My new renal doctor ordered serum free light chain (FLC) testing on me along with a lot of other tests. The results were:
Kappa FLCs 18.61 (3.30-19.40)
Lambda FLCs 78.07 (5.71-26.30)
Kappa/lambda FLC ratio 0.238 (0.260-1.650)
I am mildly anemic.
He mentioned multiple myeloma and I assumed he was going to do follow-up testing when I had more blood work done. He didn't, and when I saw him last week, I asked about multiple myeloma and he said that it was highly unlikely. He's planning on doing some more blood work in January when I see him next.
My family doctor said he talked to the renal doctor and said there was no evidence of multiple myeloma. My family doctor doesn't want to step on his toes.
Should I seek a referral or second opinion?
Nathan
Forums
Re: Initial test results - should I get a second opinion?
Yes you should definitely get checked by a MGUS / smoldering multiple myeloma / multiple myeloma specialist. I don't know where you live, i.e., if you need a U.S. or international specialist.
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Anonymous
Re: Initial test results - should I get a second opinion?
Hello Nathan:
I am not the expert on analysis of detailed lab results, you K/L ratio does look sort of OK. One test that could be ordered is the serum protein electrophoresis (SPEP) to measure your "M-spike". It is possible to have multiple myeloma with zero M-spike, but that is rare.
Good luck.
I am not the expert on analysis of detailed lab results, you K/L ratio does look sort of OK. One test that could be ordered is the serum protein electrophoresis (SPEP) to measure your "M-spike". It is possible to have multiple myeloma with zero M-spike, but that is rare.
Good luck.
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JPC - Name: JPC
Re: Initial test results - should I get a second opinion?
Thanks for the advice. I'm going to seek a referral. I live near Pittsburgh, so I'll be looking for a doctor at UPMC.
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mrzippy - Name: Nathan
Re: Initial test results - should I get a second opinion?
Hi,
Definitely worth getting an electrophoresis, further blood tests and a second opinion. Either way you'll have a clearer picture.
Good luck,
Mijji
Definitely worth getting an electrophoresis, further blood tests and a second opinion. Either way you'll have a clearer picture.
Good luck,
Mijji
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Mijji - When were you/they diagnosed?: 2011
Re: Initial test results - should I get a second opinion?
I did get referred to an Oncologist - here is the results of my lab tests
FREE KAPPA 3.3 - 19.4 MG/L 20.9 H
FREE LAMBDA 5.7 - 26.3 MG/L 77.6 H
FREE KAPPA LAMBDA RATIO 0.26 - 1.65 0.27
SPEP
Total Protein 6.2 - 8.3 G/DL 7.9
Albumin 3.5 - 4.7 G/DL 4.1
ALPHA 1 0.1 - 0.3 G/DL 0.2
ALPHA 2 0.5 - 1.0 G/DL 0.9
Beta Globulin 0.8 - 1.4 G/DL 1.0
Gamma Globulin 0.6 - 1.6 G/DL 1.7 H
INTERPRETATION
MONOCLONAL BAND PRESENT (M-PROTEIN). SUGGEST SERUM IMMUNOFIXATION FOR IDENTIFICATION.
MONOCLONAL SPIKE 0.9 G/DL
Immunoelectrophoresis
IMMUNOFIXATION ELECTROPHORESIS DEMONSTRATES THE PRESENCE OF IGG LAMBDA MONOCLONAL GAMMOPATHY.
Quantitative Immunoglobulins
IGA 81 - 463 MG/DL 248
IGG, SERUM 694 - 1618 MG/DL 1644 H
IGM 48 - 271 MG/DL 138
B2 Microglobulin 0.00 - 2.51 MG/L 4.01 H
24 Hour Urine Protein Electrophoresis
Urine Protein mg/dl 10
Urine Protein 24HR mg/24HR 0 - 149 MG/24HRS. 172 H
RANDOM URINE CREATININE 20 - 370 MG/DL 120
Urine Protein 24HR mg/g Creat <85 MG/G CREATININE 83
Albumin %, Urine 24.85
Urine Alpha 1 4.31
Alpha 2 (SPE) 12.61
Beta (SPE) 38.42
GAMMA GLOBULIN % 19.82
Interpretation of Result
MONOCLONAL PROTEIN PRESENT. SUGGEST URINE IMMUNOFIXATION FOR IDENTIFICATION.
