Hello Everyone,
I just received my latest labs and my oncologist gave me the good news that I have achieved a great response from my latest treatments. My SPEP has shown for the last 3 labs no gamma globulin protein M-spike but this time my IFE also shows no monoclonal protein spike.
I was pretty happy, to say the least. All my labs are in their ranges except for my anion gap, which is low at 4 (normal range is 8-15).
Now here comes the results that have me puzzled. First, my free kappa and lambda plus my kappa/lambda ratio seem to always show up a few days after my other labs are accessible. So I just received them today through my hospital's lab site. I am listing a few other labs so maybe someone can respond to what I think is a possible labs mistake.
My concerns are the kappa/lambda ratio at 11.43. As I understand it, if either kappa or lambda are very high, and the other chain is normal or low, then the ratio is abnormal. Mine show no increase to a high level for the kappa or lambda. If anything, lambda is low.
Could this be a lab mistake on the kappa / lambda ratio? Or does this indicate some other issue?
I also had a Zometa treatment a few days before lab draw, if that has something to do with it. Not sure.
I am thinking that, instead of the 11.43, it should read 1.43. That would be more inline with the last lab at 1.53. Quite a change in just a few weeks. Any thoughts on this would be greatly appreciated.
Thank you, Castaway
IgA 147 (73-347)
Total protein 6.1 (6.4-8.3)
Anion gap 4 (8-9)
December 29, 2014 lab results
Free kappa 8.0 (3.3-19.4)
Free lambda 0.7 (5.7-26.3)
Kappa/lambda ratio 11.43 (0.26-1.65) **
December 2, 2014 lab results
Free Kappa 7.2
Free Lambda 4.7
Kappa/lambda ratio 1.53 **
Forums
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Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
Re: No M-spike on SPEP or IFE, but abnormal K/L ratio?
Hi George,
I hope your oncology team will soon put your concerns (kappa lambda levels) to rest.
We both had posted messages on Peggy B's thread "How did you decide whether to have a SCT or not". It seems the months of chemo has made a big impact and I hope you will write soon about the next phase of your treatment.
Wish you all the best and I hope your results indicate a complete remission.
K_Shash
I hope your oncology team will soon put your concerns (kappa lambda levels) to rest.
We both had posted messages on Peggy B's thread "How did you decide whether to have a SCT or not". It seems the months of chemo has made a big impact and I hope you will write soon about the next phase of your treatment.
Wish you all the best and I hope your results indicate a complete remission.
K_Shash
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K_Shash - Name: K_Shash
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: November 2014
- Age at diagnosis: 67
Re: No M-spike on SPEP or IFE, but abnormal K/L ratio?
Hi,
What type of myeloma do you have?
What type of myeloma do you have?
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blair77 - Who do you know with myeloma?: My husband
- When were you/they diagnosed?: April 2013
- Age at diagnosis: 43
Re: No M-spike on SPEP or IFE, but abnormal K/L ratio?
Blair77, I have IgA kappa light chain.
K_Shash,
I talked to my oncologist, and he doesn't seem concerned given that all my other labs are normal and the SPEP and IFE no longer show a spike. So another bone marrow biopsy is in the works. He said he has seen this before.
I was concerned about the ratio being really high, thinking that it could be some indication of kidney issues. But from what I understand, I would have to have a very high chain on one side, and the other normal or low, creating the high ratio to be concerned about a kidney problem.
All other indicators in the lab tests that would refer to this are normal also. So I get my CBC and CMP this weekend, and the following weekend, I do the same with SPEP, IFE, IGA, kappa / lambda added to it. Will see what that shows.
I'm calling tomorrow to go over details about my stem cell harvest and storage. I have my fingers crossed that my insurance will cover the storage.
Thanks for the reply, Cataway.
K_Shash,
I talked to my oncologist, and he doesn't seem concerned given that all my other labs are normal and the SPEP and IFE no longer show a spike. So another bone marrow biopsy is in the works. He said he has seen this before.
I was concerned about the ratio being really high, thinking that it could be some indication of kidney issues. But from what I understand, I would have to have a very high chain on one side, and the other normal or low, creating the high ratio to be concerned about a kidney problem.
All other indicators in the lab tests that would refer to this are normal also. So I get my CBC and CMP this weekend, and the following weekend, I do the same with SPEP, IFE, IGA, kappa / lambda added to it. Will see what that shows.
I'm calling tomorrow to go over details about my stem cell harvest and storage. I have my fingers crossed that my insurance will cover the storage.
Thanks for the reply, Cataway.
-
Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
Re: No M-spike on SPEP or IFE, but abnormal K/L ratio?
