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Smoldering Myeloma and Kappa/Lambda Ratio
On April 17, 2013, I made a follow-up visit to my Hematologist and learned that I have smoldering myeloma. She had performed a bone marrow biopsy on March 27 which revealed that there are 10% to 15% abnormal plasma cells in my marrow, but my M spike is .95 g/dl. The doctor wants to see me again in three months--she has adopted a wait and see attitude since other tests such as a skeletal survey and 24 hour urine test were negative; however, I am concerned about my kappa/lambda ratio of 5.53 mg/l---kappa is 77.01, while lambda is 13.92. Does anyone know if this ratio means that I could progress to multiple myeloma in the near future?
Re: Smoldering Myeloma and Kappa/Lambda Ratio
Hey there Gran67,
I am smoldering as well with 11% plasma cells, but I am Lambda type, so my FLC ratio is on the bad low end at 0.03. You really can't use FLC ratios as a predictor of when (or even if) you might progress to multiple myeloma. In fact, no combo of markers will tell you when you when might progress and you very well might smolder the rest of your life.
Did you have a chromosome/FISH test when you had your bone marrow biopsy? This is one of key tests that will tell you whether you may be at a higher risk for progression, but again, it won't tell you how soon you might progress.
Getting re-tested in 3 months is pretty normal under your circumstances and this is my current period for having your blood and urine re-tested (with xrays every 6 months). You probably won't need to get another bone marrow biopsy unless one or more of your markers go south (at least that is what my doc is telling me). You really won't be able to start getting an initial picture of where your markers and disease might be headed until you have about 2-3 tests behind you. Hope that you just smolder the rest of your life
You might find these two threads to be helpful as you come to grips with all this:
https://myelomabeacon.org/forum/formal-risk-of-progression-classification-for-smoldering-multiple-myeloma-t1542.html?hilit=risk%20of%20progression#p7933
https://myelomabeacon.org/forum/looking-for-feedback-on-recommended-first-round-treatment-t1502.html?hilit=progression#p7717
I am smoldering as well with 11% plasma cells, but I am Lambda type, so my FLC ratio is on the bad low end at 0.03. You really can't use FLC ratios as a predictor of when (or even if) you might progress to multiple myeloma. In fact, no combo of markers will tell you when you when might progress and you very well might smolder the rest of your life.
Did you have a chromosome/FISH test when you had your bone marrow biopsy? This is one of key tests that will tell you whether you may be at a higher risk for progression, but again, it won't tell you how soon you might progress.
Getting re-tested in 3 months is pretty normal under your circumstances and this is my current period for having your blood and urine re-tested (with xrays every 6 months). You probably won't need to get another bone marrow biopsy unless one or more of your markers go south (at least that is what my doc is telling me). You really won't be able to start getting an initial picture of where your markers and disease might be headed until you have about 2-3 tests behind you. Hope that you just smolder the rest of your life
You might find these two threads to be helpful as you come to grips with all this:
https://myelomabeacon.org/forum/formal-risk-of-progression-classification-for-smoldering-multiple-myeloma-t1542.html?hilit=risk%20of%20progression#p7933
https://myelomabeacon.org/forum/looking-for-feedback-on-recommended-first-round-treatment-t1502.html?hilit=progression#p7717
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Smoldering Myeloma and Kappa/Lambda Ratio
Hi Multibilly,
Thanks for the information and links. I did have a chromosome/FISH test, not sure how to read the results, it appears that most of the results showed normal nuclei, however, there were positive nuclei with dual fusion, 0.2% and positive nuclei with p53 deletion, 0.7%. Another Hematologist is reviewing these reports and will notifiy me of her recommendations soon.
Thanks for the information and links. I did have a chromosome/FISH test, not sure how to read the results, it appears that most of the results showed normal nuclei, however, there were positive nuclei with dual fusion, 0.2% and positive nuclei with p53 deletion, 0.7%. Another Hematologist is reviewing these reports and will notifiy me of her recommendations soon.
Re: Smoldering Myeloma and Kappa/Lambda Ratio
I have to admit that I have a real hard time interpreting chromosome and FISH reports, even when I know what I'm looking for. Hopefully, there is a summary at the end that indicates if you have any serious translocations or deletions associated with multiple myeloma. Otherwise, I suggest you rely on a professional's interpretation of the report..
p53 deletions are something to be concerned with when it comes to multiple myeloma, but I'm not sure if that 0.7% percentage means it is not present in any sort of significant number, or ??? There are also doctors and other more seasoned patients that monitor this site that may be able to better comment on this than me.
p53 deletions are something to be concerned with when it comes to multiple myeloma, but I'm not sure if that 0.7% percentage means it is not present in any sort of significant number, or ??? There are also doctors and other more seasoned patients that monitor this site that may be able to better comment on this than me.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Smoldering Myeloma and Kappa/Lambda Ratio
No need to start treatment just for the abnormal free light chain ratio. Treatment decisions are made based on high blood calcium levels, anemia, lytic bone lesions, or kidney dysfunction.
The FISH studies that you describe are normal. There is not deletion of p53.
The FISH studies that you describe are normal. There is not deletion of p53.
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Dr. Jason Valent - Name: Jason Valent, M.D.
Beacon Medical Advisor
Re: Smoldering Myeloma and Kappa/Lambda Ratio
Thanks Dr. Valent, I guess I can breathe easier for now.
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