The Myeloma Beacon

Independent, up-to-date news and information for the multiple myeloma community.
Home page Deutsche Artikel Artículos Españoles

Forums

General questions and discussion about multiple myeloma (i.e., symptoms, lab results, news, etc.) If unsure where to post, use this discussion area.

What is the significance of IgG kappa vs. IgG lambda?

by Henry Heck on Mon Jan 30, 2012 4:33 pm

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?

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?

by Billy1 on Mon Jan 30, 2012 7:19 pm

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

Billy1

Re: What is the significance of IgG kappa vs. IgG lambda?

by Snip on Mon Jan 30, 2012 7:26 pm

This article may help you better understand, although it doesn't seem to offer a prognostic opinion: http://www.emp-myeloma.eu/AboutMyeloma/MiscellaniousInformation/tabid/65/Default.aspx
John Snippe
** I prefer not to think of myself as a cancer patient,
but rather as a cancer survivor trainee! **

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?

by suzierose on Mon Jan 30, 2012 7:57 pm

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://myeloma.org/pdfs/U-Freelite-Eng2011_g2web.pdf

http://www.ncbi.nlm.nih.gov/pubmed/17408464
http://www.aboutcancer.com/myeloma_prognosis_0610.htm
http://edoc.hu-berlin.de/oa/degruyter/cclm.2009.260.pdf

suzierose
Name: suzierose
When were you/they diagnosed?: 2 sept 2011

Re: What is the significance of IgG kappa vs. IgG lambda?

by Snip on Mon Jan 30, 2012 9:28 pm

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.
John Snippe
** I prefer not to think of myself as a cancer patient,
but rather as a cancer survivor trainee! **

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?

by Dr. Edward Libby on Wed Feb 01, 2012 9:29 pm

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.
Dr. Edward Libby
University of Washington & Fred Hutchinson Cancer Research Center

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. Edward Libby
Name: Edward Libby, M.D.
Beacon Medical Advisor

Re: What is the significance of IgG kappa vs. IgG lambda?

by suzierose on Wed Feb 01, 2012 9:40 pm

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?

suzierose
Name: suzierose
When were you/they diagnosed?: 2 sept 2011


Return to Multiple Myeloma