Hi all from a very windy and wintry Melbourne.
I was diagnosed with MGUS in 2005 with an incidental paraprotein (M-spike) level of 4g/l [0.4 g/dL] and monoclonal IgM kappa. This has gradually risen to 15g/l [1.5 g/dL].
In recent protein studies I also had kappa free light chain 53.7, lambda free light chain 6.3, and K/L ratio 8.52, total protein 78, albumin 39, globulin 40, IgG 6, IgA 8.
Is anyone able to tell me if this alters my MGUS status in any way?
I had an initial bone marrow biopsy which was normal and another 18 months ago also normal.
The whole scenario worries me particularly when each 6 monthly test time comes around.
I would appreciate any and all assistance. Thank you. Loretta
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Re: MGUS and higher kappa/lambda ratio
Here is a snipit from the Multiple Myeloma Patient Handbook.
http://myeloma.org/pdfs/Patient_Handbook_2013.pdf
TABLE 1: Definitions of MGUS and Myeloma
NAME DEFINITION
Monoclonal Gammopathy of Undetermined Significance (MGUS)
• Monoclonal protein present but usually <3.0 g/dL
• No CRAB features or other indicators of active myeloma
• Bone marrow monoclonal plasma cells <10%
Asymptomatic or Smoldering Multiple Myeloma (SMM)
• Higher level of disease than MGUS: serum m-component can be >3.0 g/dL
and/or bone marrow plasma cells >10%, but
• No CRAB features or other indicators of active myeloma
Active or Symptomatic Myeloma
• Monoclonal protein present, and
• One or more “CRAB” features and/or indicators of organ damage*
* organ damage classified as “CRAB” or any other significant clinical problem linked to myeloma progression such as recurrent infections or neuropathy unrelated to treatment
C – calcium elevation (>10 mg/dL)
R – renal dysfunction (creatinine >2 mg/dL) A – anemia (hemoglobin <10 g/dL o r >2g/dL decrease from patient’s normal)
B – bone disease (lytic lesions or osteoporosis)
one or more “CRAB” features or other significant problem required for diagnosis of symptomatic myeloma
Your SFLC assay indicates that you have elevated kappa and your ratio is high. With a high ratio and M spike of 1.5, by the definition above you have at least smoldering myeloma.
If you also have any of the CRAB indicators, you would be classified with active multiple myeloma and should probably begin treatment.
If I were you, I would be wanting to discuss these results with my oncologist now and determine when and what what type of treatment should begin. I would not wait another 6 months.
Good Luck
Ron
http://myeloma.org/pdfs/Patient_Handbook_2013.pdf
TABLE 1: Definitions of MGUS and Myeloma
NAME DEFINITION
Monoclonal Gammopathy of Undetermined Significance (MGUS)
• Monoclonal protein present but usually <3.0 g/dL
• No CRAB features or other indicators of active myeloma
• Bone marrow monoclonal plasma cells <10%
Asymptomatic or Smoldering Multiple Myeloma (SMM)
• Higher level of disease than MGUS: serum m-component can be >3.0 g/dL
and/or bone marrow plasma cells >10%, but
• No CRAB features or other indicators of active myeloma
Active or Symptomatic Myeloma
• Monoclonal protein present, and
• One or more “CRAB” features and/or indicators of organ damage*
* organ damage classified as “CRAB” or any other significant clinical problem linked to myeloma progression such as recurrent infections or neuropathy unrelated to treatment
C – calcium elevation (>10 mg/dL)
R – renal dysfunction (creatinine >2 mg/dL) A – anemia (hemoglobin <10 g/dL o r >2g/dL decrease from patient’s normal)
B – bone disease (lytic lesions or osteoporosis)
one or more “CRAB” features or other significant problem required for diagnosis of symptomatic myeloma
Your SFLC assay indicates that you have elevated kappa and your ratio is high. With a high ratio and M spike of 1.5, by the definition above you have at least smoldering myeloma.
If you also have any of the CRAB indicators, you would be classified with active multiple myeloma and should probably begin treatment.
If I were you, I would be wanting to discuss these results with my oncologist now and determine when and what what type of treatment should begin. I would not wait another 6 months.
Good Luck
Ron
-
Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
Re: MGUS and higher kappa/lambda ratio
Ron has done a wonderful job of explaining this. From the labs provided, there is no change in the MGUS status, but you need to have blood counts and calcium levels as well.
The other issue is that you have an IgM protein. If this progresses to a disease needing treatment, it progresses to lymphoplasmacytic lymphoma (Waldenstroms macroglobulinemia) most of the time. The criteria to start symptoms for this lymphoma are mostly based on blood counts.
The other issue is that you have an IgM protein. If this progresses to a disease needing treatment, it progresses to lymphoplasmacytic lymphoma (Waldenstroms macroglobulinemia) most of the time. The criteria to start symptoms for this lymphoma are mostly based on blood counts.
-
Dr. Jason Valent - Name: Jason Valent, M.D.
Beacon Medical Advisor
Re: MGUS and higher kappa/lambda ratio
Thank you Ron and Dr Jason.I am trying hard to understand all the nuances of the various tests and their implications. I am so grateful for the chance to be able to read everyone's posts and the helpful answers given by all in the community.
Does what Dr Jason said mean that because I have the IgM protein that I am more likely to get WM than myeloma?
Loretta
Does what Dr Jason said mean that because I have the IgM protein that I am more likely to get WM than myeloma?
Loretta
Re: MGUS and higher kappa/lambda ratio
Hi all,
I'm back again because I've just had some more tests done and I just want to clarify a couple of things.
My SFLC ratio has almost doubled since last test, although nowhere near some of you who are in a far worse position than I am.
Comparing with my results, which are in the post above:
serum kappa flc now 81.1mg/l
lambda flc 5.2 mg/l
ratio 15.60
what would be the significance of this rise please?
Serum electrophoresis:
total protein 75g/L
Albumin 38g/L
Globulin 37g/L
IgG 5.2g/L (6.5-16.0)
IgA 0.6g/L (0.4-3.5)
IgM Kappa 13g/L
ESR 52mm/h (<21)
The only other blood result that is steadily climbing and almost out of range is bicarbonate 30 mmol/L, but I'm not sure how important that is.
I'll be seeing my haemo-oncologist on 27 November but I'd like some other thoughts before then if I can please.
Calcium 2.32mmol/L
I'm back again because I've just had some more tests done and I just want to clarify a couple of things.
My SFLC ratio has almost doubled since last test, although nowhere near some of you who are in a far worse position than I am.
Comparing with my results, which are in the post above:
serum kappa flc now 81.1mg/l
lambda flc 5.2 mg/l
ratio 15.60
what would be the significance of this rise please?
Serum electrophoresis:
total protein 75g/L
Albumin 38g/L
Globulin 37g/L
IgG 5.2g/L (6.5-16.0)
IgA 0.6g/L (0.4-3.5)
IgM Kappa 13g/L
ESR 52mm/h (<21)
The only other blood result that is steadily climbing and almost out of range is bicarbonate 30 mmol/L, but I'm not sure how important that is.
I'll be seeing my haemo-oncologist on 27 November but I'd like some other thoughts before then if I can please.
Calcium 2.32mmol/L
Re: MGUS and higher kappa/lambda ratio
Sorry, posted before I could say thank you. Thank you for taking the time to read this and hopefully give an opinion.
Loretta
Loretta
6 posts
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