Specimen Minimum Volume 0. Test Classification This test has been cleared or approved by the U. Believer that patients can help accelerate a cure by weighing in and participating in clinical trials. Carol - My husband was just told yesterday that he needed to see a hematologist. His Kappa Light Chain, free serum level is high. His Lambda level is within normal range. Your article has helped me to understand what this means. I guess we are going on a journey and I pray he will come out on the other side.
Learn more about laboratory tests, references ranges, and understanding results. A free light chains test is often ordered with other tests, including an immunofixation blood test , to help confirm or rule out a diagnosis.
The medical information provided is for informational purposes only, and is not to be used as a substitute for professional medical advice, diagnosis or treatment. Please contact your health care provider with questions you may have regarding medical conditions or the interpretation of test results. Free Light Chains. What is a free light chains test? What is it used for? Most people have a type of myeloma that causes the abnormal plasma cells to produce abnormal proteins.
These proteins are called immunoglobulin also called abnormal protein, paraprotein, monoclonal protein or monoclonal spike. As well as the whole immunoglobulin, often a small part called the free light chain called Bence Jones protein in urine is made in big amounts by the plasma cells.
Each immunoglobulin is made up of 2 long protein chains called heavy chains and 2 shorter protein chains called light chains. Immunoglobulins can be classified into one of 5 types depending on their heavy chains.
Your type of myeloma is named after the abnormal immunoglobulin it is making. Only one type of immunoglobulin Ig is overproduced when you have myeloma. This test is used to help diagnose a type of cancer called multiple myeloma. It may also be used to diagnose other conditions affecting the cells in your bone marrow.
These include a usually benign condition called monoclonal gammopathy of undetermined significance, or MGUS, and a serious disease called amyloidosis. You may need this test if your healthcare provider suspects a problem with your plasma cells or multiple myeloma.
You may not have signs and symptoms, but if you do, they may include:. Serum free light chain SFLC testing is ordered to help detect, diagnose, and monitor plasma cell disorders dyscrasias , including multiple myeloma , primary amyloidosis, and related diseases or to monitor the effectiveness of treatment.
Light chains are proteins produced by plasma cells. Within a plasma cell, two light chains and two heavy chains combine to form an immunoglobulin. With a group of conditions called plasma cell disorders or monoclonal gammopathies, a plasma cell becomes neoplastic, dividing more than it should, and produces large amounts of an abnormal monoclonal immunoglobulin M-protein.
This protein may be an intact immunoglobulin or only one of its components — a kappa or lambda light chain, or rarely, a heavy chain. Blood tests may also be ordered to measure levels of intact immunoglobulins e. Serum free light chain testing provides complementary information. It can detect the excessive free light chains that may be produced by neoplastic plasma cells and changes in the ratio of kappa and lambda production, which indicate an excess of these clonal plasma cells.
If the protein electrophoresis test is abnormal, then an immunofixation electrophoresis test is performed to determine which immunoglobulin is present in excess. If a plasma cell disorder is detected, then the free light chain test may be ordered periodically to monitor the condition or to evaluate the effectiveness of treatment. This test is particularly useful for diagnosing and monitoring select patients who have a less common oligosecretory myeloma, non-secretory myeloma, or light chain-only multiple myeloma.
These signs and symptoms will vary from person to person and tend to worsen over time. They involve various parts of the body and may include:. A healthcare practitioner may also order this test when someone has signs and symptoms associated with primary amyloidosis. Amyloidosis develops when abnormal proteins build up in organs or tissue, particularly the heart, liver, kidneys, spleen, gastrointestinal tract, and nervous system. In primary amyloidosis, the proteins are free light chains.
Various other clinical presentations can provide diagnostic clues that a plasma cell disorder may be present. Depending on the plasma cell disorder and which organs are affected, the person may have a variety of symptoms, such as:. When a plasma cell disorder is diagnosed, the test may be ordered periodically to monitor the condition and to evaluate the effectiveness of treatment.
