My husband was diagnosed with IGG Lambda and multiple lesions on September 28 2012. He had a stem cell transplant on may of 2013.
The flow cytometry on Oct 29 were as follows; plasma cell immunophenotype shows rare poly-clonal cells 0.04 cells, CD 56 normal, and 1% plasma cells.
The FLC ratio was normal even several months after the May transplant.
The FLC ratio went down in October. The FLC kappa dropped to 0.16mg/dl and the lambda to 1.18mg/dl. The FLC ratio dropped to 0.14mg/dl which is low.
The last check up was on December 19 2013. The FLC went down even more; to 0.11mg/dl. The kappa FLC went down as well; 0.13mg/dl. The FLC Lambda stayed stable at 1.20mg/dl
I looked all over the internet but I wasn't able to understand what this means.I was wondering if anybody could help me understand these results?
Thank You
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Re: Need help understanding post-transplant FLC results
Regarding,
...The FLC RATIO down even more; to 0.11 [note that no units would be show for a ratio]
The kappa FLC went down as well; 0.13mg/dl.
The FLC Lambda stayed stable at 1.20mg/dl...
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The changes in the FLCs between the two tests are extremely minor and for all intents and purposes, are unchanged.
I honestly don't know what to tell you about the kappa FLC being lower than normal (which also makes the free light chain ratio lower than normal). I'm only used to seeing FLCs being higher than normal. Maybe somebody else in the know can comment here.
An overall plasma cell count of 1% is great. The presence of polyclonal cells is actually a good thing ... at least that is what I've heard every time I've come across this.
What was his serum M-spike?
...The FLC RATIO down even more; to 0.11 [note that no units would be show for a ratio]
The kappa FLC went down as well; 0.13mg/dl.
The FLC Lambda stayed stable at 1.20mg/dl...
---------------
The changes in the FLCs between the two tests are extremely minor and for all intents and purposes, are unchanged.
I honestly don't know what to tell you about the kappa FLC being lower than normal (which also makes the free light chain ratio lower than normal). I'm only used to seeing FLCs being higher than normal. Maybe somebody else in the know can comment here.
An overall plasma cell count of 1% is great. The presence of polyclonal cells is actually a good thing ... at least that is what I've heard every time I've come across this.
What was his serum M-spike?
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Need help understanding post-transplant FLC results
I would be careful over reading into just the serum free light chain levels and the serum free light chain ratio. If your husband was diagnosed with IgG lambda multiple myeloma - with an M-spike (serum and or urine) as well as an altered serum free light chain ratio (because of an elevated lambda light chain), then you want to take them all into account. Importantly, the serum and urine M-spikes represent only myeloma-produced antibodies. Where quantitative immunoglobulins and serum free light chain (sFLC) results also contain your/his normal antibodies (or pieces of antibodies) in addition to myeloma-specific antibodies (the proteins produced by the myeloma cells).
If I am making the correct assumption and reading your post correctly the kappa/lambda ratio was normal. Note that normal has a range of typically 0.26 to 1.62, because the normal (non-myeloma) sFLC may vary. It is also important to note that when the light chains are relatively small slight changes in the "normal/non involved" light chain can lead to changes in the ratio without large (significant) changes in the actual disease-involved light chain. In your husbands case the kappa light chain (non-involved) may be contributing to the changes in the ratio.
Now, your husbands ratio has changed in small amounts with a maintenance of his lambda light chain at 1.2ish. I would suggest that this is not something to overly concerned about at this time. This is especially true in the first year post-transplant when the immune system is regenerating.
Please trying to keep an eye on all of his parameters and let that be your guide. Please let us know if there is anything else that we can help you with.
If I am making the correct assumption and reading your post correctly the kappa/lambda ratio was normal. Note that normal has a range of typically 0.26 to 1.62, because the normal (non-myeloma) sFLC may vary. It is also important to note that when the light chains are relatively small slight changes in the "normal/non involved" light chain can lead to changes in the ratio without large (significant) changes in the actual disease-involved light chain. In your husbands case the kappa light chain (non-involved) may be contributing to the changes in the ratio.
Now, your husbands ratio has changed in small amounts with a maintenance of his lambda light chain at 1.2ish. I would suggest that this is not something to overly concerned about at this time. This is especially true in the first year post-transplant when the immune system is regenerating.
Please trying to keep an eye on all of his parameters and let that be your guide. Please let us know if there is anything else that we can help you with.
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Dr. Ken Shain - Name: Ken Shain, M.D., Ph.D.
Beacon Medical Advisor
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