Hi George,
You've probably figured this out by now, but the kappa-lambda ratio in your lab report is exactly what it sounds like. It's calculated by dividing the kappa free light chain level from your lab reports by the lambda free light chain level in the reports.
For example, on December 2, your kappa level was 7.2, your lambda level was 4.7, so your ratio was (7.2/4.7), which is 1.53 – exactly what was in your lab report.
Similarly, on December 29, your kappa was 8.0 and your lambda was 0.7, so your ratio was (8/0.7), which is 11.43 – again, exactly what was in your lab report.
In your case, because kappa is your "involved" free light chain (you have "kappa-type" myeloma), you particularly want to be on the lookout for changes in your kappa level and any changes in the ratio that are driven by changes in the kappa level.
The change in your ratio from the beginning of December to the end of December, however, was driven mainly by a significant drop in your lambda level. So, while it would be interesting to know exactly why that happened, I don't think it's that unusual, and it suggests that the change in the ratio should not be too much of a concern.
Hope this helps a bit. Good luck!
You've probably figured this out by now, but the kappa-lambda ratio in your lab report is exactly what it sounds like. It's calculated by dividing the kappa free light chain level from your lab reports by the lambda free light chain level in the reports.
For example, on December 2, your kappa level was 7.2, your lambda level was 4.7, so your ratio was (7.2/4.7), which is 1.53 – exactly what was in your lab report.
Similarly, on December 29, your kappa was 8.0 and your lambda was 0.7, so your ratio was (8/0.7), which is 11.43 – again, exactly what was in your lab report.
In your case, because kappa is your "involved" free light chain (you have "kappa-type" myeloma), you particularly want to be on the lookout for changes in your kappa level and any changes in the ratio that are driven by changes in the kappa level.
The change in your ratio from the beginning of December to the end of December, however, was driven mainly by a significant drop in your lambda level. So, while it would be interesting to know exactly why that happened, I don't think it's that unusual, and it suggests that the change in the ratio should not be too much of a concern.
Hope this helps a bit. Good luck!
Re: No M-spike on SPEP or IFE, but abnormal K/L ratio?
Cheryl G,
Thank you so much for your information and calculations. When I receive my labs, they also come with reports by the lab tech. Like on my IFE and SPEP, they report any indications of a spike. This last set of labs had some comments but nothing about the ratio, so I feel they would have indicated any issues with the ratio if there was one.
My oncologist had the same thoughts that you spoke of as far as the significant drop on the lambda driving the ratio up. He really wants to do another bone marrow biopsy to get more information from my latest response, but he doesn't like doing those any more than is necessary. Plus, my transplant hospital said they want to have a biopsy done prior to my cell harvest, which should take place in March.
Thank You, Castaway
Thank you so much for your information and calculations. When I receive my labs, they also come with reports by the lab tech. Like on my IFE and SPEP, they report any indications of a spike. This last set of labs had some comments but nothing about the ratio, so I feel they would have indicated any issues with the ratio if there was one.
My oncologist had the same thoughts that you spoke of as far as the significant drop on the lambda driving the ratio up. He really wants to do another bone marrow biopsy to get more information from my latest response, but he doesn't like doing those any more than is necessary. Plus, my transplant hospital said they want to have a biopsy done prior to my cell harvest, which should take place in March.
Thank You, Castaway
-
Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
Re: No M-spike on SPEP or IFE, but abnormal K/L ratio?
Good morning and Happy New Year, George,
I was quite impressed with the latest results you had posted on January 4 and as Cheryl G pointed out, your lambda chains were very close to the "normal range", as recently as Dec. 4. Now that your oncologist has also laid your concerns to rest (about the low lambda), I hope you have no problems with the bone marrow biopsy and proceed with the "insurance policy" of the stem cell harvesting and s-torage.
I have had so many questions for you about your myeloma diagnosis, almost a year ago, and about the chemotherapy, dosages (I did see most of this in your post in the thread "How did you decide...ASCT") and about the time line of the improvement in your blood test results. Therefore, I could not write a 'quick post' and also waited to see your post about your oncologist's opinion about your concerns.
It seems that you, too, have the kappa IgG myeloma like me. However, I started with kappa free light chains free (KFLC?) at over 1,000, and all my IgG protein was found only in the urine. So far, the kidney function has not been affected. In two separate 24-hour tests, the urine collection showed that the IgG leaked in the urine was about 2,500 mg. I just completed 3 weeks of my induction phase and my current dosages are:
15 mg Revlimid daily, 3 weeks and 1 week off
20 mg dex once a week every week
2+ mg subQ Velcade (based on the body surface area?) once a week, every week
81 mg of Aspirin every morning
Acyclovir every morning and at night
Other nausea drug that I have not needed.
