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What is the significance of IgG kappa vs. IgG lambda?
My clone is IgG lambda, but I know of people with IgG kappa who have survived for 10 years or more. Can those with IgG lambda expect similar survival outcomes to those with IgG kappa?
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Henry Heck - Name: Henry Heck
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: Sept., 2011
- Age at diagnosis: 72
Re: What is the significance of IgG kappa vs. IgG lambda?
Henry Heck wrote:
> My clone is IgG lambda, but I know of people with IgG kappa who have
> survived for 10 years or more. Can those with IgG lambda expect similar
> survival outcomes to those with IgG kappa
I do believe that a preponderance of patients have IgG kappa FLC over IgG lambda FLC. IgG lambda individuals with high numbers outside the normal range of 5.7-26.3 mg/dL will have low K/L ratio's assuming the kappa FLC is in normal range. The reverse holds true if one has high kappa numbers and lower lambda numbers. I have not seen or heard of any clinical articles stating one is worse than the other, however it is documented that the degree of the K/L ratio being out of range is significant. Normal K/L range is .26-1.70. It is also important with the numbers being in range since one could have high (or low) FLC numbers and still have a normal K/L ratio.
I don't think the Freelite numbers by themselves are a signicant determinantal advancement of multiple myeloma but rather one of several factors involved. I believe Mayo clinic has reported a signicant no. of patients with MGUS and harboring FLC with extended survival patterns.
Regards from the west coast:
Billy1
> My clone is IgG lambda, but I know of people with IgG kappa who have
> survived for 10 years or more. Can those with IgG lambda expect similar
> survival outcomes to those with IgG kappa
I do believe that a preponderance of patients have IgG kappa FLC over IgG lambda FLC. IgG lambda individuals with high numbers outside the normal range of 5.7-26.3 mg/dL will have low K/L ratio's assuming the kappa FLC is in normal range. The reverse holds true if one has high kappa numbers and lower lambda numbers. I have not seen or heard of any clinical articles stating one is worse than the other, however it is documented that the degree of the K/L ratio being out of range is significant. Normal K/L range is .26-1.70. It is also important with the numbers being in range since one could have high (or low) FLC numbers and still have a normal K/L ratio.
I don't think the Freelite numbers by themselves are a signicant determinantal advancement of multiple myeloma but rather one of several factors involved. I believe Mayo clinic has reported a signicant no. of patients with MGUS and harboring FLC with extended survival patterns.
Regards from the west coast:
Billy1
Re: What is the significance of IgG kappa vs. IgG lambda?
Hi Henry,
My understanding is the same as Billy's.
Lambda vs kappa is not the issue rather it is the ratio that is important and is prognostic. The higher the ratio the poorer the survival.
http://www.ncbi.nlm.nih.gov/pubmed/17408464
http://edoc.hu-berlin.de/oa/degruyter/cclm.2009.260.pdf
My understanding is the same as Billy's.
Lambda vs kappa is not the issue rather it is the ratio that is important and is prognostic. The higher the ratio the poorer the survival.
http://www.ncbi.nlm.nih.gov/pubmed/17408464
http://edoc.hu-berlin.de/oa/degruyter/cclm.2009.260.pdf
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suzierose - Name: suzierose
- When were you/they diagnosed?: 2 sept 2011
Re: What is the significance of IgG kappa vs. IgG lambda?
oh wow.. this whole lamba/kappa thing is starting to freak me out a bit: my bone marrow biopsy report has a comment from the testing physician offering some concern:
"There are numerous single and small clusters of plasma cells, more than seen in smears of the aspirate. They are estimated to compromise fewer than 10% of nucleated marrow cells, but most express lamba light chain. Few are kappa positive. These cells are CD56- and CD20-. It is noted from the previous flow cytometry report (dated Feb, 2011) that plasma cells were monoclonal kappa light chain."
I don't really know what most of the above means, but I have a feeling that a reversal from Lamba to Kappa is weird, at least. The doctor quoted above wasn't too convinced of this set of tests in general: he recommends re-doing the bone marrow biopsy again "after an appropriate interval"... and we've booked one for the beginning of May.
"There are numerous single and small clusters of plasma cells, more than seen in smears of the aspirate. They are estimated to compromise fewer than 10% of nucleated marrow cells, but most express lamba light chain. Few are kappa positive. These cells are CD56- and CD20-. It is noted from the previous flow cytometry report (dated Feb, 2011) that plasma cells were monoclonal kappa light chain."
I don't really know what most of the above means, but I have a feeling that a reversal from Lamba to Kappa is weird, at least. The doctor quoted above wasn't too convinced of this set of tests in general: he recommends re-doing the bone marrow biopsy again "after an appropriate interval"... and we've booked one for the beginning of May.
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Snip - Name: John Snippe
- Who do you know with myeloma?: me
- When were you/they diagnosed?: Jan, 2011
- Age at diagnosis: 56
Re: What is the significance of IgG kappa vs. IgG lambda?
Greetings from sunny (today at least) Seattle,
A good question. My simple answer to this is that in terms of a myeloma patient's overall prognosis and response to treatment there is no real significance to the type of free light chain. Kappa is more common than lambda.
The free light chain ratio is by definition the kappa level divided by the lambda level.
Therefore if a patient has elevation in lambda free light chains the ratio will be inverted and will fall instead of climb. So, patients with high lambda levels will have very low kappa/lambda ratios and patients with high kappa levels will have high kappa/lambda ratios.
A good question. My simple answer to this is that in terms of a myeloma patient's overall prognosis and response to treatment there is no real significance to the type of free light chain. Kappa is more common than lambda.
The free light chain ratio is by definition the kappa level divided by the lambda level.
Therefore if a patient has elevation in lambda free light chains the ratio will be inverted and will fall instead of climb. So, patients with high lambda levels will have very low kappa/lambda ratios and patients with high kappa levels will have high kappa/lambda ratios.
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Dr. Edward Libby - Name: Edward Libby, M.D.
Beacon Medical Advisor
Re: What is the significance of IgG kappa vs. IgG lambda?
Hi Dr. Libby,
Glad to hear Seattle was sunny today, I know that is uncommon, and therefore that much more delightful. Need a little rain to appreciate the sunshine, no?
...although Seattle does go overboard on the rain, lol
Is it true that lamba (aka amylodisis) vs. FLC kappa patients have far poorer surival? I did see an article that proported that, has that been disproved?
Glad to hear Seattle was sunny today, I know that is uncommon, and therefore that much more delightful. Need a little rain to appreciate the sunshine, no?
...although Seattle does go overboard on the rain, lolIs it true that lamba (aka amylodisis) vs. FLC kappa patients have far poorer surival? I did see an article that proported that, has that been disproved?
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suzierose - Name: suzierose
- When were you/they diagnosed?: 2 sept 2011
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