Hi, I have just been diagnosed with Kappa Light Chain Monoclonal gammopathy of unknown significance (MGUS). My Kappa levels are 178 and my Kappa:Lambda ratio is 18.5. In addition I have immunoparesis with both my IgG and IgM levels just below the bottom of the normal range. I understand that a ratio of 20 is one of the criteria for Smouldering Multiple Myeloma. My question is, should I have been offered a bone marrow biopsy as my ratio of 18.5 is so close to 20, particularly with the immunoparesis? I am due to be seen by the consultant at the end of December to discuss the results of follow up blood tests. Assuming the levels haven’t changed much by then, should I ask for a bone marrow biopsy?
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Hi there I’m going to link you to myeloma uk
The Monoclonal gammopathy of unknown significance (MGUS) diary may also be useful
You allowed to ask any questions of your consultant and your consultant will know if you need a bone marrow biopsy.
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Hello there @CaptainKappa, and welcome to the forum. I’m glad you found us, though I’m sorry you’re having to grapple with all of this uncertainty.
I’m going to loop in our @BloodCancerUK_Nurses here, as they may be able to offer insight into how these thresholds are usually interpreted in practice, what that means in terms of a bone marrow biopsy, and how people often approach conversations like this with their consultant.
In the meantime, you’re very welcome to keep posting here if more questions come up as you process everything.
Take care,
Ceri - Blood Cancer UK Support Services
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Dear @CaptainKappa ,
Welcome to our forum. I am sorry to read about your recent diagnosis of Kappa Light Chain Monoclonal Gammopathy of Undetermined Significance. If it would be helpful to talk things through in more detail, please do hesitant to contact the haematology support nurses on 0808 2080 888
Bone marrow biopsies are not routinely required for a diagnosis of Monoclonal gammopathy of unknown significance (MGUS), this however can depend on many factors including your risk factor and other blood abnormalities including anaemia, having raised calcium levels in the blood and renal impairment. Also, symptoms including bone pain, recurrent infections and generally feeling unwell.
You will not necessarily have been offered a bone marrow biopsy and I suspected as you are being followed up within 3 months, your consultant may want to review the results of any other blood tests first. It is absolutely fine to ask your consultant if you need a bone marrow biopsy, and any concerns that you may have. They will have all your medical records and will be able to discuss in more detail with you. This is a common question asked by patients and one that is completely justified.
Kind regards
Fiona (support services nurse)
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Hello @CaptainKappa,
How are you? My Kappa chains are getting close to 100. And also fear that getting close to SMM. How long have you been diagnosed with Monoclonal gammopathy of unknown significance? IgG Monoclonal gammopathy of unknown significance and Myeloma treatment has better prognosis. I hope you are well.
Hi, I’m doing well, and like you, I’m navigating the ‘watch and wait’ process. My diagnosis is quite recent (from late 2025). I actually just had my 3-month check-up, and it was reassuring to see that my Kappa levels and ratio have remained stable—my Kappa is currently 166 mg/L with a ratio of 18.44, which is almost identical to my first tests.
It’s interesting you mention the Kappa level of 100. My specialist explained that while the absolute number matters, they look even more closely at the ratio between Kappa and Lambda. A ratio of 100 is often the clinical threshold where they consider it more than Monoclonal gammopathy of unknown significance ('MGUS'), so hopefully your ratio is still well below that.
You’re definitely right about the treatment progress for Myeloma; survival and quality of life have improved so much recently. How frequently is your team monitoring your bloods and what was your most recent ratio?
Hi @CaptainKappa ,
Thank you for your reply. I am a bit stressed my Kappa is close to 100 and Lambda 19. So ratio over 5:1. My platelets got quite low too. A 3rd what it was 2-3 years ago. So I am nervous.
When my Monoclonal gammopathy of unknown significance ('MGUS') was discovered I thought that I have years until the progression but not sure what will happen now.
I also got quite panicky recently, my ALT - one of the liver enzymes suddenly came up very elevated 7 months ago. I had loads of tests and a liver scan. And at some point my GP texted me that he suspected Amyloidosis. As they could find the reason of the liver inflammation / damage. Amyloidosis can damage single organs. He even wrote a letter to my Hematologist asking to investigate my ALT and Amyloidosis risk. Eventually my ALT got back to norm but had a couple of very stressful months.
I am glad to heard that your blood tests remain stable.
Keep strong and try to stay positive and surround yourself by positive people and do things that give you joy.
Thank you so much for your reply and your kind words of support. It really helps to connect with someone who understands the ‘watch and wait’ rollercoaster.
I’m sorry to hear you’ve been so stressed. Regarding your ALT, I can certainly empathize—I’ve actually had a similar experience recently. My own ALT has been trending upwards and reached 64~U/L at my last check-up. While it can be alarming to see a ‘red’ result, my specialist explained that these mild elevations can happen due to subtle liver inflammation and aren’t always a cause for panic. It is such a relief that your levels returned to normal, and it sounds like your GP was being extra cautious by ruling out amyloidosis, which is a scary word to see in a text!
Regarding your light chains, I hope I can offer some comfort about your ratio. While a ratio of 5:1 (your 5.26) is technically outside the normal range, in the world of Monoclonal gammopathy of unknown significance (‘Monoclonal gammopathy of unknown significance ('MGUS')’), it is actually quite modest. When doctors look for signs of progression toward smouldering or active myeloma, the ‘red flag’ they typically look for is a ratio that reaches or exceeds 100. At 5.26, you are still very far from that high-risk threshold.
Even your Kappa level of 100~mg/L, while elevated, is often considered a stable baseline for many patients. The most important thing is that your ratio remains low compared to the levels seen in more advanced stages.