This test must be interpreted in conjunction with other laboratory and clinical findings. A slightly abnormal result does not prove that someone has a plasma cell disorder. Conversely, someone may have a plasma cell disorder despite a normal result from this test. If a person has a plasma cell disorder, the result of this test won't indicate what specific plasma cell disorder is present.
Results of a serum free light chain test will often be evaluated in conjunction with the results of a protein electrophoresis test. However, a biopsy of affected tissue establishes the diagnosis. Monoclonal gammopathy of undetermined significance MGUS is the most common plasma cell disorder and it usually does not cause symptoms. The hazard ratio for the risk of progression in these 2 groups was 1. The effect of an abnormal FLC ratio on risk of progression was independent of the size of the M protein, as illustrated in Figure 2B , which has been adjusted for the size of the serum M protein.
After adjusting for the size and type of the serum M protein on multivariate analysis, the hazard ratio for progression associated with an abnormal FLC ratio was only slightly reduced hazard ratio, 2. In this multivariate model the hazard ratio for the size of the serum M protein was 2.
Multivariate analysis of prognostic factors for progression of monoclonal gammopathy of undetermined significance. The use of these 3 risk factors identified 4 cohorts of patients with MGUS with significantly different rates of progression Table 4 ; Figure 3.
Risk of progression of MGUS to myeloma or related disorder using a risk-stratification model that incorporates the FLC ratio and the size and type of the serum monoclonal protein. Risk-stratification models to predict progression of monoclonal gammopathy of undetermined significance to myeloma or related disorders. Moreover, there is no decline in the risk of progression over time, 5 , 6 necessitating lifelong follow-up, usually performed by primary-care providers.
Patients are referred to hematologists typically in the face of a rising M protein on follow-up, or when other symptoms and signs suggestive of myeloma or related malignancy develop.
Given the uncertainty that follows the diagnosis of MGUS and the need for long-term follow-up, clinical management would be greatly enhanced by identification of factors that more accurately predict progression or stability.
We recently conducted a small case-control study to determine if the presence of an abnormal FLC ratio was associated with progression of MGUS. The presence of an abnormal FLC ratio was associated with a 2. Given the significant clinical implications of this finding, the present study was undertaken with the goal of validating and confirming these findings in a large, well-established population-based cohort of patients with MGUS in whom long-term follow-up was available.
The results of this study confirm our hypothesis that an abnormal FLC ratio is an important risk factor for progression and is independent of the size and type of the serum M protein, 2 known prognostic factors. We also show that the size and type of the M protein and the serum FLC ratio can be combined to yield a powerful risk-stratification model for the progression of MGUS.
Clearly, this group of patients can be reassured to a great extent. In fact, the serum M protein levels may need to be rechecked in this group only if symptoms of myeloma or related disorder become apparent. On the other hand, the smaller group of high-risk patients needs to be monitored more closely before pathologic fractures, hypercalcemia, renal failure, paraplegia from extramedullary plasmacytoma, primary amyloidosis, overwhelming infection, or other serious complications develop.
Another goal of the study was to identify patients in whom prophylactic interventions can be justified. Low-risk patients should clearly be excluded from preventive strategies and trials that typically carry adverse effects and cost. Clearly, additional risk factors are needed, and we are currently exploring factors such as bone marrow microvessel density, marrow angiogenic potential, and presence of circulating plasma cells in predicting progression of MGUS.
