[lschulze]

Low lambda FLC level, high kappa-lambda ratio

by lschulze on Sat Jan 31, 2015 7:46 pm

I am new to this forum. I recently had a series of blood tests and have questions about the serum free light chain test. My results are:

Kappa free light chains 7.20 mg/L
Lambda free light chains 1.58 mg/L
Kappa/lambda ratio 4.56

According to the lab test, the lambda is low and the ratio is high.

My albumin is slightly elevated along with BASO %. I have had low white and red blood cell counts for six months, many respiratory infections with chronic cough and hoarseness. In the last six weeks have developed an enlarged lump on the left side of my neck. I also have hypothyroidism.

I underwent a CT scan and a throat scope yesterday and am concerned at this point. My new oncologist / hematologist will not comment as of yet, but I did test negative for lupus and rhematoid arthritis (RA).

Any information or thoughts on this would be greatly appreciated. Thanks.

[Multibilly]

Re: Low lambda FLC level, high kappa-lambda ratio

by Multibilly on Sat Jan 31, 2015 8:05 pm

Hi Ischulze,

Welcome to the forum.

If you are asking whether you can determine if multiple myeloma might be involved here, you really can't tell that from just this data on your post. Since your doctor ordered a serum free light chain assay, he very likely also ordered a "Serum Protein Electrophoresis" (SPEP) test and a serum Immunofixation test (IFE). Did the IFE say there was any monoclonal protein present? Did the SPEP report any values for monoclonal protein (it might also be called an M-Spike or paraprotein or M-protein) on the SPEP?

While abnormal free light chain results can possibly suggest something like MGUS, I would suggest not just looking at the serum free light chain test results without also looking at the SPEP and IFE findings. Things other than multiple myeloma can sometimes throw off one's free light chains, but the SPEP and IFE findings may help you zero in on the potential cause.

This handbook might give you a better idea of the things to look for if you suspect multiple myeloma.

http://myeloma.org/pdfs/PHB_2015_g1_web.pdf

I know it's hard to do, but it might be best to wait for the results of the PET/CT scan and see what your doc has to say (I just had a routine PET/CT yesterday and I expect to hear back from my doc on Monday or Tuesday, so the wait shouldn't be that long for you). A PET/CT can give one a pretty good first indication if there are any cancerous tumors present in your body.

Hope this helps. I know that waiting for lab and test results can sometimes cause one to go crazy with anxiety.

[lschulze]

Re: Low lambda FLC level, high kappa-lambda ratio

by lschulze on Sat Jan 31, 2015 9:52 pm

The test result reads:

Increased albumin sug­gests hemo­con­cen­tra­tion / dehydration. Negative immunofixation study and no abnormal bands or paraproteins were detected. The serum free light chain study suggests some degree of immune function impairment.

The peripheral smear report reads:

Macrocytosis without anemia.

I am concerned about all of the respiratory infections I have had over the last six months and the enlarged lymph nodes. My general doctor sent me to an oncologist and now have seen an ear, nose, and throat doctor. So many doctor appointments in the last two weeks, and feeling over­whelmed.

[Ron Harvot]

Re: Low lambda FLC level, high kappa-lambda ratio

by Ron Harvot on Sun Feb 01, 2015 12:13 am

Based on all of the tests, it does not sound like multiple myeloma is behind your health issues. You don't have an M-spike and the IFE was negative. Usually, if multiple myeloma is the cause, the serum free light (FLC) test would show a very high kappa or lambda reading. You are not showing that. You have a com­pro­mised immune system, but something other than multiple myeloma appears to be the cause.

Ron

[loislane]

Re: Low lambda FLC level, high kappa-lambda ratio

by loislane on Thu Aug 13, 2015 2:10 am

Dear Ischulze,

I saw your post and wondered what your results turned out to be? I have a daughter who has the exact serum blood resutls as you. She also has had many respiratory infections, and she has been battling an endocrine/thyroid problem for several years. Her IFE was normal with no M-spike. I wondered if this sort of a reading had anything to do with thyroid?

[Tuco]

Re: Low lambda FLC level, high kappa-lambda ratio

by Tuco on Fri Sep 04, 2015 9:37 pm

Hi,

I am in the same situation than yours (low lambda, normal kappa, ratio around 10) and mys doctors are puzzled. Thus, I would be very interested to know if you got any diagnosis for your case.

In your post ,you stated:

"In the last six weeks have developed an enlarged lump on the left side of my neck."

I was wondering if you got a lymph node biopsy to exclude a lymphoma ?

Best regards.

[Multibilly]

Re: Low lambda FLC level, high kappa-lambda ratio

by Multibilly on Sat Sep 05, 2015 12:34 am

Tuco,

Have you had a bone marrow biopsy? I assume from your earlier post that, when you say you have no monoclonal spike, you mean you have no monoclonal spike that was measured in your blood via a serum protein electrophoresis test. If you indeed have no serum M-spike, but have low lambda, high kappa, and a high FLC ratio, a possibility could be light chain myeloma (where there is no serum M-spike) with bone marrow suppression. That would explain the odd FLC values.

See: http://www.thebindingsite.com/interpretation-of-freelite-results

But the only way to truly confirm light chain myeloma is via a bone marrow biopsy.

[lschulze]

Re: Low lambda FLC level, high kappa-lambda ratio

by lschulze on Tue Nov 10, 2015 5:51 pm

In response to my original post ... My doctors are still puzzled. Many, many blood tests with macrocytic anemia and a few myelocytes in the blood. I am seeing a hematologist / oncologist and rheumatologist.

Basically, they are telling me I have abnormal blood results and they are not sure why. Multiple respiratory infections and urinary tract infections this year. I have also developed petachiae (small blood spots) on skin. My CT scan showed a calcium stone in the parotid gland (it is not cancer of the glands).

Doctors have suggested some gamma globulin infusions but I understand they are costly. Oncologist believes a bone marrow scan is not needed as of yet. I am wondering about seeking a second opinion.

Any thoughts would be appreciated. Thanks.

[Bubba4571]

Re: Low lambda FLC level, high kappa-lambda ratio

by Bubba4571 on Tue Apr 12, 2016 12:06 am

I have the exact same blood test results with no answer.

My symptoms are similar, but I also have bone and joint pain, night sweats, and chest pain. I've been going to doctor after doctor. Just recently, the last doctor I saw claims I have lupus. My ANA has been negative with IFA testing but after testing it with ELISA it showed positive. Not sure if it is a definitive diagnosis, but after three years of dealing with all these mystery symptoms it brings happiness just to think I have a diagnosis, so I started taking Plaquenil (hydroxychloroquine).

Did you ever find out what was going on with you? I'm very interested in knowing! Thanks!