I ws diagnosed in March, 2017 and have completed 3.5 cycles of cyclophosphamide, Velcade, and dexamethasone (CyBorD). Side effects have been minimal and I'm fortunate that I have no bone, kidney, liver or other organ involvement. No hyper calcium, glucose is good etc. RBC and WBC are low, although hemoglobin just increased to over 10 (yay!). Bone marrow biopsy results in March at time of diagnoses were 35% plasma cells
FISH results are positive for a good outcome:
FISH. hyperdiploidy associated with good prognosis.
Hyperdiploid cell clone with trisomy 3 and 15, trisomy/tetrasomy 9 and tetrasomy 11.
Lab numbers are slowly going in the right direction
Total protein has dropped from 10.8 to 9.0
April 5 serum protein electropheresis 2.47 (gamma 3.28)
May 15 serum protein electropheresis 2.03 (gamma 2.70)
However, my kappa light chains seem to be very unstable and nowhere near normal values.
As of May 30,
kappa light chain, free, serum, mg/dL = 97.34, and
lambda light chain, free, serum, mg/dL = 0.07
which obviously makes the ratio absurdly high at 1390.61.
My doctor doesn't seem to be overly concerned but I haven't seen anyone else post with these kind of numbers. Should I be concerned?
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GoDucks - Name: GoDucks
- Who do you know with myeloma?: me
- When were you/they diagnosed?: March, 2017
- Age at diagnosis: 61
Re: Unstable kappa level, very high kappa-lambda ratio
My husband's starting values (IgG lambda) in March 2016 were:
Kappa Free Light Chain 0.6 mg/dl
Lambda Free Light Chain 87.0 mg/dl
So the ratio is also absurdly wrong, only in the opposite direction (Kappa / lambda 0.00689).
They have not been testing and tracking these numbers for him.
The primary number we are tracking is the M-spike (the serum protein electrophoresis). While it seems some hematologists do test and track the free light chain numbers, my understanding is that as long as your M-spike is high and not close enough to zero, it's a good enough measure of the myeloma burden and response to treatment.
I would be interested in input from others as to whether we should request a test for these numbers, as it has been a long time since this read we got.
Kappa Free Light Chain 0.6 mg/dl
Lambda Free Light Chain 87.0 mg/dl
So the ratio is also absurdly wrong, only in the opposite direction (Kappa / lambda 0.00689).
They have not been testing and tracking these numbers for him.
The primary number we are tracking is the M-spike (the serum protein electrophoresis). While it seems some hematologists do test and track the free light chain numbers, my understanding is that as long as your M-spike is high and not close enough to zero, it's a good enough measure of the myeloma burden and response to treatment.
I would be interested in input from others as to whether we should request a test for these numbers, as it has been a long time since this read we got.
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Alizabeth - Name: Alizabeth
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: March 2016
- Age at diagnosis: 61
Re: Unstable kappa level, very high kappa-lambda ratio
The serum free light chain (sFLC) test is generally a more accurate and sensitive measure than the standard M-spike. There are many (including myself) that upon original diagnosis had no measurable M spike but nevertheless had active disease based on bone marrow biopsy, lesion burden, and the sFLC. The ratio is important, but so also is the total for the involved, or burdened, chain. Generally treatment starts when the involved chain goes over 100. The test is more sensitive than the serum protein electrophoresis test (SPEP) and will show changes before they are picked up by the SPEP.
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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: Unstable kappa level, very high kappa-lambda ratio
In my mother's case, she never had a M-spike, so her treatment is totally based on the kappa-lambda value. Her kappa value keeps on increasing, increasing the ratio. The doctor monitors this ratio and treats her accordingly.
Re: Unstable kappa level, very high kappa-lambda ratio
I'm not sure I would call the serum free light chain test "more accurate" than the paraprotein (M-spike) measurement that comes out of the serum protein electrophoresis (SPEP) test. My impression is that for patients whose disease is relatively stable, free light chain levels can vary a lot more from test to test than M-spike levels. The margin of error for the free light chain test, expressed as a percentage of the patient's "true" kappa or lambda level, seems to me to be noticeably higher than the margin of error for the M-spike test.
Keep in mind that the free light chain test is measuring proteins that are found at very low levels in a patient's blood. We're talking milligrams (one thousandth of a gram) per liter. A patient's paraprotein (M-spike) level, on the other hand, is being measured at the grams per liter (or deciliter) level.
That said, it is true that the free light chain test is more sensitive to changes in a patient's disease. This is because the half life of free light chains is on the order of hours or days, while the half life of the immunoglobulins making up paraprotein (the M-spike) is on the order of weeks. So a patient's M-spike won't move as much when a patient's disease is changing, such as after the start of treatment, as a patient's free light chain levels.
It's also true that some 15 to 20 percent of patients have light chain multiple myeloma, which can only can be tracked by the free light chain test.
