Question: Hello,
I'm being evaluated for multiple myeloma, MGUS, amyloidosis, and other monoclonal protein disorders, following an adult age diagnosis of von Willebrand disease with no known family history nor prior bleeding history. I will attach the lab reports of tests that have been done thus far, but the most important points are as follows:

1) Serum and urine electrophoresis detected no monoclonal proteins.

2) Serum immunofixation detected no monoclonal proteins, but demonstrated slightly elevated IgA and slightly low IgG. Still awaiting urine immunofixation results.

3) Possibly most important, my serum free light chain testing revealed a normal kappa and a decreased lambda, which in turn produced a high kappa/lambda ratio.

4) CBC and metabolic panel normal
(Please see attached lab reports for the actual values and reference ranges)

My question is whether the abnormalities in my IgA, IgG, and light chain results are suggestive of light chain MGUS, light chain myeloma, or amyloidosis? The information online seems to suggest that one of these is inevitable with my altered light chain ratio and that I now need a bone marrow biopsy and a fat pad biopsy, but I spoke with a doctor who said these results were actually NOT consistent with any of these diseases and I'm very confused. Please help me understand what my results are suggesting. Thank you!!

Thank you, I will post the urine immunofixation results as soon as I receive them.

Out of curiosity, if the urine immunofixation results come back negative, what conditions would be suspected on the basis of the existing results?

Thanks very much for the clarification. I will post urine immunofixation as soon as it's in.

Hello again doctor,

My urine immunofixation results are in (see attached report). It states no monoclonality was detected, which is in keeping with my urine electrophoresis, serum electrophoresis, and serum immunofixation.

If you will recall, my abnormalities thus far include mildly low IgG, mildly elevated IgA, and the following free light chain results:

Free Kappa Lt Chains,S 8.77 mg/L 3.30 - 19.40 01
Free Lambda Lt Chains,S 3.80 Low mg/L 5.71 - 26.30 01
Kappa/Lambda Ratio,S 2.31 High 0.26 - 1.65

In our last round of dialogue you had indicated that the urine immunofixation might rule out monoclonal disorders like MGUS, myeloma, amyloidosis, so I'm very glad the urine immunofixation results were negative. Is it still possible, however, that I could have the light chain only version of MGUS, myeloma, or AL amyloidosis?

Thank you so very much for your help. I just want to raise one more question, just to make sure I'm leaving no stone un-turned. I'm VERY happy to hear that my results at this point are not suggestive of MGUS/myeloma/amyloidosis, but the interpretive chart that labcorp provides (see attachment) to accompany the test results suggests that a normal kappa, low lambda, and high k/l ratio equates to a monoclonal gammopathy with bone marrow suppression. I just want to verify that your opinion that I do not have a monoclonal disorder remains unchanged, despite what this chart says. Please know that I'm not second guessing you at all, as you have the clinical experience and I'm just a lay person, but when I saw this chart I was under the impression that my free light chain results were practically diagnostic of a monoclonal gammopathy of some kind. If you could please confirm that your opinion remains unchanged I'll get on with my life. Otherwise I'll continue aggressively pursuing a diagnosis. Thank you so much for your help!!! Oh, and by the way, my CBC is completely normal, which I assume would be unusual if I had bone marrow suppression, right?