The drop in your platelets is something I’m sure your haematologist is investigating closely. While it’s natural to feel nervous about changes, Monoclonal gammopathy of unknown significance (‘Monoclonal gammopathy of unknown significance ('MGUS')’) can remain stable for many years even with these fluctuations. I’m glad your ALT is back to normal—that is a great sign of your liver’s resilience.
I will definitely take your advice to stay positive and find joy where I can. Wishing you all the best for your next check-up, and I hope your results stay as stable as possible!
Hi @CaptainKappa ,
Many thanks for your reply. I am glad too that there is this place where people can find support and place where they can share their worries, good words. Especially that I do not want to be a burden and put more worries on my family. But sometimes I want to speak with someone. So I am grateful for this place.
My ALT was usually 15, then in the summer it was 140 and was rising up to 190 for a couple of months. I read somewhere that milk thistle supplement are good for the liver. I started drinking milk thistle herbal tea (I am sure it was a coincidence) but eventually the ALT dropped to normal levels. The GP thought I had some virus or antibiotics which caused a liver damage.
ALT around 60 is not very high. But it is best to avoid any alcohol, processed foods. I eat too many sweets. I am trying to limit them but not always succeed. I’m thinking of starting drinking vegetable juices to boost my immune system.
There are some early studies saying that Turmeric supplements can help slow down (some types of Monoclonal gammopathy of unknown significance ('MGUS') or smoldering myeloma). Again it was a small trial, and did not have effect on everyone taking part in it. However, I do not recommend taking that without doctors advice. it is always best to ask the Hematologist for the advice. As Turmeric can be toxic and damage liver and even have negative impact on some immune system reactions. Many herbal supplements can help and cause damage. I got some tablets from Holland and Barrett but will take one tablet every few day max.
Look after yourself. And stay in touch and share your updates.
P.s. to avoid overthinking I read novels and some light books.
Regards Anna
Hi Anna, just checking in to see how you are doing and to give you an update on my situation. Between January and April I started experiencing back, hip and leg pain which got progressively worse. I have longstanding lower back degeneration so I put it down to that. In early April I mentioned it to my Haematologist and they referred me for a full spine scan. However in the days following my pain in my right hip was so bad that I paid for a private MRI of that area. I received the news the next day that my pelvis had been badly eaten away around the hip socket, and down into the pubic and sitting bone areas with some areas eroded to the muscle layer. At this point my Kappa sFLC ratio was 24. I had a bone marrow biopsy taken from my right hip and got the news a few weeks later that the plasma cell %age was 0.7%. They needed 10% or greater to confirm a multiple myeloma diagnosis. My haematologist told me that it wasn’t multiple myeloma and wrote to my GP to say the same. I asked for a copy of the bone marrow biopsy laboratory report and discovered that of the 4 modalities tested, each had a comment saying inadequate sample unable to comment, poor sample no comment, etc. The biopsy had actually failed to draw a viable aspirate (liquid) or bone core sample and was undiagnostic. I requested another biopsy and on the day that I arrived at the hospital I asked them to take two (one from the left hip, and another from the right hip). They took 2 from the left (first one didn’t work) and one from the right. I got the results on 21 May and the only biopsy that worked was the third one I had requested. It showed 15-20% plasma cells so I finally got my diagnosis. I asked the consultant if I could be put on Bisphosphonates to reduce the bone damage; he told me it was normally meant for osteoporosis which I don’t have. I knew through my research that Bisphosphonates is standard treatment for myeloma bone disease. Luckily in the meantime I had lost faith in my consultant and insisted on a referral to Clatterbridge Cancer centre in Liverpool as I had met the wonderful myeloma team that work there at a Myeloma Info day they put on for patients and their carers. I did have to get PALS involved to expedite the request I put to my consultant as it was taking too long. I started treatment at Clatterbridge on June 1st and was immediately but on Bisphosphonates and I had radiotherapy to the hip and have just finished the first monthly cycle of my DVTd systemic MM treatment. My Kappa sFLC ratio was 87 and my Kappa Light Chains were 475 just 2 weeks before I commenced treatment so they had started to climb exponentially. I expect to have four (month-long) cycles of DVTd treatment and then will go into hospital for about 3-4 weeks for an autologous stem cell transplant (using my own stem cells). After that hopefully I will be in remission and will then take Lenalodimide daily as maintenance to try and hold the disease at bay for as long as possible (hopefully many years). I’m tolerating the treatment well but it is the damage to my pelvis that affects my quality of life and could take 18-24 months to recover to a point where I hope to be able to get back to walking unaided. I’m currently on dual crutches and have to be very careful putting weight through my right hip as it is at high risk of collapse (the pelvic roof and pillar surrounding the hip joint have been badly eroded by the disease). My aim is to be able to do 3 mile flat walks, unaided, in 18-24 months time. I do hope your Monoclonal gammopathy of unknown significance ('MGUS') has remained stable. Do keep in touch. I have my fingers crossed for you.
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Dear CaptainKappa,
I am so sorry to hear that. I am so saddened by this news. I am so glad to hear that you have a good care. I fear where I live they have not much experience.
I am due to have blood tests in 3 weeks and the appointment in 4. I am totally scared now.
I also have some persona stress. So I am totally scared.
Is your treatment closed to home?
I am so shocked to hear about this accelerated increase in Kappa Light Chains.
Stay strong.
This is sad that your former consultant was so ignorant and unhelpful. This is the common problem with the NHS service.
Well done for fighting for a second opinion.
I hope things will improve even more.
Feel free to write anytime you need. Fighting cancer or any serious illness is very lonely and frightening.
May I ask what is your age.
Sending positive thoughts. The main thing is that you are in good hands.
I also have been having an unexplained cough for over a year. I had a couple of x-ray but fear I will need a chest CT. Which I would like to avoid if I can.
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