In another post and by email, Cmouli has written about her 80-year old dad's numbers coming down remarkably after on 8 weeks of treatment, and his oncologist planning a maintenance phase. Her father unfortunately has had a lot of side effects and now is quite weak. I am sure he would regain his strength and confidence as his induction phase ends.
I have been a very active 67.7 year old (usually less tired after a round of golf, carrying my bag, than my 38 year old son pushing his golf cart), and I seem to have only 2 days a week of my usual energy level, that too, at about 50% stamina. The day and the day after of the dex and Velcade are major problems, for sleep and heart pounding if I walk a bit of a pace or try to do my 2-minute exercise.
I am hoping that I can be done with this induction phase soon and get back to my active life. Therefore, I am wondering at what levels your kappa and gamma globulins were at diagnosis of the myeloma and how rapidly they came down in the first few months of your chemo.
It has been only 3 weeks of the chemotherapy for me. My detailed blood test would only be done after another 5 weeks. I sure hope that I do not develop any major problems like the body rash you developed or experience some of the other symptoms other patients had and could not tolerate the Velcade or Revlimid.
Yes, my oncologist will advise me after the detailed blood test in 5 weeks or so, but I would like all the information and my reasoning to decide
As I wrote in a post on the other thread, I will most probably harvest and store my stem cells, assuming my HMO allows that, mainly to appease my wife and my son. However, IF I do well and manage well past 10 years just with the maintenance therapy, I would be past 78 IF and when I get a relapse. I am wondering if another Induction therapy won't be a better choice at that age.
This is a long and detailed post. However, it is quite difficult to get to 'the bottom of things" when I get some indirect advice from some oncologists associated with my wife and some with transplant centers that "transplant first, ask questions later".
I think they all mean well but may not be considering that all myelomas are not equal, different patients have different reactions to (and tolerance of) chemo drugs, and for me most importantly, six months of an active and happy life at 68 would be worth more than 5 years in a retirement home at 80.
I must confess: I have yet to find out how painful the stem cell harvesting is.
K_Shash
I was quite impressed with the latest results you had posted on January 4 and as Cheryl G pointed out, your lambda chains were very close to the "normal range", as recently as Dec. 4. Now that your oncologist has also laid your concerns to rest (about the low lambda), I hope you have no problems with the bone marrow biopsy and proceed with the "insurance policy" of the stem cell harvesting and s-torage.
I have had so many questions for you about your myeloma diagnosis, almost a year ago, and about the chemotherapy, dosages (I did see most of this in your post in the thread "How did you decide...ASCT") and about the time line of the improvement in your blood test results. Therefore, I could not write a 'quick post' and also waited to see your post about your oncologist's opinion about your concerns.
It seems that you, too, have the kappa IgG myeloma like me. However, I started with kappa free light chains free (KFLC?) at over 1,000, and all my IgG protein was found only in the urine. So far, the kidney function has not been affected. In two separate 24-hour tests, the urine collection showed that the IgG leaked in the urine was about 2,500 mg. I just completed 3 weeks of my induction phase and my current dosages are:
15 mg Revlimid daily, 3 weeks and 1 week off
20 mg dex once a week every week
2+ mg subQ Velcade (based on the body surface area?) once a week, every week
81 mg of Aspirin every morning
Acyclovir every morning and at night
Other nausea drug that I have not needed.
In another post and by email, Cmouli has written about her 80-year old dad's numbers coming down remarkably after on 8 weeks of treatment, and his oncologist planning a maintenance phase. Her father unfortunately has had a lot of side effects and now is quite weak. I am sure he would regain his strength and confidence as his induction phase ends.
I have been a very active 67.7 year old (usually less tired after a round of golf, carrying my bag, than my 38 year old son pushing his golf cart), and I seem to have only 2 days a week of my usual energy level, that too, at about 50% stamina. The day and the day after of the dex and Velcade are major problems, for sleep and heart pounding if I walk a bit of a pace or try to do my 2-minute exercise.
I am hoping that I can be done with this induction phase soon and get back to my active life. Therefore, I am wondering at what levels your kappa and gamma globulins were at diagnosis of the myeloma and how rapidly they came down in the first few months of your chemo.
It has been only 3 weeks of the chemotherapy for me. My detailed blood test would only be done after another 5 weeks. I sure hope that I do not develop any major problems like the body rash you developed or experience some of the other symptoms other patients had and could not tolerate the Velcade or Revlimid.
