M-Spike and Lambda light chain increasing while KL ratio decreasing

lamda Qn is 53. Should I be worried

This must be distressing for sure. No one likes seeing lab values going up albeit slowly. There are cutoffs before treatment or clinical studies are started. For me I was like start me now. Pronto. I have SMM and again values slightly go up but not enough to tip the scales. It’s like what are we waiting for Xmas. I feel fine physically. But man the mind and mental stress has aged me some. The little I can do is worry. The most I can do though and this is important is find a good doctor/specialist who can relate to you and treat you when and if the time comes. Instead of wow where did this come from type of scenario. Gain confidence by the one overseeing your care kind of takes the edge off. You’re in for the long haul. The rest of your life actually. And you need someone on your side who will deliver exceptional care you’ve come to expect.

In your place, I would be concerned. These numbers are all rising, indicating possible progression. You should be followed at frequent intervals with blood tests - maybe every 3 or 6 months. The ratio is decreasing because your lambda FLC is increasing.
When your lambda number over the kappa number equals or exceeds 20, you may have a problem.
Definitely, an M spike of 3 is problematic. However, some hematologists argue that 1.5 is concerning.
Is your doctor a MM specialist? If not, you need to find one to guide your current doctor.
Have you enrolled in SmartPatients.com? This is an online group of mainly MM patients but you can obtain very knowledgeable information from this website.
Best wishes. Feel free to contact me privately.
I have had rising MGUS numbers for 23 years. I am still classified as MGUS.

There are two “schools of thought” these days based on clinical trials. The one school says treat patients early on because they are then progression free, do much better, and overall survival is convincing -
Much better. These trials are out of Dartmouth - Irene Ghobriel.
There are other hematologists who note the high risk MM patients that do just fine under observation and are not exposed to toxic drugs and their side effects; there is also a cohort of patients under observation that do progress. The problem is as I see it, we do not seem to have useful biomarkers that will enable us to know who will progress and who will not. Algorithms do not agree about who is higher risk and who is not.
You need to find a MM subspecialist that can sort your situation out for you - and who falls into which “camp” concerning risk.

Thank you for taking the time to respond to my post. My current Lambda over Kappa is about 13. I have a follow up with my oncologist mid June with another round of bloodwork prior to.
Just want to be proactive and stay ahead of it. Going to be 5 years out from radical prostatectomy surgery in August. Had high grade prostate cancer that was caught very early.....not interested in any last minute surprises!!

Unfortunately, decisions about MM treatment or no treatment/observation is still an art and not a science for many patients. I do not know who is doing research on biomarkers to guide us.

Hi @gstone, welcome. I moved your question to this existing related discussion:

- M-Spike and Lambda light chain increasing while KL ratio decreasing https://connect.mayoclinic.org/discussion/m-spike-and-lambda-light-chain-increasing-while-kl-ratio-decreasing/

I did this so you can click the link to read previous posts and connect with members like @msh466 and @hsminc, who have experience with light chain blood test results.

May I ask what symptoms led to your getting tested?

My L/K is 110 as of this month. However, M-spike varies between .1 and PEP-undetectable (that is, only detectable on SIF), everything else is normal, and I feel fine except for some mild fatigue (at age 73) and work out every day. Treating hem/onc is comfortable with close monitoring (vs treatment).

This is a complex condition, and no one test tells the whole story. The one thing you can't do without is a physician - specifically a hematologist/oncologist - with experience in treating blood cancers.

I have a complicated case with my precancerous SMM. I have IGA lambda with biclonal M spikes. On top of that I have Celiac disease. My IGA level is increased triple of what normal values should be. It is concerning but for now I am stable. Appx 1 year ago I was diagnosed. Quite by accident. Numbness in hands and feet with abnormal EMG. The neurologist ordered tons of blood work. Out comes not MGUS but SMM. One step away from MM. I don’t know if it was fate or luck or both. I have had numbness for years and learned to live with this. Now a new chapter starts. One that is unsettling full of doubt and worry. So it’s always a good thing to get the total picture. Though I now want to bury my head on the sand. Complications do not always mean bad outcomes. Searching for the truth is difficult and you may not like what’s on the other side of the rainbow. But it’s your life. And in the end knowledge is power.