Is there anything other than multiple myeloma that could cause the kappa free light chains to elevate? Dehydration? Exercise?
It appears that my husband has no M-spike and his kappa free light chain level is elevated at 1.88 His kappa-lambda ratio is 11.9. His bone marrow plasma cell percentage is 5% and his IgA is 360. All other tests are normal.
I'm just worried about that kappa light chain elevation. Could something else be going on?
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PJD143 - Name: PJD143
- Who do you know with myeloma?: learning more as I go along
- When were you/they diagnosed?: My husband was diagnosed in August 2016
- Age at diagnosis: 57
Re: Possible causes for elevated kappa & kappa-lambda ratio?
Hi PJD143,
If I look at one of your earlier posts, it would appear that your husband's earlier free light chain (FLC) and immunoglobulin numbers back in January 2017 were as follows:
Test Result Std Range
Kappa 189.9 mg/L 3.3-19.4 mgL
Lambda 17.6 mg/L 5.7-26.3 mgL
Kappa/Lambda 10.78 0.26-1.65
IgG 831 (700-1600 mg/dl)
IgA 454 (70-400 mg/dL)
IgM 60 (40-230 mg/dl)
Assuming your most recent kappa FLC level is expressed in g/L, it would appear that his kappa FLC level remains unchanged (188.9 mg/L = 1.89 g/L). Additionally, his FLC ratio is essentially unchanged (10.78 versus 11.9). Also, his IgA level has drifted back down into the normal range.
Given the above situation, what's the concern? His disease appears to be holding quite steady (at least based on the info you've provided here).
If I look at one of your earlier posts, it would appear that your husband's earlier free light chain (FLC) and immunoglobulin numbers back in January 2017 were as follows:
Test Result Std Range
Kappa 189.9 mg/L 3.3-19.4 mgL
Lambda 17.6 mg/L 5.7-26.3 mgL
Kappa/Lambda 10.78 0.26-1.65
IgG 831 (700-1600 mg/dl)
IgA 454 (70-400 mg/dL)
IgM 60 (40-230 mg/dl)
Assuming your most recent kappa FLC level is expressed in g/L, it would appear that his kappa FLC level remains unchanged (188.9 mg/L = 1.89 g/L). Additionally, his FLC ratio is essentially unchanged (10.78 versus 11.9). Also, his IgA level has drifted back down into the normal range.
Given the above situation, what's the concern? His disease appears to be holding quite steady (at least based on the info you've provided here).
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Possible causes for elevated kappa & kappa-lambda ratio?
Maybe the increase is to 1880 mg/L. I don’t know why ratio is unchanged.
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Arizonan - Name: Arizonan
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: April 2010
- Age at diagnosis: 54
Re: Possible causes for elevated kappa & kappa-lambda ratio?
I believe 189.9 mg/L is 0.1899 g/L, rather than 1.899 g/L. It's also 18.99 mg/dL.
The new kappa level of "1.88" (without units) that PJD143 mentioned may be 1.88 mg/dL, which would be on the high end of the normal range, but still within the normal range. I wouldn't call it "elevated," but someone else might.
A reading of 1.88 mg/dL would be much lower than the previous level of 189.9 mg/L (18.99 mg/dL).
This is why it's important to include units or reference ranges with lab values posted here in the forum.
The new kappa level of "1.88" (without units) that PJD143 mentioned may be 1.88 mg/dL, which would be on the high end of the normal range, but still within the normal range. I wouldn't call it "elevated," but someone else might.
A reading of 1.88 mg/dL would be much lower than the previous level of 189.9 mg/L (18.99 mg/dL).
This is why it's important to include units or reference ranges with lab values posted here in the forum.
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JimNY
Re: Possible causes for elevated kappa & kappa-lambda ratio?
Jim,
Of course, you are right. My bad at doing a quick conversion.
Indeed, one should always include the units of measure (and the lab's reference ranges for those values) when citing any lab figures on this forum. It really helps to avoid any confusion.
PJD143,
In any case, if you could re-post the kappa and lambda FLC figures with the units of measure and associated reference ranges, that would help clear things up.
Of course, you are right. My bad at doing a quick conversion.
Indeed, one should always include the units of measure (and the lab's reference ranges for those values) when citing any lab figures on this forum. It really helps to avoid any confusion.
PJD143,
In any case, if you could re-post the kappa and lambda FLC figures with the units of measure and associated reference ranges, that would help clear things up.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Possible causes for elevated kappa & kappa-lambda ratio?
