[glenn]

Kappa-lambda ratio has become normal - why?

by glenn on Thu Jan 11, 2018 4:57 pm

Hi,

Tirst post here, long time reader. I've been MGUS now for a little over two years. These forums have been an incredible resource for knowledge about MGUS and multiple myeloma. Thanks so much to all who contribute!

So I've been tracking my numbers for 2 years now. My bloodwork has been done roughly every 3 months throughout this period. Here is what I know:

• I am IgG kappa.
• My IgG continues to hover between 2700 and 2900 mg/dL
• My IgA and IgM (my uninvolved immunoglobulins) consistently are below normal ("suppressed")
• My M-spike has remained around 2.0-ish g/dL the entire time, with a slight upward trend (2.2 at last report).

What is puzzling to me are the free kappa and free lambda light chain numbers.

My kappa number started at 7.2 mg/L and has trended downward consistently since then, it is currently at 3.7 mg/L two years later.

My lambda number started at 2.0 mg/L (low) and has trended slightly upward, currently at 3.0 mg/L two years later.

My kappa/lambda ratio started at 3.6 (high) and has trended downward, currently at 1.23 mg/L.

So as far as I can tell, the reason my ratio was high in the first place was only because my lambda number was low. At no time has either kappa or lambda been above normal. The ratio has effectively "corrected itself" only because my kappa number keeps decreasing, Kappa is now at the very low end of normal.

I see my oncologist in a week to review my numbers. Has anyone here seen this kind of trend with free light chains, or can put forth an interpretation?

I guess I am happy that my ratio is now in the normal range, although my other numbers (M-spike, protein level, IgG / IgA / IgM still seem to indicate something is going on.

Thanks in advance!
Glenn

[ricejon]

Re: Kappa-lambda ratio has become normal - why?

by ricejon on Fri Jan 12, 2018 11:02 am

Hi Glenn,

Your post resonated with me for a couple of reasons. I have been tracking my numbers for close to 2 years and I agree with you that this forum provides a wealth of information to sift through.

My IgG is elevated (has fallen to 1793)
My IgA is low (currently 28 and has been slowly dropping, unfortunately)
My IgM is on the low side of the desirable range (also has been slowly dropping, unfortunately)
My M-spike is 1.1 (down from 1.5)
My ratio is 3.01 (has been in this neighborhood for 18 months)

I'm kind of in a similar but different boat...

I'm happy my M-spike and IgG came down but I'm disappointed that my IgA and IgM are creeping lower.

Sorry I don't have any insight for you, but I would be curious to know your age and if you experience any symptoms. Have you had a bone marrow biopsy? I think that is in my not too distant future.

Good luck with your next visit!

Jon

[glenn]

Re: Kappa-lambda ratio has become normal - why?

by glenn on Fri Jan 12, 2018 12:54 pm

Hey Jon,

Thanks for the reply.

I'm almost 55, diagnosed at 52. Other than MGUS, pretty healthy, long-time runner, exercise regularly, etc.

I had a bone marrow biopsy 2 years ago at diagnosis. Results came back at 4%.

The FLC ratio thing has been the most puzzling to me, because although the ratio was high at diagnosis (3.6), it was only high because of a below normal lambda. The ratio has only become "normal" because in the past 2 years, my kappa level has dramatically gone down from 7.2 to 3.7, bringing it closer to the lambda level and an "even" kappa/lamba ratio.

I haven't been able to find anything online that indicates this is a known phenomenon as part of MGUS or myeloma. Prior visits to the oncologist have had him scratching his head noting that the ratio behavior was strange, but he said not to worry; he seemed to be focused more on my M-spike and IgG levels. I will bring this up again with him next week, but was wondering if anyone on this forum has seen or heard of this kind of activity with the FLC ratio.

Glenn

[ricejon]

Re: Kappa-lambda ratio has become normal - why?

by ricejon on Sat Jan 13, 2018 8:17 am

Hi Glenn,

More similarities: we are close in age (I'm 49) and I've been active and fit my whole life too - involved in running, triathlons, former college athlete, etc. My diagnosis really threw me for a loop. Unfortunately, on top of my MGUS diagnosis I am also contending with idiopathic peripheral neuropathy. At this point, my doctors do not think the two are connected.

My doctor got back to me yesterday regarding my bone marrow biopsy. He wants to schedule one - not necessarily because my most recent results dictate a need, but more out of caution and to use as a reference point moving forward.

Please stay in touch and let us know how your appointment goes. I find it comforting to connect with folks in a similar boat.

Best of luck to you.

