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High FLC Ratio, No M-spike, No Crab- MGUS? Risk of MM?

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treatment of MGUS/SMM patients with curcumin resulted in an improvement in markers of disease progression (i.e., free light-chain ratio (rFLC), paraprotein levels, percentage plasma cells) in some patients [8]. 

Hi David- Following a routine blood test it appears I have a really abnormal light chain ratio just over 100. I have no m-spike no other CRAB criteria. 

It has been about a year now and I still feel absolutely fine. My light chain ratio was monitored over a few months and it remained stable. 
 I have been on:
  • curcumin
  • resveratrol
  • quercetin and
  • black seed oil
  • plus other supplements for over a year now and I feel amazing.

Could I normalize my light chain ratio with evidence based natural therapies?? Alan

Hi Alan- 
Several things to consider. 
First and foremost, while you have pre-MM or monoclonal gammopathy of undetermined significance  (MGUS), from your description, you have the lowest level of pre-MM I have ever seen. I work with lots of MGUS patients who have pre-MM but they have a small m-spike, say under 1.0. You have NO m-spike/monoclonal protein.
I mention this because you can live a perfectly normal life as you are. You know this because you feel fine.
To answer your question, “Could I normalize my light chain ratio with evidence based natural therapies??” The research is limited but according to the third study linked below, curcumin can reduce FLC your ratio.
I think the more important question for you to consider is outlined in the second study linked below. Does your increased FLC ratio increase your risk of a MM diagnosis above what is considered to be the “normal” risk of MM? 
If I read the study properly, you must have 2 or 3 of the increased risk factors in order to have an above average risk of MM (the average increased risk of MM for MGUS patients is 1% yearly). 
Do you know what type of MM you have? IgG? IgA? IgM? If you have IgG MM then you have only one increased risk factor (high FLC ratio) and therefore, according to the study, your annual risk of MM is the average of 1% annually. 
Most importantly, supplementing with curcumin, etc. decreases your risk of a MM diagnosis overall. My point then, is that you appear to be doing all you can to reduce your risk of MM. 
Let me know if you have any questions. 
David Emerson
MM Survivor
MM Cancer Coach
Director PeopleBeatingCancer

Recommended Reading:

How Serious Is Monoclonal Gammopathy of Undetermined Significance ?

“…monoclonal gammopathy of undetermined significance, is a condition that causes the body to create an abnormal protein. This protein is called monoclonal protein, or M protein. It’s made by white blood cells called plasma cells in the body’s bone marrow.

Usually, MGUS isn’t a cause for concern and has no adverse health effects. However, people with MGUS have a slightly increased risk of developing blood and bone marrow diseases. These include serious blood cancers, such as multiple myeloma or lymphoma

MGUS usually doesn’t lead to any symptoms of illness. Many doctors find M protein in the blood of people with MGUS while testing for other conditions. Some people may have symptoms such as a rash, numbness, or tingling in the body.

The presence of M proteins in the urine or blood is one sign of MGUS. Other proteins are also elevated in the blood when a person has MGUS. These could be signs of other health conditions, such as dehydration and hepatitis.

To rule out other conditions or to see if MGUS is causing your health problems, a doctor may run other tests…

How does Monoclonal gammopathy progress over time?

Many people with MGUS never end up having health issues related to this condition.

However, according to the Mayo Clinic, about 1 percent of people with MGUS develop a more serious health condition every year. The type of conditions that can develop depend on which type of MGUS you have.

There are three types of MGUS, each associated with an elevated risk of certain health conditions. These include:

  • Non-IgM MGUS (includes IgG, IgA or IgD MGUS). This affects the highest number of people with MGUS. There’s an increased chance that non-IgM MGUS will develop into multiple myeloma. In some people, non-IgM MGUS may lead to other serious disorders, such as immunoglobulin light chain (AL) amyloidosis or light chain deposition disease.
  • IgM MGUS. This affects about 15 percent of those with MGUS. This type of MGUS carries a risk of a rare cancer called Waldenstrom macroglobulinemia, as well as lymphoma, AL amyloidosis, and multiple myeloma.
  • Light chain MGUS (LC-MGUS). This has only been classified recently. It causes M proteins to be detected in the urine, and it can lead to light chain multiple myeloma, AL amyloidosis, or light chain deposition disease.

The diseases triggered by MGUS may cause bone fractures, blood clots, and kidney problems over time. These complications can make managing the condition and treating any associated diseases more challenging…”

Serum free light chain ratio is an independent risk factor for progression in monoclonal gammopathy of undetermined significance

“An abnormal FLC ratio (kappa-lambda ratio < 0.26 or > 1.65) was detected in 379 (33%) patients. The risk of progression in patients with an abnormal FLC ratio was significantly higher compared with patients with a normal ratio (hazard ratio, 3.5; 95% confidence interval [CI], 2.3-5.5; P < .001) and was independent of the size and type of the serum monoclonal (M) protein.
Patients with an abnormal serum FLC ratio,
  • non–immunoglobulin G (non-IgG) MGUS,
  • and a high serum M protein level (≥ 15 g/L)
had a risk of progression at 20 years of 58% (high-risk MGUS) versus 37% with any 2 of these risk factors (high-intermediate risk), 21% with one risk factor (low-intermediate risk), and 5% when none of the risk factors were present (low risk)…

Risk stratification model for Monoclonal gammopathy…

The FLC ratio added additional prognostic value to all 3 subgroups of MGUS stratified by the 2 known prognostic factors, the size and type of M protein (Table 4). We constructed a model for predicting the risk of progression of MGUS based on the size of the serum M protein, the type of immunoglobulin, and the presence of an abnormal FLC ratio (< 0.26 or > 1.65). The use of these 3 risk factors identified 4 cohorts of patients with MGUS with significantly different rates of progression (Table 4Figure 3). In fact, when competing causes of death are taken into account, the true lifetime risk of progression decreases to 2% for patients in the low-risk group…
The presence of an abnormal FLC ratio is a clinically and statistically significant predictor of progression in MGUS. We identify a low-risk subset of patients with MGUS with a remarkably small lifetime risk of progression in whom less frequent follow-up can be justified. Since this subset accounts for almost 40% of all patients, this is a finding of significant importance for the management of MGUS.

Long-term follow-up of curcumin treated MGUS/SMM patients – an updated single centre experience

Based on its antimyeloma cell activity, we have performed a number of studies with curcumin in MGUS/SMM patients, including a randomised, double-blind placebo- controlled cross-over study, published in the American Journal of Hematology [7] where we showed that treatment of MGUS/SMM patients with curcumin resulted in an improvement in markers of disease progression (i.e., free light-chain ratio (rFLC), paraprotein levels, percentage plasma cells) in some patients [8]. 
A number of patients who participated in our studies and who showed a benefit, have continued to take curcumin over a number of years, of their own volition, even though the studies in which they were participating are complete…”

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