[Music] why is knowing your free light chain ratio important so light chains tend to go up in a person who has inflammation so that could be from any number of things like an infection even in what the ratio helps to do is just normalize those values so as I mentioned you know people will have higher light chains when they have kidney problems but typically you have an elevation of both Kappa and lambda and when you create that ratio it might be off a little bit but usually it's not above that cutoff of say you know a certainly of a hundred for example so so you can use that ratio to say you know do you think this is a nonspecific elevation of light chains rather than something is that is really important to look at when we do blood tests to look for the light chains in the blood or serum free light chains we get three results from the lab we get what's called a Kappa light chain of free lambda light chain and a light chain ratio of capital lambda ratio and this three values are very important for several reasons the fact that there are the Kappa and the lambda light chains are two light chains that our body normally makes whether we are healthy or we are sick or we have multiple myeloma and an elevated light chain can be caused by several things it could be caused by inflammation by an infection by stress or cancer or some therapy related to it so if we see the Kappa light chain for example go up but the lambda light chain stays the same and it's not going up they're not going up together then that can be a sign that there is a abnormal cells there that I'm making more of one type of light chain than the other if we see that both lightens are going up then that can tell is that that's more of a reactive process and that's that's normal to see in any patient we remember myeloma cell comes from an abnormal plasma cell and a plasma cell is very important for a new system and it's going to react whenever we have an infection or we're exposed to an agent like a allergen or inflammation it's it's behaviors going to be to increase the amount of antibodies that it produces so we can try to identify bacteria or pathogens that could be attacking the body and just like it produces whole antibodies is going to be producing fragments of those antibodies which are the free light chains so if we see that both light chains go up together then that tells us that this is more of a reactive process or an infectious process and not necessarily a cancer if we see that one of them is the one that's being going up while the other staying stable or going down then that tells us that there's something wrong and there's a group of cells that are making more of one elements than the other and that's where we need to focus on and in myeloma that's what we see we see an abnormal the disproportion increase of one of those free light chains compared to the other and the ratio is the one that helps us determine how much of a difference there is between one and the other a normal ratio of a light chain can go between 0.26 to 1.65 and that is something that everybody has and if we have both light chains go up at the same time the ratio should stay the same if we have somebody like the case of myeloma that has Kappa light chain go up we should see that ratio go up and that should signal us that there is a higher amount of cancer cells producing data at normal type of light chain there are some scenarios where we can see a false elevation of one of those light chains specifically people who have n stage renal disease or very bad kidney function in those cases we can see a false elevation of the Kappa light chain that make that range of 0.26 to 1.65 be extended up to three and in those cases having that abnormal ratio doesn't necessarily mean that there's a possible cancer or m Gus or an abnormal clone it just means that the kidneys are not processing the light chains at the same rate because they tend to what we tend to accumulate more Kappa than lambda and that's what throws the ratio slightly off you [Music]