Myeloma remission may bring changes in light chain values, but how often do these occur? Dr. Sikander Ailawadhi from the Mayo Clinic explains factors that can impact light chain values, light chain trends he watches for, and frequency of checking light chain values.
So another patient asking, I was told I’m in remission, but my light chain numbers are going up and the lambda is low. Are small fluctuations common?
Dr. Sikander Ailawadhi:
Very good question. And very important to keep in mind, yes, small fluctuations in light chains can happen as the patient mentioned, they said their light chains are going up, but lambda is low, so I’m assuming they’re talking about their kappa light chains higher and the lambda low. For light chains, the most important thing is that we don’t want just an individual isolated value, we want to see a trend if there is an upward trend in one of the values, the abnormal light chain, that is certainly a concern if the involved or the higher light chain is stable.
But the uninvolved or the lower light chain continues to go down. Well, that is still of concern, but may not mean that the disease is coming back, it may mean that the immune system is getting affected a little. All said and done, light chains are very volatile, they are very…they can fluctuate, they can get affected by our kidney function, they can get affected by our hydration status.
So if there is a concern with light chains, they should be re-checked and there is a persistent movement of the light chains in a certain direction, but that is an important time to figure out, is the disease coming back or is that another reason that the light chains are changing…
Okay, how often do you check those labs in your patients, their light chain?
Dr. Sikander Ailawadhi:
For somebody who’s on active treatment, we check the light chains, we do the whole panel of myeloma lab reassessment with electrophoresis, immunoglobulins, light chains, we do that on a monthly basis for somebody who’s on active treatment, that they are…some patients who are on maintenance and who are doing perfectly fine, and they typically come every three months to clinic visits on maintenance over there, although I prefer to check them every month, but I certainly know logistic challenges and frequency, so sometimes in selected cases, we’ll check it every three months, but in a patient who has been diagnosed with myeloma on treatment or has been on treatment before, personally, I don’t go beyond three months in any case.