[leeaaronhParticipant]

Hi. I was diagnosed with smouldering myeloma a few weeks ago. I had a letter from my consultant after new blood tests were taken after initial bloods were taken in hospital. My kappa light chain ratio has increased from 11 to 69. Kappa light chains have risen from 146 to 462. He describes this in the letter as a “slight” increase. I’m really confused as to me this jump seems huge and closer to the 100 ratio which they seem to class as a treatable event? Any advice or reassurance really welcome. Thank you.

[ellenModerator]

I am sorry that you haven’t had a response to your question as yet and I hope you don’t mind me replying on this occasion. My name is Ellen and I am one of the Myeloma Information Specialists here at Myeloma UK.

Normal/healthy free light chains can usually be found in the blood in small amounts (3.3 to 19.4 mg/L for kappa free light chains and 5.7 to 26.3 mg/L for lambda free light chains). For context, we often speak to patients whose light chain levels are in the hundreds and even thousands.

The levels of the free light chains can also be compared with one another. This is done by dividing the kappa and lambda free light chain levels to calculate the free light chain ratio – a normal ratio is between 0.26 to 1.65. The free light chain ratio can be interpreted by a haematologist to understand more about the nature of a patient’s condition.

The International Myeloma Working Group provide criteria for the diagnosis of myeloma. They state that the definition of active myeloma includes more than 10% abnormal cells in the bone marrow or the detection of a plasmacytoma, along with one or more myeloma defining events – one of the possible myeloma defining events is a serum involved / uninvolved free light chain ratio of 100 or greater, provided the absolute level of the involved light chain is at least 100mg/L. However, it is important to keep in mind that it can be normal for the free light chain levels to fluctuate up and down and your medical team will be monitoring for any upward trends.

Whilst the free light chain ratio is important in helping to make a diagnosis of myeloma or progression from a related condition, these test results alone only give a part of the picture. To make an accurate diagnosis, a haematologist would need to look at the results of a range of tests. These include looking at the healthy blood counts (red blood cells, white blood cells and platelets), as well as measuring kidney function and blood calcium levels – all of these can be negatively affected if smouldering myeloma progresses to active myeloma. A haematologist may also want to order additional investigations such as a bone marrow biopsy or imaging scans such as CT or MRI.

If you haven’t already found it on our website, our smouldering myeloma Infosheet may be helpful.

I hope this has been helpful, but if you have any further questions, please feel free to email myself and my colleagues at askthenurse@myeloma.org.uk or alternatively you can call the Myeloma Infoline on 0800 980 3332.

With best wishes

Ellen

• This reply was modified 1 year, 8 months ago by  ellen.

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