No worries, Multibilly. It wasn't a big deal. I just didn't want there to be any confusion on how to do conversions between g/l, mg/l, g/dL, and mg/dL. As you know, the key is to remember that a gram (g) is the same as 1000 milligrams (mg), and a liter (l) is the same as 10 deciliters (dL).
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JimNY
Re: Possible causes for elevated kappa & kappa-lambda ratio?
Thanks for getting back to me.
Test Result Std Range
Kappa 188.8 mg/L 3.3-19.4 mgL
Lambda 15.6 mg/L 5.7-26.3 mg/L
Kappa/lambda 12.0 0.26-1.65
When my husband was first diagnosed in August 2016 with high-risk smoldering myeloma, we decided to enter him into a trial for the trial with Opdivo (nivolumab), Revlimid, and dexamethasone. This trial was for one year and will be ending this month. The FDA put a hold on the Opdivo part of the trial (6 months into the trial), so he continued with the Revlimid and dexamethasone. The past three months he was on just Revlimid. With the exception of being tired, he has done well.
As for his kappa level, it was trending down nicely but never got within the normal range. The lowest point it got was 72.0 mg/L, ratio was 4.0. Since he has been on the Revlimid, only the kappa has gone up.
He had a recent bone marrow biopsy which showed less than 5%.
His most recent M-spike was not quantified by SPEP and immunofixation showed a small band. His kappa-lambda ratio was swinging in the range of 7-11. However, he doesn't have anemia, elevated creatinine, or recurrent infections. His doctors are hopeful that he could become MRD negative.
Thanks for helping me clarify this.
Test Result Std Range
Kappa 188.8 mg/L 3.3-19.4 mgL
Lambda 15.6 mg/L 5.7-26.3 mg/L
Kappa/lambda 12.0 0.26-1.65
When my husband was first diagnosed in August 2016 with high-risk smoldering myeloma, we decided to enter him into a trial for the trial with Opdivo (nivolumab), Revlimid, and dexamethasone. This trial was for one year and will be ending this month. The FDA put a hold on the Opdivo part of the trial (6 months into the trial), so he continued with the Revlimid and dexamethasone. The past three months he was on just Revlimid. With the exception of being tired, he has done well.
As for his kappa level, it was trending down nicely but never got within the normal range. The lowest point it got was 72.0 mg/L, ratio was 4.0. Since he has been on the Revlimid, only the kappa has gone up.
He had a recent bone marrow biopsy which showed less than 5%.
His most recent M-spike was not quantified by SPEP and immunofixation showed a small band. His kappa-lambda ratio was swinging in the range of 7-11. However, he doesn't have anemia, elevated creatinine, or recurrent infections. His doctors are hopeful that he could become MRD negative.
Thanks for helping me clarify this.
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PJD143 - Name: PJD143
- Who do you know with myeloma?: learning more as I go along
- When were you/they diagnosed?: My husband was diagnosed in August 2016
- Age at diagnosis: 57
Re: Possible causes for elevated kappa & kappa-lambda ratio?
Let me clarify that after 9 months of my husband being part of the trial, his numbers were significantly lower during the trial. I was hoping they would remain lower but they have creeped up and this is what was concerning.
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PJD143 - Name: PJD143
- Who do you know with myeloma?: learning more as I go along
- When were you/they diagnosed?: My husband was diagnosed in August 2016
- Age at diagnosis: 57
Re: Possible causes for elevated kappa & kappa-lambda ratio?
So from what you've shared of your husband's lab results and treatment history, it appears that he has predominantly light chain myeloma. In addition, the treatment regimen he was on lowered his free light chain numbers initially, but they've been on an upward trend lately, to the point where they're basically back to where they were before he started treatment.
In fact, if your husband were not currently being treated with Revlimid, there's a good chance his kappa and kappa-lambda ratio results would be higher than what they are.
With a kappa-lambda ratio of 12, I really doubt that that the cause is something other than myeloma cells churning out excess kappa light chains. There have been cases here in the forum, and I believe in the literature, of things like infections causing kappa-lambda ratios that are slightly outside the normal range. Impaired kidney function also causes slightly higher-than-normal kappa-lambda ratios. However, a ratio of 12, and the fact that the result is part of a trend and your husband does not have kidney problems, suggests that the ratio is due to the disease, rather than some alternative cause.
I realize your husband's latest bone marrow biopsy showed a less than 5 percent plasma cell percentage, but biopsies can be hit or miss. It's also possible your husband's myeloma cells just secrete a lot of free light chains, so a relatively low disease burden still causes high free light chain results. Has your husband had a PET scan to determine where his disease is concentrated and how extensive it is?
