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Multiple sclerosis, Aubagio, and kappa-lambda ratio
I have been diagnosed with both MGUS and multiple sclerosis. My latest lab result shows that my kappa-lambda free light chain ratio was 3.2. Could the elevated level of the ratio be due to the multiple sclerosis, or to Aubagio (teriflunomide), the medicine I'm taking for my multiple sclerosis?
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Odhransmom - Name: Patty Clark
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: 6/2015
- Age at diagnosis: 48
Re: Multiple sclerosis, Aubagio, and kappa-lambda ratio
Hi there,
A few quick pieces of info might help forum members to give you the information you need:
1) On what basis was the MUGS diagnosis made? Was it made on the basis of your free light chains or did you also have an M-spike on a serum or urine protein electrophoresis (SPEP/UPEP) and/or a monoclonal protein detected via serum or urine immunofixation?
2) What were the actual levels (with units of measure) of your free kappa and lambda light chains that resulted in the ratio of 3.2?
3) Are you known to suffer from any kidney dysfunction?
4) Have you had any other abnormalities on routine blood tests like CBC or comprehensive metabolic panel? More specifically, are any of the following out of the normal range on these tests: red blood cells, hemoglobin, serum calcium, creatinine, blood urea nitrogen (BUN), GFR or estimated GFR?
Have a good evening.
A few quick pieces of info might help forum members to give you the information you need:
1) On what basis was the MUGS diagnosis made? Was it made on the basis of your free light chains or did you also have an M-spike on a serum or urine protein electrophoresis (SPEP/UPEP) and/or a monoclonal protein detected via serum or urine immunofixation?
2) What were the actual levels (with units of measure) of your free kappa and lambda light chains that resulted in the ratio of 3.2?
3) Are you known to suffer from any kidney dysfunction?
4) Have you had any other abnormalities on routine blood tests like CBC or comprehensive metabolic panel? More specifically, are any of the following out of the normal range on these tests: red blood cells, hemoglobin, serum calcium, creatinine, blood urea nitrogen (BUN), GFR or estimated GFR?
Have a good evening.
Re: Multiple sclerosis, Aubagio, and kappa-lambda ratio
MGUS was diagnosed with a 0.5 g/dl (5 g/l) M-spike, the kappa was 27.9, lambda was 8.9, no kidney problems, everything else was within normal limits, which was unusual since I've been diagnosed with pernicious anemia and superior mesenteric artery syndrome (SMAS). Everything actually looked great except the kappa-lambda ratio.
I just started Aubagio last month, but when I called the nurse at Sanofi Genzyme (the makers of Aubagio), they had no other case to reference regarding multiple sclerosis, MGUS, and Aubagio.
Thanks for your response!
I just started Aubagio last month, but when I called the nurse at Sanofi Genzyme (the makers of Aubagio), they had no other case to reference regarding multiple sclerosis, MGUS, and Aubagio.
Thanks for your response!
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Odhransmom - Name: Patty Clark
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: 6/2015
- Age at diagnosis: 48
Re: Multiple sclerosis, Aubagio, and kappa-lambda ratio
Hi again and thanks for posting your results. Please note that I'm nothing even remotely approximating a doctor or an expert on this subject, so please consult with your doctor, but from what you've written I would tend to assume that your elevated kappa-lambda ratio is part and parcel of your known monoclonal gammopathy (as identified through protein electrophoresis) rather than being a side effect of multiple sclerosis or a drug used to treat MS. I don't know this for certain, of course, but I'm not aware of any drugs that cause a skewed light chain ratio.
The reason I asked about your kidneys is because docs sometimes employ an adjusted kappa-lambda ratio reference range in instances where the patient has known kidney dysfunction, as kidney disease can alter the relative balance of serum free light chains such that a borderline elevated free light chain ratio such as yours could possibly be an artifact of kidney disease rather than monoclonal gammopathy. In your case since you have no kidney disease, a slightly elevated kappa, normal lambda, an elevated kappa-lambda ratio and an M-spike, it seems likely that you have MGUS rather than an MGUS look-alike kind of artifact resulting from your meds.
The good news is that if all of the other tests I listed came back normal you probably don't meet any of the CRAB criteria that define myeloma ... and presumably your doctor would have been on top of looking into those criteria specifically upon discovering your M-spike.
Hope that's of some use and good luck!
The reason I asked about your kidneys is because docs sometimes employ an adjusted kappa-lambda ratio reference range in instances where the patient has known kidney dysfunction, as kidney disease can alter the relative balance of serum free light chains such that a borderline elevated free light chain ratio such as yours could possibly be an artifact of kidney disease rather than monoclonal gammopathy. In your case since you have no kidney disease, a slightly elevated kappa, normal lambda, an elevated kappa-lambda ratio and an M-spike, it seems likely that you have MGUS rather than an MGUS look-alike kind of artifact resulting from your meds.