Yes, my oncologist will advise me after the detailed blood test in 5 weeks or so, but I would like all the information and my reasoning to decide
- How long I would go on with this phase, assuming my kappa and IgG improve to a "normal range"?
- Do I even want to harvest my stem cells (I do not like the biopsies or needles in general)?
As I wrote in a post on the other thread, I will most probably harvest and store my stem cells, assuming my HMO allows that, mainly to appease my wife and my son. However, IF I do well and manage well past 10 years just with the maintenance therapy, I would be past 78 IF and when I get a relapse. I am wondering if another Induction therapy won't be a better choice at that age.
This is a long and detailed post. However, it is quite difficult to get to 'the bottom of things" when I get some indirect advice from some oncologists associated with my wife and some with transplant centers that "transplant first, ask questions later".
I think they all mean well but may not be considering that all myelomas are not equal, different patients have different reactions to (and tolerance of) chemo drugs, and for me most importantly, six months of an active and happy life at 68 would be worth more than 5 years in a retirement home at 80.
I must confess: I have yet to find out how painful the stem cell harvesting is.
K_Shash
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K_Shash - Name: K_Shash
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: November 2014
- Age at diagnosis: 67
Re: No M-spike on SPEP or IFE, but abnormal K/L ratio?
Hi K_Shash,
I've been following your posts and am happy to see that your first treatment cycle has been going well for the most part.
In your last post in this thread, you mentioned some questions you have about the stem cell harvest procedure. You may already have found this, but in case you haven't, there is a good thread about stem cell harvesting from last year at:
"Stem Cell Harvest - The Complete Guide," Beacon forum discussion started Jan 24, 2014.
(I hope my post here doesn't hijack this thread and move it in a different direction, but I did want to make sure you knew about the stem cell collection thread.)
Best wishes for continued success to you. Keep up the good work!
Mike
I've been following your posts and am happy to see that your first treatment cycle has been going well for the most part.
In your last post in this thread, you mentioned some questions you have about the stem cell harvest procedure. You may already have found this, but in case you haven't, there is a good thread about stem cell harvesting from last year at:
"Stem Cell Harvest - The Complete Guide," Beacon forum discussion started Jan 24, 2014.
(I hope my post here doesn't hijack this thread and move it in a different direction, but I did want to make sure you knew about the stem cell collection thread.)
Best wishes for continued success to you. Keep up the good work!
Mike
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mikeb - Name: mikeb
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2009 (MGUS at that time)
- Age at diagnosis: 55
Re: No M-spike on SPEP or IFE, but abnormal K/L ratio?
I cannot thank you enough, Mike!
Exactly what I was asking about. And the link opened nicely (in a new tab, from the right click menu).
Andrew, aka Goldmine848, has really written the Stem Cell Harvest - The Complete Guide. I think this guide justifies the 'goldmine' in his ID!
What a great resource this Myeloma Beacon is!
It is great to have people like you and Andrew (and Nancy in Phila, Multibilly, Dan in Arizona, Dr. Santiago, Tracy and so many more) helping the new myeloma patients like me in our journey.
Thanks again, mikeb.
K_shash
Exactly what I was asking about. And the link opened nicely (in a new tab, from the right click menu).
Andrew, aka Goldmine848, has really written the Stem Cell Harvest - The Complete Guide. I think this guide justifies the 'goldmine' in his ID!
What a great resource this Myeloma Beacon is!
It is great to have people like you and Andrew (and Nancy in Phila, Multibilly, Dan in Arizona, Dr. Santiago, Tracy and so many more) helping the new myeloma patients like me in our journey.
Thanks again, mikeb.
K_shash
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K_Shash - Name: K_Shash
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: November 2014
- Age at diagnosis: 67
Re: No M-spike on SPEP or IFE, but abnormal K/L ratio?
I'm IgG kappa. Have been in sCR for a year. Then, my FLC ratio went out of range due to the same issues you describe. My kappa is normal, but lambda was way below normal. Thus, the ratio being abnormal. After freaking out, I've been told all is good. And to watch the kappa number.
No M-spike on SPEP or IFE.
My main concern was no longer being in sCR. The doctor said, by definition, this was true. And, in my case, the significance is unknown. I plan to ask him about that next month when I see him.
No M-spike on SPEP or IFE.
My main concern was no longer being in sCR. The doctor said, by definition, this was true. And, in my case, the significance is unknown. I plan to ask him about that next month when I see him.
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Stan W. - Name: Stan
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: SMM-April 2012
- Age at diagnosis: 58
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