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Questions and discussion about monoclonal gammopathy of undetermined significance (i.e., diagnosis, risk of progression, living with the disease, etc.)

FLC ratio in urine and 1q21gain in MGUS??

by vicki h on Sat May 25, 2013 4:22 pm

I am CONFUSED on my results and my oncologist said they are not normal but doesn't know what it's meaning is for me...My background is had a bmb in 2010 which was read at 5.5% with 1q21gain and (cks1b) . Iga kappa, anemic at the time in a rash..Since then have developed an Igg as well to make me bi-clonal. The oncologist had bmb re-read by hospital pathologist and came back at 10-15%..Serum flc's run 3-6 , Mspike low at .50..Now 24 hour done in Sep't 2012 showed no albumin but a lambda of 0.10 and a flc ratio of 46 (normal to 10)..Redone May 2013 reading with flc at 59. low lambda no albumin...all serum results same as last visit..I am searching for the importance of this finding as well as my biclonal now shows in blood and urine iga kappa and igg..anemia is under control but had 3 bouts of excessive blood in urine from December till now treated with antibiotics.I am under a kidneys dr care for high blood pressure he recently did blood showing a positive ANA and CRP but had no input on any of this or those results ..any help be greatly apppreciated..!! I am still considered MGUS as far as I know but it is stated 1Q21gain is hardly ever detected in MGUS. And FLC in urine is only detected after it is very high in serum..

vicki h

Re: FLC ratio in urine and 1q21gain in MGUS??

by vicki h on Tue Jun 04, 2013 9:38 am

I saw there was a similiar question to mine posted my 24 hour urine shows I am low lambda 0.10 and high k/l ratio at 59..They were repeated twice 8 months apart with out any evidence of protein..I am Iga kappa developed a igg as well over the last year..I carry a 1q21 gain and hematologist said he does not know the meaning of all this in MGUS..my bmb was first read with a question at 5.3 then re-read at 10-15% that was in 2010 the abnormality in the 24 hour urine and the biclonal has been over 2012 not sure if this is showing a progression due to the 1q21 gain ..my serum flc range 3 to 6 lamda always low kappa always normal ...hope to get some help.thanks!

vicki h

Re: FLC ratio in urine and 1q21gain in MGUS??

by Dana H on Thu Jun 06, 2013 7:29 pm

Hi Vicki H,

I am sorry I can not offer you any help as I do not really understand the significance of the chromosome/cytogenetic abnormality you reference in your post. Perhaps some members with more knowledge of your concerns will respond and help you understand. Good luck !
All the very best.
Dana

Dana H

Re: FLC ratio in urine and 1q21gain in MGUS??

by Multibilly on Thu Jun 06, 2013 9:36 pm

Hi Vicki,

Let me try to comment on a couple of things. First, please report figures with the units and be specific when talking about "flcs" (i.e. kappa FLC, lambda FLC or FLC ratio). This helps avoid any confusion as different labs use different units.

1. One doesn't have to have high FLCs in one's blood serum for them to show up in one's urine. But your Kappa FLC in your serum is indeed elevated. If you truly have a k/l ratio = 46 with a lambda FLC of 0.10 (what units?), this would give you a kappa FLC of 4.6 (again, what units?) . The normal high limit of kappa FLC is 1.94 mg/dL = 19.4 mg/L, so I'm guessing your report was in mg/dL if you were diagnosed earlier as IgA Kappa.

2. I'm also not sure you got your upper limit right on the FLC ratio. The normal FLC ratio range is 0.26 -1.25 (these numbers are adjusted higher to 0.37 -3.1 if you have renal involvement, which it sounds like you might have). You said the normal upper limit was 10. In any case, you have an out-of-range, high FLC ratio.

3. Your are right that at least one study I've looked at shows no incidence of AMP1q21 gains in MGUS http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1895503/ But, you are neither MGUS or SMM if you have CRAB ( you did say you were anemic). And now that you have a clonal plasma count of 10-15% and have anemia, you would be classified as having symptomatic multiple myeloma.

4. The presence of an AMP1q21 gain has implications for which drugs you would use to treat the multiple myeloma (i.e. kyrpolis might be something you want to look at). Some drugs apparently work better than others with this specific gain (it also matters how many copies of AMP1q21 you have, which would show up in your FISH report).

5. Also, has the nephrologist confirmed why you have hematuria? Did you have a cystoscopy and CAT scan to rule out any other underlying conditions that caused the hematuria? You may want to see a urologist for this.

6. As always, I'm not a doc. Check all this out with a multiple myeloma specialist that can offer you insights into these results. An oncologist that doesn't understand the implications of what you summarized here is a red flag to me. Hope this helps and wish you all the best.

