I have kappa light chain multiple myeloma and have relapsed.
My free light chain test most recently showed that my kappa free light chains have climbed to 6 mg/dL, which is above the normal reference range, but still low.
However, my lambda (uninvolved) free light chains are decreasing, and are now at 0.1230 mg/dL, which results in a kappa/lambda ratio of 49.6, which is high.
But it’s only that high due to the very low level of the lambda free light chains.
Does anyone know what such drops in one’s uninvolved free light chains mean?
Thanks.
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6 posts
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MrPotatohead - Name: MrPotatohead
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: March, 2015
- Age at diagnosis: 65
Re: Significance of dropping uninvolved free light chains
Hi Mr. PH,
I believe that your combination of free light chain values signifies that you have monoclonal gammopathy that is accompanied by bone marrow suppression (myelosuppression).
Myelosuppression, as you likely know, can be caused by the myeloma disease itself or various drugs used to treat myeloma such as Revlimid, etc. Myelosuppression can result in lower red cell counts (anemia), and/or lower white blood cell counts (neutropenia) and/or lower platelet counts (thrombocytopenia).
See the chart at this link:
https://www.rmlonline.com/site/sections/127
I believe that your combination of free light chain values signifies that you have monoclonal gammopathy that is accompanied by bone marrow suppression (myelosuppression).
Myelosuppression, as you likely know, can be caused by the myeloma disease itself or various drugs used to treat myeloma such as Revlimid, etc. Myelosuppression can result in lower red cell counts (anemia), and/or lower white blood cell counts (neutropenia) and/or lower platelet counts (thrombocytopenia).
See the chart at this link:
https://www.rmlonline.com/site/sections/127
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Significance of dropping uninvolved free light chains
Thank you, Multibilly.
I appreciate your post.
I do have mildly lower red, white, and platelet counts currently, but think those are being caused by my current drug, Ninlaro.
However, I had these low lambda counts for a while, and well before there was any detectable myelosuppression.
I’m curious as to what specific mechanism would cause such a decrease in the uninvolved free light chains, and what its significance is for me. My oncologist does not seem to know.
It’s puzzling to me that the myeloma could be causing this, because my kappa light chains have just begun to climb and they still at a relatively low level.
It’s also true, that my lambda free light chains were very low all through my remission, while I was in a stringent complete response. That suggests to me that some other type of myeloma-related process could be causing this, a process that was not arrested by my autologous stem cell treatment, is not related to the level of my myeloma cells, and may be the same process that keeps all of my immunoglobulins suppressed despite the success against the myeloma cells secreting kappa light chains.
Which in turn suggests that there is more to multiple myeloma than the aberrant plasma cells we attribute the disease to. More evidence for this is the fact that my post-transplant biopsy found no myeloma cells, which would appear to rule out a non-secretory clone that may have been and continues to be active after my transplant.
The only thing I could find Googling the Internet that might be relevant to this question was a 2016 paper titled “Myleloid-derived suppressor cells: The green light for myeloma immune escape”.
There may be more than the currently so-called myeloma cells that are responsible for the effects of multiple myeloma; there may in fact be multiple aberrant cells, like the myeloid suppressor cells discussed in this paper, some of which may continue to be active even after the myeloma cells have been brought under control. If that is the case, then the focus solely on what are now identified as the myeloma cells may be missing other aberrant cells that contribute to the disease. These other cells may account for phenomena like immunoparesis and myelosuppression that continue even when the myeloma cells have been vanquished.
And there is not only no treatment for them, but also only a rudimentary idea of how they work.
I appreciate your post.
I do have mildly lower red, white, and platelet counts currently, but think those are being caused by my current drug, Ninlaro.
However, I had these low lambda counts for a while, and well before there was any detectable myelosuppression.
I’m curious as to what specific mechanism would cause such a decrease in the uninvolved free light chains, and what its significance is for me. My oncologist does not seem to know.
It’s puzzling to me that the myeloma could be causing this, because my kappa light chains have just begun to climb and they still at a relatively low level.
It’s also true, that my lambda free light chains were very low all through my remission, while I was in a stringent complete response. That suggests to me that some other type of myeloma-related process could be causing this, a process that was not arrested by my autologous stem cell treatment, is not related to the level of my myeloma cells, and may be the same process that keeps all of my immunoglobulins suppressed despite the success against the myeloma cells secreting kappa light chains.
Which in turn suggests that there is more to multiple myeloma than the aberrant plasma cells we attribute the disease to. More evidence for this is the fact that my post-transplant biopsy found no myeloma cells, which would appear to rule out a non-secretory clone that may have been and continues to be active after my transplant.
The only thing I could find Googling the Internet that might be relevant to this question was a 2016 paper titled “Myleloid-derived suppressor cells: The green light for myeloma immune escape”.
There may be more than the currently so-called myeloma cells that are responsible for the effects of multiple myeloma; there may in fact be multiple aberrant cells, like the myeloid suppressor cells discussed in this paper, some of which may continue to be active even after the myeloma cells have been brought under control. If that is the case, then the focus solely on what are now identified as the myeloma cells may be missing other aberrant cells that contribute to the disease. These other cells may account for phenomena like immunoparesis and myelosuppression that continue even when the myeloma cells have been vanquished.
