[MissMolly]

Smoldering myeloma and abnormal free light chains ratio

by MissMolly on Wed Mar 13, 2013 3:21 pm

I have a Lambda predominance in my free light chains, so my ratio is not >100, it is 0.06. Still abnormal (shows up on reports as LL), but on the low end rather than the high end. Does this still put me into a higher risk category of smoldering myeloma? There was a great article on this subject here on the Beacon, but it only talked about a ratio >100, which would equate to the more common Kappa predominance.

Other relevant info: m-spike bounces between 0.8 and 1.1. Plasma cells = 10%. I also have an IgH gene cell rearrangment -- can't figure out if that is a significant data point or not. I progressed to SMM from MGUS within about a year of my MGUS diagnosis. Had been showing serum proteins for about 6 months before MGUS diagnosis.

Serum LDH is high and on my last labs, my reticulocyte %, reticulocyte absolute, and reticulocyte hemoglobin were all high. Does this mean anything?

[terryl1]

Re: Smoldering myeloma and abnormal free light chains ratio

by terryl1 on Wed Mar 13, 2013 4:26 pm

The risk of progression is higher if you have a skewed ratio, whether your involved immunoglobulin is kappa or lambda. Obviously, there are other risk factors as well....high PC infiltration (greater than 60%), immuneparesis, abnormal PC's by flow cytometry greater than 95%, etc.

[Dr. Peter Voorhees]

Re: Smoldering myeloma and abnormal free light chains ratio

by Dr. Peter Voorhees on Thu Mar 14, 2013 8:28 am

In the publication in which the ratio of>100 was referenced, they took the affected light chain and put it in the numerator and the unaffected light chain in the denominator. In your case it would be the lambda light chain level divided by the kappa light chain level. If I am doing my math correctly, your ratio in terms of the publication would be 16 - 17. Well under 100!

Pete V.