MONOCLONAL SPIKE IN BETA 17.60%
Urine Immunofixation Electrophoresis
IMMUNOFIXATION ELECTROPHORESIS OF THE URINE PROTEIN DEMONSTRATED A BAND OF LAMBDA LIGHT CHAIN, WHICH WAS NOT ASSOCIATED WITH HEAVY CHAIN TYPE OF IGG, IGA, OR IGM. MONOCLONAL FREE LAMBDA LIGHT CHAIN IN THE PRESENCE OF THE NEPHROTIC SYNDROME MAY SUGGEST SYSTEMIC AMYLOIDOSIS OR LIGHT-CHAIN DEPOSITION DISEASE. CLINICAL CORRELATION AND FOLLOW-UP IS SUGGESTED.
IMMUNOFIXATION ELECTROPHORESIS DEMONSTRATES A SMALL BAND IN IGG LAMBDA WHICH MAY BE INDICATIVE OF A MONOCLONAL IMMUNOGLOBULIN. CLINICAL CORRELATION RECOMMENDED FOR INTERPRETATION.
FREE KAPPA 3.3 - 19.4 MG/L 20.9 H
FREE LAMBDA 5.7 - 26.3 MG/L 77.6 H
FREE KAPPA LAMBDA RATIO 0.26 - 1.65 0.27
SPEP
Total Protein 6.2 - 8.3 G/DL 7.9
Albumin 3.5 - 4.7 G/DL 4.1
ALPHA 1 0.1 - 0.3 G/DL 0.2
ALPHA 2 0.5 - 1.0 G/DL 0.9
Beta Globulin 0.8 - 1.4 G/DL 1.0
Gamma Globulin 0.6 - 1.6 G/DL 1.7 H
INTERPRETATION
MONOCLONAL BAND PRESENT (M-PROTEIN). SUGGEST SERUM IMMUNOFIXATION FOR IDENTIFICATION.
MONOCLONAL SPIKE 0.9 G/DL
Immunoelectrophoresis
IMMUNOFIXATION ELECTROPHORESIS DEMONSTRATES THE PRESENCE OF IGG LAMBDA MONOCLONAL GAMMOPATHY.
Quantitative Immunoglobulins
IGA 81 - 463 MG/DL 248
IGG, SERUM 694 - 1618 MG/DL 1644 H
IGM 48 - 271 MG/DL 138
B2 Microglobulin 0.00 - 2.51 MG/L 4.01 H
24 Hour Urine Protein Electrophoresis
Urine Protein mg/dl 10
Urine Protein 24HR mg/24HR 0 - 149 MG/24HRS. 172 H
RANDOM URINE CREATININE 20 - 370 MG/DL 120
Urine Protein 24HR mg/g Creat <85 MG/G CREATININE 83
Albumin %, Urine 24.85
Urine Alpha 1 4.31
Alpha 2 (SPE) 12.61
Beta (SPE) 38.42
GAMMA GLOBULIN % 19.82
Interpretation of Result
MONOCLONAL PROTEIN PRESENT. SUGGEST URINE IMMUNOFIXATION FOR IDENTIFICATION.
MONOCLONAL SPIKE IN BETA 17.60%
Urine Immunofixation Electrophoresis
IMMUNOFIXATION ELECTROPHORESIS OF THE URINE PROTEIN DEMONSTRATED A BAND OF LAMBDA LIGHT CHAIN, WHICH WAS NOT ASSOCIATED WITH HEAVY CHAIN TYPE OF IGG, IGA, OR IGM. MONOCLONAL FREE LAMBDA LIGHT CHAIN IN THE PRESENCE OF THE NEPHROTIC SYNDROME MAY SUGGEST SYSTEMIC AMYLOIDOSIS OR LIGHT-CHAIN DEPOSITION DISEASE. CLINICAL CORRELATION AND FOLLOW-UP IS SUGGESTED.
IMMUNOFIXATION ELECTROPHORESIS DEMONSTRATES A SMALL BAND IN IGG LAMBDA WHICH MAY BE INDICATIVE OF A MONOCLONAL IMMUNOGLOBULIN. CLINICAL CORRELATION RECOMMENDED FOR INTERPRETATION.
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mrzippy - Name: Nathan
Re: Initial test results - should I get a second opinion?
Hi Nathan,
Well, I'm not a doc, but it seems likely to me that hat you have some type of monoclonal gammopathy based on these test results. But your monoclonal spike and free light chain numbers are not that high, which is good news. Having both an elevated kappa and lambda value with a borderline low K/L ratio can suggest renal impairment (which I'm guessing you must already suspect if you are working with a nephrologist). Your beta2 microglobulin (B2M) is also fairly elevated, which suggests some amount of tumor burden in your system.
I'm not very good at interpreting urine test results, but I would heed the pathologist's statement to investigate the possibility of light chain deposition disease (LCDD) or amyloidosis in addition to other forms of monoclonal gammopathies such as MGUS, smoldering multiple myeloma, multiple myeloma, etc. LCDD and amyloidosis would likely be be verified by a kidney biopsy, if you indeed have renal impairment (I had a kidney biopsy and it was a pretty easy, painless procedure). MGUS, smoldering multiple myeloma and multiple myeloma would be verified by a bone marrow biopsy.
