa light chain multiple myeloma (which I think is my diagnosis), there wouldn’t be an M-spike? I’m still sketchy on details because I listen, then forget. I need to write things down until I understand all the new terminology.
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michaelgreer - Who do you know with myeloma?: Self
- When were you/they diagnosed?: 10/25/17
- Age at diagnosis: 68
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