Suggest Treatment For Elevated Kappa/lambda Ratio

Posted on Tue, 15 Sep 2015

Question: I have a high 2.72 kappa/lambda ratio. It went from 2.42 in February to 2.72 in August. I am see an oncologist and recently had complete body scan xrays which Doc's nurse called and said it was normal. No holes or broken bones. I am having another round of blood work. Previous labs showed no M spike. Most labs were in the low normal range. WBC was 3.7, RBC was4.26, iron is good, SED rate is 11 symptoms include, bloated feeling after eating a small meal, fatique, pain in and around joints. Nausea, headaches, low energy. Otherwise fairly healthy. Good heart rate. Doc thinks the increase in ratio is due to medication and told me to go off of Cymbalta, but I wasn't taking it in February when rato was 2.42. Any ideas why I would have an abnormal ratio and is it a big deal? What other tests might they do? Doc seems to be pretty conservative. Thanks

Answered by Dr. Anil Parth Desai (2 hours later)

Brief Answer:
Hi i would recommend following tests mam.

Detailed Answer:
hello mam,
a free light chain ratio above 1.65 especially when occurs consistently needs to be monitored and investigated.since your other counts are pretty much normal there is nothing urgent to worry about.
however, i would recommend following steps-
1) can you send me the complete light chain assay report. i wanted to see individual kappa and lambda chain amounts.
2)a serum calcium,creatinine and blood urea recent report and if not done i would recommend these.
3) consulting a local hematologist and discussing about a bone marrow aspirate/biopsy.
the free light chain.ratio is an extremely sensitive test to detect changes in light chains and it can be increased and seen in plasma cell disorders and infections.
there are a.range of plasma cell disorders and sometimes they secrete only.light chains or the disease is very early stage.so the above mentioned steps will help us completely rule out an early stage myeloma or early plasma cell dyscrasia.

waiting for your reply with reports mam
let me know if you have any concernd or questions mam.
wish you all the best.
sincerely,
dr parth desai.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Anil Parth Desai (1 hour later)

On 8-6-15 the protein serum 6.4, calcium was 10.1, no creatinine serum was done on 8/6. Most recent ua indicated WBC 0, RBC 0-3, trace of blood, I haven't had a blood urea recently.
The Kappa Lambda reports no M spike, Kappa is 16.41 and the Lambda is 6.04
Kappa/Lambda ratio was 2.72. In addition the test showed that Protein serum was 6.4, Albumin was 4.1, Alpha-1-Globulin was 0.1, Alpha-2-Globulin was.7, Beta Globulin was .9, Gamma Globulin was 0.6, Globulin total was 2.3, A/G ratio was 1.8,

Previously (2-2-15) the Kappa/Lambda ration was 2.42 with the Kappa light chain at 14.17 and the Lambda light chain at 5.85. No M spike observed. Total protein serum at that time was 6.8. The A/G ratio was 1.4, Albumin 4., Alpha-1 Globulin 0.2, Alpha 2 Globulin was 0.9, Beta Globuline was 1.0, Gamma Globulin was 0.7, Globulin total was 2.8,
Please provide information on the changes between the two dates entered and is it a positive change. And any other information you would share will be much appreciated. Is there a chance I have Multiple Myeloma, Non-secretory Myeloma or MGUS or something else. If so would it likely be a problem with the blood or bone. Thank you for your time Dr. Parth XXXXXXX XXXXXXX

Answered by Dr. Anil Parth Desai (2 hours later)

Brief Answer:
Hi I would recommend the following-

Detailed Answer:
Hi XXXXXXX
thank you for your detailed query.
the normal range for kappa is 3.4-19.4mg/l and that for lambda is 5.5 to 26mg/l although it depends from lab to lab and test to test types. however, largely your individual values are normal. the reason there is suscpicion is the ratio which is higher than 1.65. These free light chain assays are relatively newer assays and we as hematologists/hematopathologists are still learning about exact interpretations of these contradictory values (normal light chains but altered ratios.)
Infections can increase and alter the value sometimes and hence creates problems in interpretations.
Your chances of multiple myeloma are low since your serum calcium and rbc count and A/G ratios are fine.
However, to rule out non-secretory myeloma(which is rare) or light chain myelomas (rare) or MGUS, the best test would be bone marrow aspirate/biopsy and flow cytometry on bone marrow aspirate.
Now the thing here is that even if it is MGUS most clinicians would not treat it as there is no benefit offered over just simple observation.

So all in all, I would recommend that,
repeat a free light chain assay and ratio test after 1 month and then if it is altered or if kappa is showing trends of increase, a bone marrow aspirate and biopsy with flow cytometric study on aspirate is needed. Until then if you are feeling fine and not having any bone pains or backaches or fatigue there is no need for any urgent tests.

I hope this helps.
Let me know if you have any more questions or concerns.
wish you all the best mam.
sincerely,
Dr Parth Desai

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Above answer was peer-reviewed by : Dr. Neel Kudchadkar