MGUS with rising Free Lambda and falling kappa lambda ratio

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I was diagnosed with Monoclonal gammopathy of unknown significance (MGUS), 4, years ago and apart from a couple of blips have been fairly stable. My paraprotein level has remained at 2. However I noticed my Free Lambda light chain has been rising, in May it was 116.6 (should be 10.3 - 24.4) then in July 123.4, with a kappa lambda ratio of 0.15, (normal is 0.99 - 1.8) I wondered if anyone had this? I watched a YouTube video that talked about light chains and suggested that a rising Lambda free chain and an abnormal kappa / lambda ratio could be a sign of Amyloidosis. Iā€™m due a blood tests every next next month and will raise this with my haematologist if it goes up again. Has anyone experienced this? My Kappa free light chain is normal.

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Hello @Hussyhemlock

Thank you for your post.

We are sorry to hear about your diagnosis of Monoclonal gammopathy of unknown significance (MGUS).

We are unable to comment on specific blood tests however, we would advise with any health worry or concern to contact your team/ GP who monitor your Monoclonal gammopathy of unknown significance (MGUS) for you and tell them about how you are feeling. It might be a good idea to tell them you are worried about Amyloidosis, so that this could be something they can then rule in or out as it may not be at the forefront of their mind.

It sounds reassuring that you have an appt next month and can raise this issue, but if it is playing on your mind, perhaps you have a clinical nurse specialist you can contact in the meantime?

We do have a page on What is MGUS | Blood Cancer UK which has a section that talks about types of Monoclonal gammopathy of unknown significance (MGUS) and may be useful for when you speak with your team.

For further information about Monoclonal gammopathy of unknown significance (Monoclonal gammopathy of unknown significance (MGUS)) our colleagues at Myeloma UK have a useful info sheet that may be helpful to read over MGUS Infosheet.

Take care & warm wishes,

Emma (support services nurse)

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Thank you, I feel I can wait until next month, this forum is always so reassuring.

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Hi

I just have a quick question regarding immunoglobulin levels in comparison to paraprotein, it may be silly - apologies if so, but just trying to understand from some other things Iā€™ve read. is everyoneā€™s pararotein level the entire amount of that particular involved immunoglobulin or part of it?

any help would be greatly appreciated, kind regards

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Hi @Pollyp777, please donā€™t apologise for asking - itā€™s what we are here for!

Iā€™m tagging in the marvellous @BloodCancerUK_Nurses to help answer this, as Iā€™m certainly no medical expert.

Take care,

Ceri - Blood Cancer UK Support Services

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Thank you for that, much appreciated :heart:

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Hello @Pollyp777

I was once told ā€œthereā€™s no such thing as a silly question, itā€™s just a question you think you should know the answer tooā€. This really stuck with me and so now I never feel worried to ask questions that I once would. Monoclonal gammopathy of unknown significance (MGUS) is very confusing and complex (and even GPs and Haematology nurses struggle to understand it too!), so hopefully I can answer in a way that makes sense.
Plasma cells make five types of Immunoglobulin, but the three associated with M GUS are IgG, IgA and IgM. When a genetic mutation happens, the plasma cells make more of one type; this is called an M-protein or Monoclonal Protein or M-spike or paraprotein (they all mean the same thing). Each M GUS patient will have a ā€˜typeā€™; for example you may be told you have IgG M GUS.
So to answer your question: Yes, when you get blood results the paraprotein reading is the total count of that specific (abnormal) paraprotein that you have (either IgG or IgA or IgM).
I hope I havenā€™t confused you. If it would be helpful to talk this through, then do call our support line.
Best wishes, Heidi.

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Thanks for that, I understand most of it and I currently have two types of Monoclonal gammopathy of unknown significance (MGUS) igm lambda and kappa light chain Monoclonal gammopathy of unknown significance (MGUS). Looking at others results Iā€™ve seen the igm igg igm levels and then the known monoclonal band reading, but others seem to show a higher total reading of the involved chain than the paraprotein figure. Mine is exactly the same so Iā€™m wondering if that is different as in, can you have any healthy remaining for eg igm types so only a portion have turned dysfunctional or are all Monoclonal gammopathy of unknown significance (MGUS) patients completely deficient in the immunoglobulin thatā€™s gone rogue?! Hope that makes sense

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Iā€™ve had my last set of blood test results, there has been a very slight improvement, unfortunately I waited in all day for a phone call from my haematologist but he just sent a message saying they were satisfied with my blood test and just to have my next one. Because of the slight improvement Iā€™m not too worried this time and will watch for the next one. Perhaps some kind of inflammation from the last few months? I know my haematology team are very busy I donā€™t blame them for not ringing but I think they donā€™t always understand how scary this is, especially when you have changes in your results. Fingers crossed for next time.