light chains are reported there's three lines of how we report the light chains we report the Kappa the lambda and the ratio okay when a person has smile on my to look at their myeloma cells they have to decide one way or another it's like male/female so the plasma cells are gonna be Kappa or lambda and that's what they're gonna be for the rest of the life of that myeloma cell that never changes now what what we do is when we order the free light chain to determine which one is the abnormal we look at the ratio between one or the other so I use this now imagine you look out at the patty of a school and you see you know boys and girls and they seem to be about equal in number it looks like a normal school patty but if you look at that school patio and you see that in fact there's nine boys for every girl really a little bit atypical for that school but it turns out that of those nine boys any of them are the same they're just copies they're twins they're clones that's how we interpret the light chain ratio so there's an excessive amount of one and then subsequently we know it comes because there is this clone or this population 11 normal cells in the bone marrow and that's what we measure by the ratio now the ratio is just a simple computation of dividing the kappa value by the lambda well the ratio is important at the beginning because it allows you to understand which one is abnormal so if you have a very high ratio for instance Kappa lambda you would know it's a Kappa where we have an abnormally low ratio then you would know is the lambda vice-versa because it deviates from that normal distribution that you would have number one the second one the ratio is important in patients who perhaps for other reasons say for diabetes don't have very good function of their kidneys the cap on lambda would go up but they both go up together in about the same proportions it's like a bigger number of kids in the same patio so now you have an increase in Kappa so you could have a Kappa of 10 and a lambda of 10 but the ratio is normal and if I was to look carefully at the labs I may see that the kidney function the creatinine is elevated to point five so we see those abnormalities with with with the Rena of our mouth East and that's how we keep keep that in mind now here's one of the best pieces of advice for patients once you know if your cap are your lambda unless the kidney function changes or unless you're in a very detailed discussion with your doctor at very low levels ignore the ratio there's nothing that causes more stress than the ratio the ratios for the most part useless once you start going through treatment because at that point you don't care about the race you care more about the Kappa so if you're Kappa you should care about Kappa or lambda if you're lambda and and remember that the race you can change dramatically when the light chain that has nothing to do with your myeloma changes and I've seen this in patients where you may have for instance again a myeloma patient with Kappa have the lam that go down and the ratio goes up both of them are normal and we get a phone call what's happening my ratio is abnormal as long as your Kappa stays in normal there's no worry with that so a little bit of a unusual piece of advice to patients but once you know which one you have I would tell you for the most part ignore the ratio