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

@barbarian1 “requesting another test from diff provider like Quest” is a good idea.
Ask your doctor if it could also be a sign of kidney disease, chronic inflammation, or an immune system disorder, as this may require additional blood tests.

I didn't rec reply re lq 2nd test elsewhere so it's prob not ok

@swalex I will. Ty

@georgiagurl how are you doing, I was thinking about you today. I was wondering, have you had your BMB yet?

@auntieoakley Thank you for asking, that is very kind. I had the BMB on this past Friday and so I now await the results of the testing. The BMB was under sedation and I am so glad for that. But, I have to say, it really did hurt to walk the rest of that day (although I did mostly rest that day). The next day it was not so bad to walk and a couple Tylenol helped greatly. Of course, the waiting time for the results is nerve-wracking but can't do anything about that. I will update once I receive. Thank you again for inquiring.

I received some of my test results and they indicate 8%-10% plasma cells in bone marrow so the pathologist said I likely have smoldering myeloma. As noted above, I do have a very high kappa/lambda ratio of 101.55. I am now waiting for the FISH results to determine the risk level. I am now also scheduled for a PET scan to determine if there are any lesions. I initially went to the hemotologist solely to determine if I had Factor V (increased likelihood of getting blood clots) and now I may have smoldering myeloma? Geez. What a ride.

Goodness, still waiting for Fish Test results after 3 weeks of waiting. The hematologist’s nurse practitioner called to explain that doctor wants to me to begin treatment for MM regardless of not having fish results; Nurse said doctor’s decision is based on free light chain ratio of 101 and kappa level of 89. Pet scan is normal but igm is below normal at 18; iga is low normal at 76 as is igg at 660. Plasma cells at 8-10%. I still haven’t met the doctor because nurse practitioner has been handling everything. I am not sure if treatment is necessary at this point. But shouldn’t doctor have called me to set up an appointment to discuss all this?

@georgiagurl I would definitely want an appointment before starting treatment, and it seems a little strange that your doctor didn't. There are important issues to discuss - including, of course, starting treatment itself. As we noted above, your presentation is similar to mine, although 8-10% (vs 5-7%) plasma per BMB.

I know you're satisfied with your hematologist who specializes in cancer, but there is still something to be said for a dual-certified hematologist/oncologist with considerable experience in treating monoclonal gammopathies. This is complex stuff.

@wesleym Thank you for your comments. I am trying to arrange for a second opinion at the University of Michigan's Rogel Cancer Center. They have a specific Myeloma Center there. How soon did you begin to treat? Did it take you forever to get your FISH test results? I am now going on week 4 without the results.

The FISH results (GenPath) took eight days from the BMB.

I still am not in treatment, due to the BMB results (I've had three, most recently about 2 months ago). Given my LC and 24-hr urine results, the hem/onc has fully expected all of the BMBs to show >10% plasma involvement, and none has. In addition, I have none of the CRAB criteria, and feel well for my age (74); only symptom is mild fatigue, and I'm (obviously) not as young as I used to be. I work out every day, riding my bike 20 miles.

So I'm teetering on the treat / no treat edge.