The good news is that if all of the other tests I listed came back normal you probably don't meet any of the CRAB criteria that define myeloma ... and presumably your doctor would have been on top of looking into those criteria specifically upon discovering your M-spike.
Hope that's of some use and good luck!
Re: Multiple sclerosis, Aubagio, and kappa-lambda ratio
This is interesting to me as I have multiple sclerosis and MGUS and am hesitant to start treatment because of the immunosuppressive nature of it. Let us know what you dig up.
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countrygirl - Name: Countrygirl
- Who do you know with myeloma?: IgG MGUS
- When were you/they diagnosed?: September 2016
- Age at diagnosis: 35
Re: Multiple sclerosis, Aubagio, and kappa-lambda ratio
My wife was thought to have multiple sclerosis seven years ago as her neurologist found two nickel-size white lesions (sclerosis) on a brain MRI. Two comparative MRIs about 18 months apart subsequently showed no changes in the lesions. She does not have any multiple sclerosis symptoms, other than fatigue. All blood tests were normal except for a paraprotein of 0.2 g/dL (2 g/l) identified in 2012. In the summer of 2015, with a paraprotein of 0.4 g/dL, her neurologist found her neutrophils (ANC) in her white blood count were low 0.8 and 0.7 (normal is 1.5 to 6.5) on two separate tests a month apart. She was then referred to hematologist-oncologist.
He identified that she has chronic neutropenia and is on weekly injections of Neupogen for the last 17 months. Her ANC at the end of each week before her weekly injection drops to between 0.3 and 1.3 - normally at 0.9.
Other blood tests all fall into the normal ranges, including her beta 2 microglobulin of of 1.91 (normal 0.61 to 2.45), except for these below as of early September (these are tested every other month)
Steadily rising paraprotein to 1.7 g/dL
Steadily rising IgG to 2,436 (normal 650 to 1,600)
Steadily rising kappa light chains of 68.8 (normal 3.3 to 19.4).
Kappa-lambda free light chain ratio 7.97 (normal 0.26 to 1.65) in September
A/G ratio 0.6 (normal 1.1 to 2.5) in September
Gamma globulin 2.2 (normal 0.7 to 1.5) in September
IgM is 45 (normal is 50.0 to 300.0) in September
I was convinced that she was going to be diagnosed with smoldering myeloma with her second bone marrow biopsy in September, but the results of her second bone marrow biopsy were just like the first one - plasma cells of 5% and no abnormalities in the plasma cell structure. FISH testing revealed no chromosome abnormalities. Skeletal x-ray was normal. Her hematologist believes that she has autoimmune neutropenia and something else.
Her physicians keep monitoring for specific autoimmune disorders.
I say all of this .... as you need to just keep watching and asking questions with your blood work with your hematologist and neurologist. Having MGUS and an autoimmune disorder, such as multiple sclerosis, can be worrisome and difficult to understand.
He identified that she has chronic neutropenia and is on weekly injections of Neupogen for the last 17 months. Her ANC at the end of each week before her weekly injection drops to between 0.3 and 1.3 - normally at 0.9.
Other blood tests all fall into the normal ranges, including her beta 2 microglobulin of of 1.91 (normal 0.61 to 2.45), except for these below as of early September (these are tested every other month)
Steadily rising paraprotein to 1.7 g/dL
Steadily rising IgG to 2,436 (normal 650 to 1,600)
Steadily rising kappa light chains of 68.8 (normal 3.3 to 19.4).
Kappa-lambda free light chain ratio 7.97 (normal 0.26 to 1.65) in September
A/G ratio 0.6 (normal 1.1 to 2.5) in September
Gamma globulin 2.2 (normal 0.7 to 1.5) in September
IgM is 45 (normal is 50.0 to 300.0) in September
I was convinced that she was going to be diagnosed with smoldering myeloma with her second bone marrow biopsy in September, but the results of her second bone marrow biopsy were just like the first one - plasma cells of 5% and no abnormalities in the plasma cell structure. FISH testing revealed no chromosome abnormalities. Skeletal x-ray was normal. Her hematologist believes that she has autoimmune neutropenia and something else.
Her physicians keep monitoring for specific autoimmune disorders.
I say all of this .... as you need to just keep watching and asking questions with your blood work with your hematologist and neurologist. Having MGUS and an autoimmune disorder, such as multiple sclerosis, can be worrisome and difficult to understand.
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LuvHiking - Name: LuvHiking
- Who do you know with myeloma?: Wife
- When were you/they diagnosed?: Waiting for diagnosis
- Age at diagnosis: 50
6 posts
• Page 1 of 1