The high-risk patients with MGUS identified in this study will serve as the base from which additional risk factors can identify a suitable cohort for chemoprevention trials. Recent studies show that loss of heavy chain expression in myeloma is related to cytogenetic events in the heavy chain locus on chromosome 14 14qMultiple myeloma is a blood cancer of white blood cells called plasma cells. Plasma cells come litht the bone marrow and they produce antibodies also called immunoglobulins that fight wide variety of infections. In myeloma, one of these antibodies grows out lighf control kappx the bone marrow, crowding out the other antibodies. This is called a monoclonal protein also cyains M-protein kappa and lambda free light chains M-spike. Antibodies are made kappa and lambda free light chains of two parts: heavy chains and light chains. When myeloma progresses, the myeloma cells start to produce more light chains than heavy chains. This can be measured by the Free Light Chain Assay test on a blood kappa and lambda free light chains. In general, the higher the free light chains, the more aggressive the disease is. Therefore, the serum free light chain test is a better kappa and lambda free light chains of outcome than the amount of M-protein in the blood. There are kappa and lambda free light chains types of light chains: kappa and lambda. If a patient has kappa myeloma, their doctor will watch for a rise in the kappa numbers. Likewise, if a patient has lambda myeloma, the lambda number will be watched. Christina Gasparetto of Duke University. There are instances where patients can lose the heavy chain and have "light chain only" myeloma. There are kappa and lambda free light chains instances where patients no longer produce light chains in the blood and their disease must then be monitored through a bone marrow biopsy. Generally, myeloma specialists do not treat patients differently based on their heavy or light chain myeloma type. Stream great british bake off online free is research showing that lambda myeloma may be higher risk than kappa myeloma. The serum free light chain test can be used to determine light chain levels of disease, so patients will want to track their light chain numbers. Additional genetic testing of a patient's myeloma cells can be done to determine risk based on common genetic myeloma features. Living with abnormal free light chain ratios. Types of kappa and lambda free light chains myeloma. Detecting kappa and lambda free light chains relapse early with a new Hevylite test. My lab results include kappa and lambda light chain ratios. Jennifer Ahlstrom - Jenny A - Myeloma survivor, patient advocate, wife, mom of 6. Believer that patients can help accelerate a cure by weighing in and participating in clinical trials. The test measures the levels of specific types of free light chains, known as kappa and lambda, and also the ratio between the two. Normal test results for free. Serum free light chains (SFLC, kappa and lambda) are proteins produce by immune cells that are not part of whole (intact) antibodies. Lab tests. There are 2 types of light chains - called kappa and lambda. A blood test called a serum free light chain test can pick up small increases in the amount of free. Therefore, the serum free light chain test is a better predictor of outcome than the amount of M-protein in the blood. What are light chains? There. Kappa free light chain. mg/dL. Lambda free light chain. mg/dL. Kappa/lambda free light chain ratio. HOUR URINE ANALYSIS4. We hypothesized that the presence of monoclonal free kappa or lambda immunoglobulin light chains in monoclonal gammopathy of undetermined significance. A sensitive nephelometric assay specific for kappa free light chain (FLC) and lambda free light chain (FLC) that doesn't recognize light chains bound to Ig heavy. Serum free light chain (FLC) assay is a new test to detect abnormal ratios of free light chains in the serum. The test is reported as a ratio that can be used to support. There Are Two Types Of Light Chains. Kappa And Lambda. – Kappa And Lambda. Kappa Free. Light Chains. Lambda Free. Light Chains. Light Chains. Maurer , 2 James R. Under normal circumstances, concentrations of both kappa and lambda light chains are very low in the bloodstream. Rajkumar SV, et al. Updated August. Read our FAQs — for answers to the most frequently asked questions about amyloidosis. FLCs are observed in urine too but filtration and reabsorption of low molecular proteins in the kidney strongly affects the FLC concentration so that urinary FLC level is low in healthy individuals. In primary amyloidosis, the proteins are free light chains. These include multiple myeloma , a cancer of plasma cells, and amyloidosis , a condition that causes a dangerous buildup of proteins in different organs and tissues. The introduction of this test about 15 years ago was a landmark advance in the management of patients with AL amyloidosis. Since we now know the normal levels of these light chains, your doctor can monitor any changes in the levels during your treatment. A particular plasma cell will produce only one type of immunoglobulin. In serum, FLC kappa exists predominantly as a monomer with a molecular weight of It is useful both in diagnosis and in monitoring treatment response, because FLC concentration is a sensitive measure of treatment effects on abnormal plasma cells. When a plasma cell disorder is diagnosed, the test may be ordered periodically to monitor the condition and to evaluate the effectiveness of treatment. This usually takes less than five minutes.