And there is not only no treatment for them, but also only a rudimentary idea of how they work.
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MrPotatohead - Name: MrPotatohead
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: March, 2015
- Age at diagnosis: 65
Re: Significance of dropping uninvolved free light chains
For filing in the "for what its worth" category, I too have had a relapse and have also been diagnosed with IgG kappa multiple myeloma. My oncologist always concentrates on the kappa free light chain level much more than the ratio. Your kappa levels, as you noted, are not much above normal. Before you relapsed, I assume they were much higher than 6. Based on that alone, I think you are doing fine. If there are no new lytic lesions and your M-spike is steady or lower, then I don't think it's anything to be concerned about.
The serum free light chain test is only a tool to help the oncologist understand how the disease is responding to treatments. That tool, along with other tests, gives a full picture. The fact that the "uninvolved chain" may be falling without any other indicators may mean nothing.
The serum free light chain test is only a tool to help the oncologist understand how the disease is responding to treatments. That tool, along with other tests, gives a full picture. The fact that the "uninvolved chain" may be falling without any other indicators may mean nothing.
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Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
Re: Significance of dropping uninvolved free light chains
Thank you, Ron.
Your post is reassuring.
Yes, when I was diagnosed with kappa light chain myeloma, my kappa free light chains were well over 300 mg/dL.
I would like to think that my very low level of lambda free light chains is of no significance, but I can’t help but wonder what would cause the low level. Similarly, I wonder why my immunoglobulins remained suppressed despite my having achieved a stringent complete response after my 2017 autologous transplant.
It is interesting that it is so hard to find an explanation for why? Multibilly’s helpful post pointed to a table explaining various combinations of free light chains detected by the Freelite test, and it states that a high ratio caused by a normal or high level of kappa free light chains and low lambda free light chains indicates a monoclonal gammopathy. Yes, understood. But what specific mechanism causes the low lambda free light chains?
I can conjure up various theories, such as the one I presented in the previous post. Here’s another one: A totally nonsecretory myeloma clone is crowding out normal plasma cells (since my kappa free light chains are still relatively low, this would not be caused by the kappa light chain strain I was diagnosed with).
So there are much fewer normal plasma cells, leading to low levels of lambda free light chains (under the assumption that even normal plasma cells produce some free light chains, and that’s why there are “normal” ranges of both types of free light chains).
I am soon to have another bone marrow biopsy, and that may help clarify this.
It’s just strange that it is so hard to find anything about why uninvolved free light chains should nosedive in light chain myeloma.
Similarly, it is extremely difficult to find anything about why in some people, levels of the five immunoglobulins return to normal after an autologous stem cell transplant achieves a stringent complete response, while in other people (like me) the immunoglobulins never return to their normal levels despite the achievement of a stringent complete response.
Why can one find virtually no information on what causes these anomalies and what they signify is troubling.
Your post is reassuring.
Yes, when I was diagnosed with kappa light chain myeloma, my kappa free light chains were well over 300 mg/dL.
I would like to think that my very low level of lambda free light chains is of no significance, but I can’t help but wonder what would cause the low level. Similarly, I wonder why my immunoglobulins remained suppressed despite my having achieved a stringent complete response after my 2017 autologous transplant.
It is interesting that it is so hard to find an explanation for why? Multibilly’s helpful post pointed to a table explaining various combinations of free light chains detected by the Freelite test, and it states that a high ratio caused by a normal or high level of kappa free light chains and low lambda free light chains indicates a monoclonal gammopathy. Yes, understood. But what specific mechanism causes the low lambda free light chains?
I can conjure up various theories, such as the one I presented in the previous post. Here’s another one: A totally nonsecretory myeloma clone is crowding out normal plasma cells (since my kappa free light chains are still relatively low, this would not be caused by the kappa light chain strain I was diagnosed with).
So there are much fewer normal plasma cells, leading to low levels of lambda free light chains (under the assumption that even normal plasma cells produce some free light chains, and that’s why there are “normal” ranges of both types of free light chains).
I am soon to have another bone marrow biopsy, and that may help clarify this.
It’s just strange that it is so hard to find anything about why uninvolved free light chains should nosedive in light chain myeloma.
Similarly, it is extremely difficult to find anything about why in some people, levels of the five immunoglobulins return to normal after an autologous stem cell transplant achieves a stringent complete response, while in other people (like me) the immunoglobulins never return to their normal levels despite the achievement of a stringent complete response.
Why can one find virtually no information on what causes these anomalies and what they signify is troubling.
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MrPotatohead - Name: MrPotatohead
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: March, 2015
- Age at diagnosis: 65
Re: Significance of dropping uninvolved free light chains
Update: I did find an explanation for a drop in uninvolved free light chains on the Beacon, by Dr. Libby.
Here's a link to it:
http://myelomabeacon.org/forum/interpreting-results-light-chain-multiple-myeloma-t1429.html.
Dr. Libby attributes it to a treatment side effect.
Thanks again, Multibilly and Ron!
Here's a link to it:
http://myelomabeacon.org/forum/interpreting-results-light-chain-multiple-myeloma-t1429.html.
Dr. Libby attributes it to a treatment side effect.
Thanks again, Multibilly and Ron!
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MrPotatohead - Name: MrPotatohead
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: March, 2015
- Age at diagnosis: 65
6 posts
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