FRUSTRATED ABOUT LIGHT CHAINS

I just find it so hard to get good information about MGUS. When I was first diagnosed with MGUS my light chain ratio was normal.  This made me happy as it seemed to place me in a low risk category. In fact, at that time..., almost everything was good. Everything was normal but for the M-spike. Which actually went down at the first subsequent blood test.  From .5 to .3. 

But then, only 4 months after that test. 

- my M-spike went up (though just back to where it was when I got diagnosed).

- my IGM immunoglobulin went up... normal but still at the top of the range.

- my light free chain ratio went up to abnormal. From 1.5 to 1.9. (end of normal is 1.65).

This really upset me. I now have moved into a much more risk prone situation. I have both IGM (more risk for progression) and abnormal light free chains. All of this happening just one year after I was diagnosed. To me suggesting I have an aggressive problem. But my doctors seem completely unconcerned. 

What I have managed to learn. 

The ratio itself isn't that bad. Ultimately a lot of people with an abnormal ratio have a much grater ratio than I have. Some people have 17 to 20 or greater and are still MGUS. In fact, typically they won't treat you until you reach 100.  If you calculate the increase in light chains that I had in about 1 year you will see that it is about....25%. 

Light chains themselves are sort of a waste product of the immunoglobulins.  So the over producing clonal cell secretes (in my case) IGM immunoglobulins. And if you are having an excess of clonal cells and IGM immunoglobulins then you are necessarily likely to have an increase in the light chains (in my case likely Kappa) since I am IGM kappa - throwing your ratio off. 

In addition, the light chains in your blood are a function of the kidney. Your kidneys clear the light chains.  So the only thing that my specialist at Dana Farber told me to do was to drink water. Now I think very much the case could have been that drinking water helps clear the light chains and keep kidney's functioning well.  So does your hydration status play a role in your result?  I think so. From Wikipedia in normal individuals, free light chains are rapidly cleared from the blood and catabolised by the kidneys. Monomeric free light chains (kappa) are cleared in 2–4 hours, and dimeric (lambda) light chains in 3–6 hours. Removal may be prolonged to 2–3 days in people with complete renal failure. So can your hydration and also your status make a slight change? Possibly.  In my case I was not expecting at all to get my blood tests for this so I have no idea if I was dehydrated etc. 

So it seems clear that light chains, antibodies and the M spike are all closely related. With the M spike being one of the last things to move.