On the other hand, with the sort of intensive treatment that is becoming more common these days, particularly in the States, you can see significant suppression of free light chain levels, resulting in kappa-lambda ratios that are very much out of range. Normally an out-of-whack ratio is a warning signal, but it's not in this particular kind of situation, which is a bit confusing. You won't get that sort of confusion, on the other hand, with the M-spike level, which in this sort of situation will be dropping, or even hitting 0.
My point is that, for patients whose disease can be tracked via paraprotein levels (M-spikes), it can be perfectly fine to focus on that metric. Free light chain levels add additional information, but a trained eye is likely to do fine with just the paraprotein results and other standard lab tests, such as immunoglobulin levels, haemoglobin, etc.
Keep in mind that the free light chain test is measuring proteins that are found at very low levels in a patient's blood. We're talking milligrams (one thousandth of a gram) per liter. A patient's paraprotein (M-spike) level, on the other hand, is being measured at the grams per liter (or deciliter) level.
That said, it is true that the free light chain test is more sensitive to changes in a patient's disease. This is because the half life of free light chains is on the order of hours or days, while the half life of the immunoglobulins making up paraprotein (the M-spike) is on the order of weeks. So a patient's M-spike won't move as much when a patient's disease is changing, such as after the start of treatment, as a patient's free light chain levels.
It's also true that some 15 to 20 percent of patients have light chain multiple myeloma, which can only can be tracked by the free light chain test.
On the other hand, with the sort of intensive treatment that is becoming more common these days, particularly in the States, you can see significant suppression of free light chain levels, resulting in kappa-lambda ratios that are very much out of range. Normally an out-of-whack ratio is a warning signal, but it's not in this particular kind of situation, which is a bit confusing. You won't get that sort of confusion, on the other hand, with the M-spike level, which in this sort of situation will be dropping, or even hitting 0.
My point is that, for patients whose disease can be tracked via paraprotein levels (M-spikes), it can be perfectly fine to focus on that metric. Free light chain levels add additional information, but a trained eye is likely to do fine with just the paraprotein results and other standard lab tests, such as immunoglobulin levels, haemoglobin, etc.
Re: Unstable kappa level, very high kappa-lambda ratio
Ian,
I agree with your comment. I should not have used the term "more accurate". Both tests, the sFLC and SPEP, are generally given to multiple myeloma patients. For most standard (those with measurable M-spikes) myeloma patients, the SPEP is the main driver, but sFLC is also monitored since it is more sensitive and does show changes more quickly. No single test drives treatment. All the tests are reviewed, and based on a series of those tests, trends can be spotted which then guide the oncologist.
I agree with your comment. I should not have used the term "more accurate". Both tests, the sFLC and SPEP, are generally given to multiple myeloma patients. For most standard (those with measurable M-spikes) myeloma patients, the SPEP is the main driver, but sFLC is also monitored since it is more sensitive and does show changes more quickly. No single test drives treatment. All the tests are reviewed, and based on a series of those tests, trends can be spotted which then guide the oncologist.
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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: Unstable kappa level, very high kappa-lambda ratio
Update: Thanks for all the replies, they were helpful The week after my initial post, I switched from the CyBorD treatment regimen to Revlimid, Velcade, and dexamethasone (RVD). I had an immediate response and my M-spike dropped from 1.99 to 0.81 to 0.58 g/dL (19.9 to 8.1 to 5.8 g/l) and continues to go down.
The plan is to do two more cycles of RVD and then proceed to an autologous stem cell transplant. While the M-spike is moving in the right direction, the kappa free light chains have also dropped, but continue to bounce around: Dropping on one result and then bouncing back up on the next one, e.g. 63.19 mg/dL on July 24, 49.00 mg/dL on July 28, and back up to 70.69 mg/dL on August 4. I have been on vacation, so the Velcade injections have been skipped for some weeks in July and August. I'm hoping that's the reason. The lambda light chains were low and have been increasing throughout, so the ratio has improved, but is still at 152.22. My doctor(s) don't seem to concerned, but it puzzles me. I chart all the results and I can generally understand fluctuations there, but the light chains still stump me.
The plan is to do two more cycles of RVD and then proceed to an autologous stem cell transplant. While the M-spike is moving in the right direction, the kappa free light chains have also dropped, but continue to bounce around: Dropping on one result and then bouncing back up on the next one, e.g. 63.19 mg/dL on July 24, 49.00 mg/dL on July 28, and back up to 70.69 mg/dL on August 4. I have been on vacation, so the Velcade injections have been skipped for some weeks in July and August. I'm hoping that's the reason. The lambda light chains were low and have been increasing throughout, so the ratio has improved, but is still at 152.22. My doctor(s) don't seem to concerned, but it puzzles me. I chart all the results and I can generally understand fluctuations there, but the light chains still stump me.
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GoDucks - Name: GoDucks
- Who do you know with myeloma?: me
- When were you/they diagnosed?: March, 2017
- Age at diagnosis: 61
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