Thank you everyone for your most informative responses.
My oncologist does not seem concerned about my kappa/lambda ratio, saying that it is an "artifact" resulting from the suppressed lambda level. We will be monitoring the ratio over the next few months. I will report back to you whatever I learn.
My last test results were as follows (just to put things in context):
Kappa FLC: 8.3 (range: 3.3-19.4 mg/L);
Lambda FLC: 2.5 (range: 5.7-26.3 mg/L);
K/L ratio: 3.32;
IgA : 42 (range: 82-453 mg/dL).
Forums
Re: Low lambda, high kappa/lambda ratio in IgA kappa myeloma
Mikeb, I have one more question for you. What does your specialist hope to accomplish with another BMB at this point? If your M-spike continues at zero, your immunofixation is negative, your serum electrophoresis is normal, what are the chances that your bone marrow / aspirate will produce enough cancerous plasma cells to enable a decent analysis? What am I not understanding? Are they looking for something else in the marrow?
Re: Low lambda, high kappa/lambda ratio in IgA kappa myeloma
Hi Mrozdav,
I can't say for sure, but I suspect that Mike's doctor wants to do the bone marrow biopsy mainly to make sure there are no signs of myeloma cells (monoclonal plasma cells) in his bone marrow. The biopsy sample would make it possible to test for the presence of myeloma cells using both standard methods (flow cytometry) as well as one or more minimal residual disease testing techniques, which Mike has had done before.
As you'll constantly hear mentioned, myeloma is a "patchy" disease, so what you find at one bone marrow biopsy site will not necessarily be what you find at another site.
Also, M-spike, immunofixation, and even free light chain tests only have a certain level of sensitivity. For the reasons Cheryl listed earlier, the fact that Mike's free light chain ratio has been bouncing in and out of the normal range could be a sign that there are still some myeloma cells present, and measurable, in his marrow.
Again, this is just my guess at the rationale for why Mike's doctor wants to do another bone marrow biopsy. Maybe there's a completely different reason, or some additional reasons.
Hope this helps a bit.
I can't say for sure, but I suspect that Mike's doctor wants to do the bone marrow biopsy mainly to make sure there are no signs of myeloma cells (monoclonal plasma cells) in his bone marrow. The biopsy sample would make it possible to test for the presence of myeloma cells using both standard methods (flow cytometry) as well as one or more minimal residual disease testing techniques, which Mike has had done before.
As you'll constantly hear mentioned, myeloma is a "patchy" disease, so what you find at one bone marrow biopsy site will not necessarily be what you find at another site.
Also, M-spike, immunofixation, and even free light chain tests only have a certain level of sensitivity. For the reasons Cheryl listed earlier, the fact that Mike's free light chain ratio has been bouncing in and out of the normal range could be a sign that there are still some myeloma cells present, and measurable, in his marrow.
Again, this is just my guess at the rationale for why Mike's doctor wants to do another bone marrow biopsy. Maybe there's a completely different reason, or some additional reasons.
Hope this helps a bit.
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JimNY
Re: Low lambda, high kappa/lambda ratio in IgA kappa myeloma
Thanks, JimNY. I had completely forgotten about the minimal residual disease test and that it is more sensitive than the conventional tests. Does "patchiness" raise questions as to the reliability of the MRD test? If it is determined that one is MRD negative, does it have any impact on the choice of treatment going forward?
Re: Low lambda, high kappa/lambda ratio in IgA kappa myeloma
Hi Mrozdav,
Yes, patchiness can cause some of the current MRD tests to indicate a patient is MRD negative when a marrow sample taken elsewhere might show the patient has minimal residual disease (i.e., is MRD positive).
There is a common misperception that, if a patient has been tested and found to be MRD negative, they automatically must also have achieved a stringent complete response (sCR). You will find patients in trials who have achieved "only" a very good partial response (VGPR), for example, who nevertheless test MRD negative.
One reason for this is the bone marrow "patchiness" issue. The bone marrow sample used to measure MRD status might come from a part of the patient's body with no myeloma, when there are other parts of the body that still have myeloma cells.
The other reason works in the opposite direction. Response definitions like VGPR and CR involve changes in a patient's M-spike, which measures how much monoclonal immunoglobulin is in a patient's blood. Immunoglobulins of any type, monoclonal or polyclonal, stays in a patient's body for several weeks after it's created. So, even if a patient was treated and reached a point on September 1 where there were no more myeloma cells anywhere in their bone marrow, you might still find signs of an M-spike in their blood on September 15.
As for the impact of MRD negative status on treatment decisions, I think that varies from myeloma specialist to myeloma specialist. I'm really hesitant to generalize.
Hope that helps a bit.
Yes, patchiness can cause some of the current MRD tests to indicate a patient is MRD negative when a marrow sample taken elsewhere might show the patient has minimal residual disease (i.e., is MRD positive).
There is a common misperception that, if a patient has been tested and found to be MRD negative, they automatically must also have achieved a stringent complete response (sCR). You will find patients in trials who have achieved "only" a very good partial response (VGPR), for example, who nevertheless test MRD negative.
One reason for this is the bone marrow "patchiness" issue. The bone marrow sample used to measure MRD status might come from a part of the patient's body with no myeloma, when there are other parts of the body that still have myeloma cells.
The other reason works in the opposite direction. Response definitions like VGPR and CR involve changes in a patient's M-spike, which measures how much monoclonal immunoglobulin is in a patient's blood. Immunoglobulins of any type, monoclonal or polyclonal, stays in a patient's body for several weeks after it's created. So, even if a patient was treated and reached a point on September 1 where there were no more myeloma cells anywhere in their bone marrow, you might still find signs of an M-spike in their blood on September 15.
As for the impact of MRD negative status on treatment decisions, I think that varies from myeloma specialist to myeloma specialist. I'm really hesitant to generalize.
Hope that helps a bit.
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JimNY
Re: Low lambda, high kappa/lambda ratio in IgA kappa myeloma
From my readings of myeloma the last four years, my takeaway has been that history has shown that, for the vast majority of patients, no matter how good a remission status they attained and what their lab results showed, eventually the disease comes back. Sometimes quickly, and sometimes (thankfully) after many years.
There is a growing population of people with myeloma in the last few years, though, who have had aggressive and relatively new treatment regimens using the new novel agents that have been coming available in recent years, and have had very durable remissions and are remaining MRD negative, pushing out the statistics for average survival statistics every year. Maybe some significant fraction of these people have actually been cured. Time will tell. I certainly hope so. There has been previous discussions on the Beacon about this; you may be be able to dig them up with a search.
There is a growing population of people with myeloma in the last few years, though, who have had aggressive and relatively new treatment regimens using the new novel agents that have been coming available in recent years, and have had very durable remissions and are remaining MRD negative, pushing out the statistics for average survival statistics every year. Maybe some significant fraction of these people have actually been cured. Time will tell. I certainly hope so. There has been previous discussions on the Beacon about this; you may be be able to dig them up with a search.
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Eric Hofacket - Name: Eric H
- When were you/they diagnosed?: 01 April 2011
- Age at diagnosis: 44
16 posts
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