Multibilly
Name: Multibilly
Who do you know with myeloma?: Me
When were you/they diagnosed?: Nov, 2012

Re: FLC ratio in urine and 1q21gain in MGUS??

by vicki h on Thu Jun 06, 2013 11:04 pm

Thank you so much for your reply..my urine flc's are in mg/L it looks to be with a lambda of 0.06 range 0.24-6.66 a kappa of 2.85 mg/L normal is 1.35 to 24.19 and ratio at 47.50 range is 2.04 to 10.37 on a 24 hour bence jones protein in 9/2012..A repeat was done in 5/2013 showing a amda of 0.10 and a ratio of 59.00.. my serum k/l are in mg/L as well with a low lambda normal kappa and a ratio from 3-6 over last 3 years..in 2012 I also began showing a igg as well as my iga kappa which has made me bi clonal..My anemia is under control after IV iron therapy and then onto oral has now reached from a ferritin of a 2 to a 19 in 3 years..I do have a nephrologist as I am hyperaldosterone i have made him aware without any reply from him as of yet I will see urology again next week..My last bone marrow and FISH was July 2010 I had 1q21gain I have not had a repeat since showing the bi clonal or the increasing flc in bjp urine..Thank you again..Vicki

vicki h

Re: FLC ratio in urine and 1q21gain in MGUS??

by Multibilly on Fri Jun 07, 2013 6:15 am

Good luck. Couple more thoughts.

I honestly don't know if any of the conditions you outlined here can account for hematuria.

I had hematuria briefly and it was determined to be of undetermined significance and disappeared on its own. It is pretty standard procedure to get a CT scan and cystoscopy to rule out kidney stones, bladder cancer, etc.

While I'm not sure, I think you could replace the CT scan for hematuria by having a a whole-body PET/CT scan to also look for lytic bone lesions at the same time (you don't say if you ever had a full skeletal xray series or PET/CT scan to check for bone involvement from the multiple myeloma....but you really want to do this given your clonal plasma cell percentage). That way, you could have one imaging session to cover both the multiple myeloma and the hematuria and reduce the amt of radiation you might be exposed to?

You also say that you went from being bi-clonal to monoclonal and you aren't being treated for multiple myeloma? Again, I'd really seek out a top notch multiple myeloma specialist. This is probably the single most important thing that you can be doing for your health.

Multibilly
Name: Multibilly
Who do you know with myeloma?: Me
When were you/they diagnosed?: Nov, 2012

Re: FLC ratio in urine and 1q21gain in MGUS??

by vicki h on Fri Jun 07, 2013 11:22 am

Hello and thank you again..I went from monoclonal to bi-clonal in 2012..I was Iga now I am iga and igg kappa..I will have MRIs with my orthopedist to check my spine and hips next month I will ask him for skeletal survey as hematologist did not order one..Thank you for your reply!

vicki h

Re: FLC ratio in urine and 1q21gain in MGUS??

by Anonymous on Fri Jun 07, 2013 12:59 pm

Hi Just want to mention Iron deficiency anemia is not the anemia referred to in the CRAB symptom. In CRAB- the anemia is related to bone marrow failure, where the marrow fails to make enough red cells / hemoglobin.

Iron deficiency anmis can be due to blood loss, or diet etc.

Iron deficiency anemia happened with me to. (in additiona to bone marrow failure anemia) because my multiple myeloma caused a bleeding disorder. (bleedign nose, bowel etc) I had three iron IV treatments leading up from diagnosis to transplant when oral pills were just not doing it. I was on a very strong one called Pallefer. (or similar) that is supposed to be on of the strongest, i think I needed a prescription for those pills...

I can't really speak to your Bi-clonal, other then to suggest seeing a hemo doctor who treats a lot of Myeloma patients

Anonymous

Re: FLC ratio in urine and 1q21gain in MGUS??

by Multibilly on Fri Jun 07, 2013 2:03 pm

Thanks Anonymous,

I was totally unaware of this distinction of anemia type wrt multiple myeloma.

Multibilly
Name: Multibilly
Who do you know with myeloma?: Me
When were you/they diagnosed?: Nov, 2012

Re: FLC ratio in urine and 1q21gain in MGUS??

by Multibilly on Fri Jun 07, 2013 2:10 pm

vicki h wrote:
> Hello and thank you again..I went from monoclonal to bi-clonal in 2012..I
> was Iga now I am iga and igg kappa..I will have MRIs with my orthopedist to
> check my spine and hips next month I will ask him for skeletal survey as
> hematologist did not order one..Thank you for your reply!

So you may want to do the xray survey (or a whole body PET/CT) first and then do the MRI. The reason I am thinking this way is because MRIs are really good at looking at a specific areas, but you can't use them to look at your whole body. If the xray turns up something suspicious (you can have lytic lesions on your skull, ribs, etc in addition to your spine and hips), you can then use the MRI to validate any suspicious looking areas found on the xray survey, in addition to taking a closer look at your spine and hips.

Multibilly
Name: Multibilly
Who do you know with myeloma?: Me
When were you/they diagnosed?: Nov, 2012

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