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Significance of Kappa / Lambda ratio

by ankit.dave on Tue Aug 13, 2013 2:35 pm

Hello,

If someone can help me out with the information as to what is the significance of kappa / lambda ratio. I am just aware about the kappa light chain and the lambda light chain. And also came to know that very high kappa/lambda ration indicates kappa myeloma and very low indicates lambda myeloma.

what is the severity of high kappa/lambda ratio (if it is around 310)? is there any relation between this ratio and the amount of plasma cells in the bone marrow?

Can the kappa / lambda ratio controlled by medication? can the free kappa light chain be decreased?

Best Regards,

Ankit

ankit.dave

Re: Significance of Kappa / Lambda ratio

by dnalex on Tue Aug 13, 2013 4:28 pm

Hi Ankit,

The kappa/lambda, or lambda/kappa, ratio is an indicator of the balance between the two. This is in addition to the absolute values of the systemic paraproteins discovered in the blood. In myeloma patients, the absolute amount for one of the chains will increase, and the ratio will also increase, as compared to some other issue such as kidney disease, where both kappa and lambda absolutes will increase, but their ratios remain the same. Hence, it is important to look at both kappa and lambda values, and their ratios.

In patients with light chain only myeloma, this assay is particularly important.

Serum kappa or lambda light chain, and the kappa/lambda does normalize/decrease in response to treatment.

You may find to be useful reading.
http://myeloma.org/pdfs/U-Freelite-Eng2011_g2web.pdf

dnalex
Name: Alex N.
Who do you know with myeloma?: mother
When were you/they diagnosed?: 2007
Age at diagnosis: 56

Re: Significance of Kappa / Lambda ratio

by Ron Harvot on Wed Aug 14, 2013 10:21 pm

Ankit,

In addition to the great info that dnalex gave you, the following goes into great depth on the significance and tests of light chains including the light chain ratio.

http://www.wikilite.com/wiki/index.php/Main_Page

Ron

Ron Harvot
Name: Ron Harvot
Who do you know with myeloma?: Myself
When were you/they diagnosed?: Feb 2009
Age at diagnosis: 56

Re: Significance of Kappa / Lambda ratio

by TerryH on Thu Aug 15, 2013 12:56 am

While both of the resources mentioned above certainly have their merits, it's worth bearing in mind that both have been produced based on funding from the company (The Binding Site Group) that sells the light chain test.

From wikilite.com: "Wikilite.com is maintained by clinical and scientific teams at The Binding Site Group Ltd."

From the IMF PDF document: "Sponsored by an unrestricted educational grant from Binding Site."

I don't think these sponsorships necessarily affect the information from these resources that discusses how to interpret light chain tests.

But I do think the sponsorships need to be taken into account when you come across statements in these resources about how crucial, indispensable, or superior light chain testing is versus other methods of detecting and tracking the presence of multiple myeloma.

TerryH

Re: Significance of Kappa / Lambda ratio

by dnalex on Thu Aug 15, 2013 1:32 am

Terry,

Without a doubt the kappa and lambda serum light chain tests are pivotal assays in light chain myelomas. That has nothing to do with company sponsorship. It's a fact.

dnalex
Name: Alex N.
Who do you know with myeloma?: mother
When were you/they diagnosed?: 2007
Age at diagnosis: 56

Re: Significance of Kappa / Lambda ratio

by TerryH on Thu Aug 15, 2013 1:55 am

You're correct, dnalex, and I don't have any issue with light chain tests being used in patients with light chain myeloma.

However, it's also a fact that light chain myeloma accounts for only 15-20 percent of all myeloma cases, according to the MMRF.

If you want to believe that company-sponsored efforts like those linked to above aren't intended to to affect opinions about the test's value in the other 80 percent of myeloma patients, you're welcome to do so. I prefer to think about these things a bit more critically.

TerryH

Re: Significance of Kappa / Lambda ratio

by dnalex on Thu Aug 15, 2013 5:28 pm

Terry,

1 in 5 is a lot of patients, and I think we have all learned that there is a place and value for each test, and we look at each one critically.

Have a great day.

dnalex
Name: Alex N.
Who do you know with myeloma?: mother
When were you/they diagnosed?: 2007
Age at diagnosis: 56

Re: Significance of Kappa / Lambda ratio

by ankit.dave on Fri Aug 16, 2013 6:51 am

Thank you Alex, Ron and Terry for the valuable input.

I would further like to know the relation of kappa / lambda ratio and the plasma count number in the bone marrow. We had a bone marrow test and also the free light chain assay test. The bone marrow test results in the plasma cell count less than 1%. And in the free light chain assay, the value of kappa chain is around 4100, the lambda is around 12-13 and the ratio is around 313.

What does this indicate? My mom (she is the patient) is having a lesion in the left iliac bone with the bone destruction and one small lesion in the L3/L4 region for your information.

It will be very helpful if you can provide your valuable inputs on this.

Best Regards,

Ankit Dave

ankit.dave

Re: Significance of Kappa / Lambda ratio

by Dr. Ken Shain on Sat Aug 17, 2013 9:07 am

The quantification of serum free kappa and lambda light chain is an additional and quite sensitive techinique to quantify the presence of multiple myeloma. She should have a myeloma burden assessed by SPEP- IFE (serum protein eletrophoresis and immunofixation), UPEP-IFE (24 hours urine), quantitative immunoglobulins, and SFLC. Like quantitative immunoglobulins (IgG, IgA, IgM) there are endogenous kappa and lambda SFLCs- those made by your normal B cells. The ratio is a the designated manner in which to measure the presence of an abnormal SFLC i.e. that produced by myeloma. The typical normal range for a SFLC ratio is from 0.26-1.62. As you can see the ratio in our mother's case is markedly elevated.

In your mother's case she has an abnormal SFLC ratio and, therefore, has multiple myeloma- specifically in the context of her her destructive lesion in iliac bone and lumbar spine. You do not comment on anemia, hypercalcemia, kidney function or significant infectoins- these too are the classically effected organs involved in myeloma.

The lack of a "apparent equivalent" elevation in bone marrow plasma cells is likely the result of a sampling bias. A bone marrow is only taking a very small sample of the bone marrow. Myeloma is not always diffusely spread throughout the marrow- can be patchy. On other occasions myeloma will present as multiple plasmacytomas. To this end, there is not a lot of marrow involvement outside the involved plasmacytomas.

We wish your mom the best and i hope that this answered your question.
Dr. Ken Shain
H. Lee Moffitt Cancer Center & Research Institute

Any advice provided in these postings is based on a very limited amount of information. There is no substitute for the care of your oncologist/hematologist. Therefore, all suggestions should be discussed with your treating physician. None of the comments presented here are meant to replace the evaluation of a patient by a knowledgeable physician.


Dr. Ken Shain
Name: Ken Shain, M.D., Ph.D.
Beacon Medical Advisor


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