[Eric Hofacket]

Re: Are these free light chain results possible?

by Eric Hofacket on Mon Dec 07, 2015 5:28 pm

Lacerta,
I started relapsing in March of this year and in the last few months I have had serum free Kappa light chain values between 2500 mg/L and 3000 md/L with the listed normal reference very close to what you have listed. So based on my experience I would say that yes this is possible.

When my kappa light chain values started climbing they climbed very rapidly in an almost exponential way, not linear. Four years ago at diagnosis this was not the case. I believe my Kappa light chain never went above about 60 mg/L. I was on the Velcade dexamethasone regime I did 4 years ago to try and control the relapse and it did to do much. I went on pomalidomide for one month and the kappa light chain went from about 4000 mg/L to one 100 mg/L in just one three week treatment cycle. That was great news as it seems to be working well. The challenge was that pomalidomide was very hard on the rest of my bone marrow. My hemoglobin kept trending lower the entire thee week with each CBC and when I finally went on the week off cycle it was 9 g/dL and there was discussion of transfusing and using EPO. Platelets also took a big dip getting close to being a problem as well. So did white blood cell count. I picked up a pneumonia infection that landed me in the hospital for 4 days and I had to stop treatment for between 3 and 4 week. In those weeks my kappa light chain went back up to 700 mg/L so I need to stay on the meds, I am not slipping back into a remission state. I just finished my second month of pomalidomide and started my third today. So far things are OK. This time my hemoglobin held up well but the WBC is very low now 2.0, at the start of the cycle. Time will tell how things go.
The interesting thing is that will all these test with sky high kappa light chains my serum immunoglobulins have been not that bad. That last test I had with kappa light chains of 700 mg/L had normal immunoglobulins across the board. Four years ago with much low kappa light chains my immunoglobulins where much higher. My oncologists tell me the means I have a different clone of myeloma now that I did 4 years ago. Now I have light chain myeloma. This could explain why it did not respond to Velcade this time. Light chain myeloma is not rare but most people do not have this type. I do not know it is treated any differently but progress is measured by looking at a different set lab numbers as the main focus.

I understand that having all these light chains in the blood is not a good thing but I have not come up with any information at what levels does light chains start creating serious health problems. I will be meeting with my doctor this week and plan to ask that question. This is where a myeloma specialist could prove to be particularly valuable.

[Multibilly]

Re: Are these free light chain results possible?

by Multibilly on Mon Dec 07, 2015 5:55 pm

Your M-spike can't be larger than the involved immunoglobulin (in your case, that is IgG). So I assume your IgG measurement of 65.9 g/L was taken after you started treatment and when your M-spike got down to 48 g/L. If that was the case, then these "might" be your M-spikes numbers. In any case, I would try to get this sorted out with the doctor the next time you see him/her.

Again, M-spikes are a good thing to track over time to see how you are doing.

[Lacerta]

Re: Are these free light chain results possible?

by Lacerta on Mon Dec 07, 2015 6:06 pm

Dear Eric, thanks for sharing your experience with rapidly changes in kappa light chains.

To Multibilly, I will meet my mothers doctors tomorrow and hopefully I will get the laboratory reports from the days before they starting the treatments. If I interpret the it right, I do think it was 100 in the beginning, 65.9 midways and 48 g/L at the end of the first period.

[Lacerta]

Re: Are these free light chain results possible?

by Lacerta on Tue Dec 08, 2015 12:02 pm

On behalf of my mother, I got some graphs from the doctor today showing some trends and I also got blood samples report of today. New values on free kappa chains will take c. one week.

The trend seems to be positive (day.month.year in parantheses), but I will be glad to get help with interpreting the results.

P-Immunoglobulin monoclonal (g/L) was c. 90 (23.10.15) and c. 7 (24.11.15)
P-lgG (g/L) was c.105 (23.10.15), c. 73 (26.10.15) , c. 15 (12.11.15) and c. 11 (24.11.15),

I'm not sure what 'P' stands for?

U-Protein ('U' = urine?) (g/L) was 2.2 (25.10.15) and 0.07 (18.11.15).

B-leukocytes varies a lot throughout the period ranging from 5.5 to 20 10E9/L, it fluctuates rapidly approximately every week. And today it was 14.6 10E9/L (08.12.15) which is above normal range (3.4-11.0).

B-neutrophile granulocyte have been has high as 19.5 10E9/L, but last month it has been stable below 8 10E9/L, although higher today 12.1 10E9/L (08.12.15).

I'm not sure what 'B' stands for?

I hope that the results above indicates that she is responding well to the treatment.

They will take biopsy of her kidney next week to decide if she could take high dose chemotherapy and stem cell transplantation.

Thanks for help.