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MGUS (IGA) with low IgM, high KAPPA/LAMBDA CHAIN.

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I have recently been diagnosed with MGUS (IgA). I have 2 M-spikes both are IgA kappa light chain type. My IgM is low but my doctor isn't concerned about that. I'm curious if I should be concerned that my kappa/lambda light chain ratio is high. To a layman it looks really high since the labs upper range is only 1.65 and mine is greater than 88.20, however, my doctor isn't concerned. Does this put me in a high risk for progression category? My doctor also said I do have proteins in my urine which does put me at a slightly high risk.

I think they only test I have not had done is the BMB, all others are good and even though my blood work does show highs and lows again, my doctor isn't concerned.

I would like an 2nd opinion that this is in fact MGUS only and that nothing has been overlooked or this is MGUS but because of A B or C this has a higher chance of progressing.

My aunt has MM so I want to stay ahead of this and catch this as early as possible.

Thank you.

Category: Hematologist

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Category: Hematologist
 19 Doctors Online

Hello,
Thank you for your query at DoctorSpring.com
Monoclonal gammopathy of unknown significance (MGUS) is an asymptomatic plasma cell disorder, with a propensity to progress to symptomatic MM after 15 to 20 years. In recent years old patientthere have been improvements in risk stratification models (involving molecular markers), which have led to better understanding of the biology and probability of progression of MGUS.

MGUS prognosis

Risk stratification of monoclonal gammopathy of uncertain significance

1. Assess patient for each of three risk factors
  • Abnormal serum free light chain ratio (SFLC)
  • Serum M protein = 15 g/L
  • M protein not of IgG subtype
2. Sum the number of risk factors to determine risk category and prognosis
Number of factors Risk cate­gory 20 year pro­gression risk (%) 20 year pro­gression risk ac­counti­ng for death as com­peting factor (%)
0 Low 5 2
1 Low-inter­mediate 21 10
2 High-inter­mediate 37 18
3 High 58

This prognostic system for monoclonal gammopathy of uncertain significance (MGUS) was developed following a retrospective analysis of serum free light chain (SFLC) ratio of 1148 patients presenting between 1960 and 1994.1 Each of the three risk factors studied (abnormal SFLC, serum M protein (paraprotein) = 15 g/L, non-IgG paraprotein subtype) carried a hazard ratio of ~2.5 for progression.


Dr. Prasad Eswaran
Category: Hematologist
Experience: 
Doctorate in Medicine (Fellowship in Oncology), DM,  Madras Medical College & Govt. General Hospital, Chennai, India.

Doctor of Medicine (Residency in Radiation Oncology) , MD, Christian Medical College, Vellore, Tamilnadu, India, 2004-06.

Diploma in Medical Radiology & Therapy (Residency in Radiation Oncology), D.M.R.T, Madras Medical College & Govt. General Hospital, Chennai, India, 2004-06.

Bachelor of Medicine & Bachelor of Surgery - M.B.B.S, Govt. Stanley Medical College & Hospital, Chennai, India, 1998-2004.
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