Multiple myeloma is a blood cancer that affects plasma cells. In light chain myeloma, cancerous plasma cells create a specific type of immunoglobulin known as light chains.

Healthy plasma cells create immunoglobulins, or antibodies, that protect you against foreign invaders such as viruses and bacteria. In light chain myeloma, these cells malfunction.

Myelomas are subcategorized depending on the type of immunoglobulins produced by the cancerous plasma cells. Light chain myeloma is the third most common type of myeloma, making up about 15% of cases.

Keep reading to learn about light chains and how light chain multiple myeloma differs from other myelomas.

Plasma cells produce immunoglobulins to fight against foreign invaders. Immunoglobulins are made up of two subunits called light chains and two called heavy chains.

Normal immunoglobulins are classified as polyclonal proteins, whereas cancerous plasma cells produce monoclonal proteins made up of only one light chain and one heavy chain. These abnormal proteins can’t defend your body like normal immunoglobulins can.

Depending on their molecular structure, light chains are classified as kappa or lambda. Heavy chains are classified as G, A, D, E, or M.

Immunoglobin can be divided into 10 types depending on the heavy and light chains they’re made up of:

  • IgG kappa
  • IgG lambda
  • IgA kappa
  • IgA lambda
  • IgD kappa
  • IgD lambda
  • IgE kappa
  • IgE lambda
  • IgM kappa
  • IgM lambda

Multiple myeloma can be classified based on the types of immunoglobulins produced by cancerous plasma cells. The most common type is IgG kappa.

In people with light chain myeloma, cancer cells do not produce entire immunoglobins. They only produce light chain proteins and no heavy chains. Light chain myeloma is also called Bence-Jones myeloma.

What does it mean if your lambda or kappa light chain is high?

Light chain myeloma can be classified as lambda or kappa light chain myeloma, depending on which type the cancerous cells produce. These light chains can build up in the kidneys, nerves, or other organs and cause serious complications.

These two types of proteins have different structures. The genes that code for kappa light chains are found on chromosome 2, while lambda genes are found on chromosome 22.

Research from 2017 suggests that lambda light chain myeloma has a poorer prognosis than kappa light chain myeloma.

Illustration of light chain vs heavy chain myelomaShare on Pinterest
Immunoglobulins are made of glycoproteins composed of two units or chains: a light chain and a heavy chain. Illustration by Sophia Smith

Specific symptoms of multiple myeloma can vary between people. Some people don’t have any symptoms, while others develop serious complications.

The most common symptom associated with multiple myeloma is bone pain, which usually develops in the lower back or ribs.

People with light chain myeloma frequently develop symptoms affecting the kidneys due to the buildup of light chain proteins. A 2018 study found that along with bone pain, kidney failure was the most common symptom at the time of diagnosis. Weakness is also commonly reported.

In the later stages, light chain myeloma can develop into extramedullary disease. This is when cancerous cells form tumors outside of the bone marrow.

People with light chain myeloma often develop medical problems that fall under the acronym CRAB, which stands for:

Light chain myeloma shares a number of general symptoms with other forms of myeloma:

According to the American Cancer Society (ACS), risk factors for multiple myeloma include:

  • increasing age, with most people diagnosed over age 65
  • being male
  • family history, although many people have no affected relatives
  • having obesity or overweight
  • having another plasma cell disease, such as monoclonal gammopathy

ACS also reports that multiple myeloma is twice as common in African Americans as in people who are white.

Exposure to some toxic chemicals such as benzene and Agent Orange has been identified as a myeloma trigger.

Diagnosis of light chain multiple myeloma starts with a general diagnosis of myeloma. Multiple myeloma is often detected with a blood or urine test before symptoms develop.

If your doctor detects signs of myeloma, you’ll need to undergo further tests. Blood and urine tests are used to look for markers of myeloma, such as:

  • elevated M protein
  • abnormal plasma cells
  • signs of kidney disease
  • low blood cell counts
  • high calcium levels

People with light chain myeloma don’t have the same characteristic spike of M protein as many other types of myeloma, which makes the disease more difficult to detect.

A blood or urine test will show increased levels of free light chains and, more importantly, an abnormal ratio of kappa to lambda light chains.

Once myeloma is detected on blood or urine tests, a doctor will order a bone marrow biopsy to look for cancerous plasma cells and confirm the diagnosis of multiple myeloma.

The best treatment for light chain myeloma depends on your symptoms and overall health. Your care team can help you determine the best options for your situation.

Multiple myeloma doesn’t have a cure, but it can often be successfully managed for many years. Types of treatment include:

People with a buildup of light chains in their tissues are often given some combination of the drugs bortezomib, lenalidomide, and dexamethasone. Many other combinations are being considered.

Research has found an overall response rate of more than 95% in people with light chain myeloma treated with bortezomib and dexamethasone compared to only 60% in people treated with non-bortezomib regimens.

According to the ACS, multiple myeloma has a 5-year relative survival rate of 79% when isolated to a solitary mass of cancerous cells. The survival rate drops to 57% if tumors have spread to more than one location.

The outlook for light chain myeloma is not as good as other myelomas, such as IgG or IgA variants.

Light chain myeloma tends to more frequently cause kidney failure, bone disease, and a buildup of light chain cells in organs (light chain amyloidosis) when compared with classic multiple myeloma.

Only about 5–10% of cases progress to light chain amyloidosis, and it can affect any organ except for the brain. The heart and kidneys are most commonly affected.

If more than 2 organs are affected, the estimated survival time of light chain myeloma is 13 months without treatment.

How fast does light chain myeloma progress?

According to research from 2019, people living with monoclonal gammopathy of undetermined significance (MGUS) can progress to multiple myeloma within 5 years. This includes light chain myeloma.

MGUS is a relatively symptomless plasma cell disorder that can become cancerous.

Light chain myeloma is a rare type of blood cancer and a subtype of multiple myeloma. It’s characterized by the presence of light chain immunoglobulins in the blood and urine without a heavy chain component.

The outlook for light chain myeloma tends to be poorer compared with other myelomas. This is because it’s frequently aggressive and often presents with kidney failure.

Take the time to discuss your outlook and treatment options with your doctor and cancer team so that you can create a management plan that works best for your individual needs.