Jon

[glenn]

Re: Kappa-lambda ratio has become normal - why?

by glenn on Sat Jan 13, 2018 9:44 am

Will do Jon.

Good luck with your biopsy. I was pretty nervous before mine, but it turned out not as hard to endure as I had built it up to be. It was more uncomfortable, not painful, and the nurse and doctor talked me through it. Hopefully yours is similarly uneventful, and best wishes for good results. I did some counting and going through songs in my head during the procedure to help distract me from what was going on ...

Aside from general tiredness and some lower back pain, I am asymptomatic, and who knows if those things are even related to MGUS. Skeletal survey 2 years ago was negative. I have been B12 deficient since 2013, requiring monthly shots. All manageable stuff, generally healthy.

There are days when I don't even think about MGUS/myeloma. Other days, I worry about what's to come, if I do progress, what will life be like. The days leading up to my quarterly bloodwork and appointment are the worst, it's hard not to think about it.

This forum provides comfort as you point out, and helps me remember to live my life for each day and not worry so much about what might happen tomorrow.

Glenn

[Multibilly]

Re: Kappa-lambda ratio has become normal - why?

by Multibilly on Sat Jan 13, 2018 11:00 am

HI Glenn,

Are you taking curcumin? At least one study has shown that curcumin tends to improve one's free light chain numbers more so than their M-spike. Both my involved free light chain number and ratio have improved over the years, while my M-spike has remained fairly stable.

See my historical numbers here:

https://myelomabeacon.org/forum/fenofibrate-tricor-and-multiple-myeloma-t2690-80.html#p52895

[glenn]

Re: Kappa-lambda ratio has become normal - why?

by glenn on Sat Jan 13, 2018 11:40 am

Hey Multibilly,

I've read many of your posts here, thanks for all your contributions! Thanks for replying about my questions.

No, I'm not taking curcumin, nor doing anything else unusual to address MGUS.

I have no explanation for why my free light chain ratio has dropped dramatically and consistently the last 2 years. If that was the only metric I was tracking, it would be a cause for relief. But my M-spike is still at 2.2, my protein and IgG numbers elevated, and IgA and IgM suppressed. So it's a difficult picture to understand.

So far I haven't found any info online anywhere that describes a variation of MGUS / myeloma where the free light chain ratio was abnormally high only because lambda was abnormally low. Everything I've seen indicates that high ratio is due to elevated kappa or lambda. Nor have I seen anything discussing the phenomenon of the ratio and kappa dropping steadily (other than as a response to treatment).

Best,
Glenn

[glenn]

Re: Kappa-lambda ratio has become normal - why?

by glenn on Mon Jan 22, 2018 2:25 pm

Just an update since I met with my oncologist and there may be others here who are unsure what is the meaning behind low free light chain readings.

Her perspective was that the free light chain ratio is just a calculated number and to understand the number you also have to look at the kappa and lambda values. Since the only reason the free light chain ratio was high in the first place was because of a low lambda, she said she was not too concerned about it. The more worrisome thing would be if kappa or lambda were abnormally high. Since they are not, don't worry about them.

Bottom line, the 2.2 g/dL (22 g/l) M-spike and high IgG warrant continued watching and waiting, but she expects those numbers will bounce around a bit. What she would be looking for would be either some more dramatic changes, or a continued upward drift of the M-spike to 3.0+. Hoping neither one happens.

Glenn

[pinball]

Re: Kappa-lambda ratio has become normal - why?

by pinball on Sun Jan 28, 2018 11:54 pm

That's an awesome update Glenn. It's good to see an upbeat update. Definitely don't sweat it, but keep an eye on it, which you are doing.

Though my "good" IgG is low, as is my IgM, outside of a freak 6-month staph infection I'm hardly ever sick. I used to get sick often, but for the past 5+ years I hardly ever even get a common cold (in fact, I haven't had a cold in a couple of years and haven't had the flu since 2006). I also have never had a flu vaccine. I used to get the flu nearly yearly my entire life up until approx 12 years ago.

Doctors have diagnosed me with selective IgM deficiency besides the high-risk MGUS / smoldering myeloma diagnosis, so it seems that on paper I should get sick a bit more often than a normal person. But it's the opposite; I'm never sick! Outside of joint (right knee) swelling, I don't have nor have I had any issues, so definitely for all of us here that are not active myeloma, we are truly blessed to be healthy and happy!

In fact, it's as if changes associated with my high-risk MGUS / smoldering myeloma have improved my immune system's functioning, as I no longer get sick!

Good luck in your case remaining a non-issue for many years.