Multiple Myeloma an incurable disease, but I have spent the last 25 years in remission using a blend of conventional oncology and evidence-based nutrition, supplementation, and lifestyle therapies from peer-reviewed studies that your oncologist probably hasn't told you about.
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If your free light chains (FLC) are slightly out of range, have you come out of remission? If you are experiencing no symptoms and all other diagnostic markers are within the normal range then what do you do? More importantly, when does a multiple myeloma (MM) patient decide he or she has relapsed and should undergo more toxicity?
The second study linked and excerpted below raises the issue of MM patients who may be in remission yet have one or more free light chain markers out of the normal range. As a MM survivor who is often out of normal ranges on tests large and small, I think it is normal to be out of the normal range sometimes. I think MMers should try to balance the damage caused by their MM with the damage caused by the toxicity of therapy.
Please watch the video below to learn more about the evidence-based, integrative therapies to combat treatment side effects and enhance your chemotherapy.
To put it another way, in or out of remission is a judgement call. This is why the judgement of more experienced myeloma specialists is, on average, more accurate than oncologists who do not specialize in MM. Further, diagnostic testing is helpful in managing myeloma. But as anyone who suffers from scanxiety knows, patients and survivors can become too focused on testing specifics and not see the big picture.
Are you a MM survivor who has had a serum free light chain assay with one or more values out of the normal range yet was still in remission? Have you ever had your oncologist tell you were still in remission even though one of your sFLC values was out of the normal range?
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“Immunoglobulins are made by white blood cells called plasma cells to help protect you against infection and illness. Plasma, or myeloma, cells are found in your bone marrow. Light chains, also called Bence Jones proteins, make up part of the structure of immunoglobulins. Immunoglobulins are also made up of heavy chains.
The light chains attach themselves to the heavy chains and are then called bound light chains. When you have more light chains than heavy chains, those extra light chains are called “free” because they don’t bind to the heavy chains. Instead, they are released in the blood. The more free light chains in your blood, the more plasma cells you have, which may mean there is a problem with the plasma cells.
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…
Test results may vary depending on your age, gender, health history, the method used for the test, and other things. Your test results may not mean you have a problem. Ask your healthcare provider what your test results mean for you.
Results are given in milligrams per liter (mg/L). 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 light chains are:
3.3 to 19.4 mg/L kappa free light chains
5.71 to 26.3 mg/L lambda free light chains
0.26 to 1.65 ratio of kappa/lambda
“Response to treatment in patients with a plasma cell disorder is typically measured by evaluating the bone marrow and myeloma markers, including monoclonal protein spike and immunofixation (IFE) in blood and urine, and serum free light chains (sFLCs).
Stringent complete response criteria for Multiple Myeloma (MM) patients require a normal Free Light Chain ratio and absence of clonal cells in bone marrow by immunohistochemistry or immunofluorescence. We performed a retrospective chart review to further evaluate these criteria. A total of 142 patient charts were analysed. Of these, 17 patients were found to have an abnormal serum Free Light Chain ratio, but no other evidence of disease, including normal flow cytometry and normal fluorescence in situ hybridization (FISH) analysis on highly selected plasma cells.
In all patients, the abnormal sFLC ratio was caused by abnormalities in the serum kappa light chains. These results suggest that current definitions may need to be revised to take aberrancies related to abnormal immune recovery into account.”