One of my cancer doctors said that if the ratio of over 10 it will be time for a treatment plan. To find this number divide your kappa free light chain by your lambda free light chain.
Another indicator is your paraproteins or m spike.
My last ratio was 9.55, doing bloodwork in a few weeks and hoping it stays down.

I was diagnosed last Oct/Nov 2022 with IGG MM. My IgG was 2490 (which is abnormally high) when my chest/sternum was having severe pain from a lytic lesion. After 9 months of chemo, my IgG is now 740, which is in the normal range. A bone marrow biopsy at diagnosis showed 30% bad plasma cells (which is where the IgG cells show up in labs for IGG MM). My kappa/lamba light chain ratio was 27 at diagnosis and then quickly was around 10 after 6 weeks of chemo, but I was far from under control. After lots more chemo and radiation, another bone marrow biopsy shows 2-3% bad plasma cells. I just had my stem cells collected as part of SCT and hope for deep remission from SCT/BMT.

Everyone is different, but if you haven't had a bone marrow biopsy or scans (CT/Pet-CT) I would encourage you to be persistent with your doctors to get biopsy and scans now and then go from there. If you're not getting either, then I would definitely look for second opinion now.

God Bless,

Bill

And please don't forget two things:
1) 2nd/3rd opinions
2) Clinical Trials
I had a tandem STC and it didn't bring me close to remission.
I have been on two amazing clinical trials, both BiSpecific Antibodies.
Although results vary by individual, they were unbelievable for me. Teclistamab, now approved and Cevostamab.
Good luck, my friend

Steven

Actually, I do not think I would want BMT. I’ve been told that it would involve Serious down time from my work with our homeless people, due to being immunocompromised. And at some point they use strong chemo to kill your existing bone marrow. If I were younger, I’d likely do it. But 76 it’s as likely I will die of something else as MM. You can live a long time with these meds. If you are on Darsalex and Revlimid (and if you don’t get any serious side effects) you can do very well.
As a person of deep conviction, I put questions of life and death in Gods hands, and focus on today. And mostly my days are terrific. So, it doesn’t “suck” and in fact I feel I am blessed.
I did not say this before, but I’ve lived with another cancer, stage IV, for 7.5 years. It is also controlled with medication. Yet, by God’s mercy I feel good, do Christian work, spend time with my wife, and go rock climbing. I’m living life on purpose.
I tell this so you will know that the disease is just an issue we deal with. It doesn’t get the last word in any way. We don’t quit living a meaningful life ever while we draw breath.

Blessings

I believe your IgG needs to be over 3000 (3g/dl) along with several other indicators to start treatment. Your BMT should show over 60% of myeloma cells and your FLC ratio needs to be high among several other secondary counts as well.