What to think when only free light chain ratio is abnormally high?

@georgiagurl all of these tests combined with the bone marrow biopsy should give you more answers. My husband has light chain myeloma, and his SPEP would no longer accurately monitor his myeloma. His numbers were quite high of lambda light chains, which caused a kidney injury. The bone marrow biopsy gave the doctors the answers they needed to treat him and his kidneys are recovering.
Unfortunately they probably won’t be able to answer your question before that biopsy. When is that scheduled? Will you come back after and let me know what they find?

I am waiting for hospital to call (hopefully tomorrow) to up the biopsy appt. I will let you know.

A small amount of a kappa-type monoclonal protein was also found, but it's too little to measure precisely.
Your test results show a high level of kappa free light chains in your blood, with a very high free light chain ratio of 101.55 (normal is around 0.26 to 1.65). This means there's a much larger amount of kappa chains compared to lambda chains, which is not typical.
The kappa light chain level itself is also elevated at 89.36 mg/L (normal is about 3.3 to 19.4 mg/L). These findings suggest that a group of identical plasma cells (a "clone") is making too many kappa light chains, which may be a sign of a condition like MGUS, multiple myeloma, or another plasma cell disorder.
While this doesn’t confirm cancer, it is an abnormal result that needs further evaluation by a specialist.
Next step: CBC, calcium, creatinine (to assess anemia, kidney function, etc.)

@swalex : All of those tests you list were normal.

georgiagurl's presentation is actually quite similar to mine. M-spike .1 to undetectable on SPEP (but always present on SIF). BJ protein in urine. Kidney function normal, PET negative for lesions, cardiac MRI negative for amyloid. But light chains off the charts (ratio 150:1 L:K, free L 1400). Just had my third BMB last month - 5-7% plasma cell, same as other two. My hem/onc fully expected the last two BMBs to show >10% (diagnostic threshold for MM) - he even hand-wrote for me the DVRd first-line regimen, expecting to begin treatment. So I'm still teetering on the treat / no-treat edge It's a complex disease.

And, as they say, diseases don't read medical texts.

@wesleym
You’re so right. It’s important that we don’t draw too much comparison between our various lab results and procedural outcomes. There are so many variables that it’s impossible to tell with any certainty what your lab results mean in relationship to mine. I think you summed it up nicely.

@wesleym It is very interesting that you had similar test results to mine! I love your last statement that "diseases don't read medical texts." My BMB is on this upcoming Tuesday so more to follow.

@georgiagurl The BMB results mean a lot. Good luck.

You mention seeing a hematologist - if the physician you are seeing is not a hematologist/oncologist with considerable experience treating monoclonal gammopathies, you should find one. A general-practice hematologist may see only a handful of MG patients in a given year.

By the way, as you may well know, a BMB need not be traumatic. As I wrote above, I (age 74) have had three in the last 18 months. All were performed in hem/onc's office, only with local anesthetic (i.e., no sedation), and none were a big deal. Vibration, pressure, minimal pain. Just don't think about what they're doing.

@wesleym My BMB will be under sedation as I have read too many non-sedation online horror stories to do it otherwise. Luckily, my hematologist’s office specializes in cancer treatment. My internal medicine doctor recommended her because she is very thorough.

@swalex I just got my latest light chains blood results (slightly higher than April test) w kappa 26.3 mg/L and lambda 11 w ratio 2.39 w normal range .26-1.65 w my IgM 4,655 and normal range 20-172 mg/dl which seems ridiculously highly inaccurate. How could ur #s be that high? Im requesting another test from diff provider like Quest