I would also be asking for a PET/CT or whole-body MRI at this point (not a skeletal xray survey).
You said you were working with an oncologist and I believe you ended up at UPMC. But given these initial test results, I might suggest seeking out a hematologist/oncologist that specializes exclusively in multiple myeloma. I may be wrong, but I don't think that UPMC currently has any multiple myeloma specialists still on their staff (although I'm sure they have oncologists that have some familiarity with multiple myeloma - which is not the same as a multiple myeloma specialist). So, you may want to consider a trip to another city or facility at some point to get a second opinion as you get further into your diagnosis.
Hope this helps a bit.
Well, I'm not a doc, but it seems likely to me that hat you have some type of monoclonal gammopathy based on these test results. But your monoclonal spike and free light chain numbers are not that high, which is good news. Having both an elevated kappa and lambda value with a borderline low K/L ratio can suggest renal impairment (which I'm guessing you must already suspect if you are working with a nephrologist). Your beta2 microglobulin (B2M) is also fairly elevated, which suggests some amount of tumor burden in your system.
I'm not very good at interpreting urine test results, but I would heed the pathologist's statement to investigate the possibility of light chain deposition disease (LCDD) or amyloidosis in addition to other forms of monoclonal gammopathies such as MGUS, smoldering multiple myeloma, multiple myeloma, etc. LCDD and amyloidosis would likely be be verified by a kidney biopsy, if you indeed have renal impairment (I had a kidney biopsy and it was a pretty easy, painless procedure). MGUS, smoldering multiple myeloma and multiple myeloma would be verified by a bone marrow biopsy.
I would also be asking for a PET/CT or whole-body MRI at this point (not a skeletal xray survey).
You said you were working with an oncologist and I believe you ended up at UPMC. But given these initial test results, I might suggest seeking out a hematologist/oncologist that specializes exclusively in multiple myeloma. I may be wrong, but I don't think that UPMC currently has any multiple myeloma specialists still on their staff (although I'm sure they have oncologists that have some familiarity with multiple myeloma - which is not the same as a multiple myeloma specialist). So, you may want to consider a trip to another city or facility at some point to get a second opinion as you get further into your diagnosis.
Hope this helps a bit.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Initial test results - should I get a second opinion?
Thanks Multibilly! I do have a followup with the Hematologist/Oncologist in 3 weeks. We'll see what he has to say then. I do have chronic kidney disease (stage 3), but my latest results were actually good although I have been in kidney failure at least once that we know of but it resolved itself.
Nathan
Nathan
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mrzippy - Name: Nathan
Re: Initial test results - should I get a second opinion?
Sorry you need to be here, but I'm glad you found us.
I second what Multibilly said about making sure you get to a heme/onc doctor. I'm glad to see you already have an appointment scheduled. Let us know what happens there!
Just a quick note: if they are looking for AL amyloidosis, and they SHOULD be looking for AL amyloidosis, they need to do Congo Red Stain on any and all biopsy samples they get. I would certainly hope your heme/ onc doctor knows this, but you never know...
If you end up with a diagnosis like AL amyloidosis, MGUS, or active myeloma, we all always recommend that you make your way to a center of excellence - a place that sees a lot of myeloma patients - at least once toward the beginning of your treatment. Most of us seem to go to big myeloma centers regularly.
Good luck, and I'll be waiting to see what develops!
Tracy
I second what Multibilly said about making sure you get to a heme/onc doctor. I'm glad to see you already have an appointment scheduled. Let us know what happens there!
Just a quick note: if they are looking for AL amyloidosis, and they SHOULD be looking for AL amyloidosis, they need to do Congo Red Stain on any and all biopsy samples they get. I would certainly hope your heme/ onc doctor knows this, but you never know...
If you end up with a diagnosis like AL amyloidosis, MGUS, or active myeloma, we all always recommend that you make your way to a center of excellence - a place that sees a lot of myeloma patients - at least once toward the beginning of your treatment. Most of us seem to go to big myeloma centers regularly.
Good luck, and I'll be waiting to see what develops!
Tracy
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Tracy J - Name: Tracy Jalbuena
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 2014
- Age at diagnosis: 42
Re: Initial test results - should I get a second opinion?
Tracy,
thanks for the encouragement! I go back to my oncologist in 2 weeks to find out what is next. I'll post an update when I know more.
Nathan
thanks for the encouragement! I go back to my oncologist in 2 weeks to find out what is next. I'll post an update when I know more.
Nathan
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mrzippy - Name: Nathan
12 posts
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