It's possible for someone to have a free light chain ratio that stays nearly constant at a level similar to your husband's. In fact, if you look at Multibilly's lab result history in this post, you'll see that his ratio has swung around a bit, but has been stable around 11 to 13 for two or three years. (Multibilly was diagnosed with smoldering myeloma and has never undergone any myeloma drug treatment.)
In your husband's case, though, you'll probably have to wait a bit to see whether his numbers stabilize, or come back down a bit, or if they keep climbing. I don't think there's anyway to tell what will happen other than by waiting things out.
Good luck!
In fact, if your husband were not currently being treated with Revlimid, there's a good chance his kappa and kappa-lambda ratio results would be higher than what they are.
With a kappa-lambda ratio of 12, I really doubt that that the cause is something other than myeloma cells churning out excess kappa light chains. There have been cases here in the forum, and I believe in the literature, of things like infections causing kappa-lambda ratios that are slightly outside the normal range. Impaired kidney function also causes slightly higher-than-normal kappa-lambda ratios. However, a ratio of 12, and the fact that the result is part of a trend and your husband does not have kidney problems, suggests that the ratio is due to the disease, rather than some alternative cause.
I realize your husband's latest bone marrow biopsy showed a less than 5 percent plasma cell percentage, but biopsies can be hit or miss. It's also possible your husband's myeloma cells just secrete a lot of free light chains, so a relatively low disease burden still causes high free light chain results. Has your husband had a PET scan to determine where his disease is concentrated and how extensive it is?
It's possible for someone to have a free light chain ratio that stays nearly constant at a level similar to your husband's. In fact, if you look at Multibilly's lab result history in this post, you'll see that his ratio has swung around a bit, but has been stable around 11 to 13 for two or three years. (Multibilly was diagnosed with smoldering myeloma and has never undergone any myeloma drug treatment.)
In your husband's case, though, you'll probably have to wait a bit to see whether his numbers stabilize, or come back down a bit, or if they keep climbing. I don't think there's anyway to tell what will happen other than by waiting things out.
Good luck!
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JimNY
Re: Possible causes for elevated kappa & kappa-lambda ratio?
There's a journal article (actually a letter to the editor) that came out almost 10 years ago that speaks to this issue a bit. The full text of the article is available at this link:
Marshall, G, et al,, "Borderline High Serum Free Light Chain κ/λ Ratios Are Seen Not Only in Dialysis Patients but Also in Non–Dialysis-Dependent Renal Impairment and Inflammatory States," American Journal of Clinical Pathology, August 2009 (full text of article)
The authors of the article looked at people with "borderline" kappa-lambda ratios who did not have either MGUS, myeloma, or any other kind of monoclonal gammopathy. A "borderline" kappa-lambda ratio was one that was either (a) above the upper limit, but not more than twice the upper limit, or (b) below the lower limit, but not less than half the lower limit.
Interestingly, none of the patients in the study had a borderline "low" kappa-lambda ratio. They all had a slightly high kappa-lambda ratio.
In addition, about two thirds of the patients with the borderline ratio were found to have kidney impairment.
Among those who did not have kidney impairment, some form of infection or inflammation was thought to be the driving force behind the kappa-lambda ratio elevation in a bit more than half the cases.
(I don't think this study has been mentioned in the forum before. If it has, my apologies.)
Marshall, G, et al,, "Borderline High Serum Free Light Chain κ/λ Ratios Are Seen Not Only in Dialysis Patients but Also in Non–Dialysis-Dependent Renal Impairment and Inflammatory States," American Journal of Clinical Pathology, August 2009 (full text of article)
The authors of the article looked at people with "borderline" kappa-lambda ratios who did not have either MGUS, myeloma, or any other kind of monoclonal gammopathy. A "borderline" kappa-lambda ratio was one that was either (a) above the upper limit, but not more than twice the upper limit, or (b) below the lower limit, but not less than half the lower limit.
Interestingly, none of the patients in the study had a borderline "low" kappa-lambda ratio. They all had a slightly high kappa-lambda ratio.
In addition, about two thirds of the patients with the borderline ratio were found to have kidney impairment.
Among those who did not have kidney impairment, some form of infection or inflammation was thought to be the driving force behind the kappa-lambda ratio elevation in a bit more than half the cases.
(I don't think this study has been mentioned in the forum before. If it has, my apologies.)
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