scholarly journals Serum free light chains and multiple myeloma: Is it time to extend their application?

2020 ◽  
Vol 8 (4) ◽  
pp. 617-624
Author(s):  
Uros Markovic ◽  
Valerio Leotta ◽  
Daniele Tibullo ◽  
Rachele Giubbolini ◽  
Alessandra Romano ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Light Chains ◽  
Free Light Chains ◽  
Serum Free ◽  
Serum Free Light Chains

scholarly journals Bleeding due to acquired dysfibrinogenemia as the initial presentation of multiple myeloma

2019 ◽  
Vol 12 (7) ◽  
pp. e229312
Author(s):  
Namrah Siddiq ◽  
Colin Bergstrom ◽  
Larry D Anderson ◽  
Srikanth Nagalla
Keyword(s):  
Multiple Myeloma ◽  
Activity Level ◽  
Initial Presentation ◽  
Bleeding Complications ◽  
Light Chains ◽  
Bleeding Diathesis ◽  
Antigen Level ◽  
Free Light Chains ◽  
Serum Free ◽  
Serum Free Light Chains

Patients with multiple myeloma (MM) are at risk for acquired dysfibrinogenemia resulting in laboratory abnormalities and/or bleeding complications. We describe a 63-year-old man who presented with bleeding diathesis in the presence of a low fibrinogen activity level with a normal fibrinogen antigen level. Further studies revealed elevated levels of lambda free light chains, and he was diagnosed with MM. Despite initiating treatment with bortezomib/dexamethasone, he continued to have recurrent bleeds along with hypofibrinogenaemia, prompting a switch to carfilzomib/dexamethasone. The patient responded with improvement in bleeding symptoms, normalisation of fibrinogen activity and a decrease in serum free light chains.

Impact of Novel M-Component Based Biomarkers On to Progression Free Survival After Treatment in Intact Immunoglobulin Multiple Myeloma.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2927-2927
Author(s):  
Efstathios Koulieris ◽  
Dimitrios Maltezas ◽  
Nikolaou Eytychia ◽  
Vassiliki Bartzis ◽  
Tatianna Tzenou ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Binding Site ◽  
Progression Free Survival ◽  
Normal Serum ◽  
Light Chains ◽  
Free Light Chains ◽  
Serum Free ◽  
Depth Of Response ◽  
Serum Free Light Chains

Abstract Abstract 2927 Background and Aims: Multiple Myeloma (MM) is characterized by bone marrow (BM) plasma cell infiltration and the presence of serum/urine monoclonal immunoglobulin (Ig). The depth of response has been associated with longer PFS in MM causing subsequent prolonged survival. Recently novel M-based biomarker immunoassays have been developed (Freelite™, Hevylite™) and their significance in MM diagnosis and prognosis has been demonstrated.1,2 Furthermore serum Free Light Chains (sFLC) are used for better assessment of treatment response, thus patients are considered to achieve stringed Complete Response (sCR) by having CR criteria plus normal serum Free Light Chains Ratio (sFLCR) and absent clonal cells on BM.3 The significance of Hevylite™ on response has not been assessed so far. Patients in nCR or better do not automatically restore their ratio of intact monoclonal Ig/intact polyclonal Ig of the same class (Hevylite™ or HLCR). We therefore investigated the importance of sFLCR and HLCR normalisation at plateau on PFS, in a series of patients with intact Ig MM. Patients and Methods: 50 intact immunoglobulin MM patients were studied from diagnosis to last follow up. Immunofixation was IgG (26 -kappa and 12 –lamdba) and IgA (6 –kappa and 6 -lambda). All patients were symptomatic at diagnosis. Sera samples (n=312) were analyzed for sFLC-kappa and sFLC-lambda with Freelite™ and sFLCR were calculated, and for IgGkappa, IgGlambda IgAkappa, IgAlambda with Hevylite™ and ratios IgGkappa/IgGlambda, IgGlambda/IgGkappa, IgAkappa,/IgAlambda and IgAlambda/IgAkappa (HLCRs) were calculated. sFLCRs and HLCRs values above the 95%-ile of normal individuals were considered abnormal. Statistical analysis was performed using SPSS ver 15.0. File data were reviewed. Results: At diagnosis sFLCR was abnormal in 86% of patients while HLCR was abnormal in all. All treatment lines were initiated according to standard criteria and median lines of therapy were 2 (range 1–11). Median follow up was 33 months (7–145). During patients' cumulative follow-up, 145 lines of therapy were studied and the subsequent responses were estimated. Thirty eight percent of responses were sCR, CR and nCR, 20% PR, 18% MR and 24% refractory and progressive disease. HLCR normalized in 44% of patients with sCR, CR and nCR. The depth of response correlated to PFS and patients in sCR, CR and nCR had longer PFS than the others (p<0.001). Serum FLCR and HLCR normal values at response were both strong parameters of increased PFS after treatment at any line (p=0.035 and p=0.046 respectively). Conclusion: Serum HLCR normalization at plateau reflects prolonged responses in intact Ig MM. Disclosures: Harding: Binding Site: Employment. Bradwell:The Binding Site: shareholder Other.

scholarly journals Response to: Serum free light chains for monitoring multiple myeloma

2005 ◽  
Vol 128 (3) ◽  
pp. 406-407 ◽  
Author(s):  
Graham P. Mead ◽  
Hugh Carr-Smith ◽  
Mark T. Drayson ◽  
Gareth T. Morgan ◽  
Anthony J. Child
Keyword(s):  
Multiple Myeloma ◽  
Light Chains ◽  
Free Light Chains ◽  
Serum Free ◽  
Serum Free Light Chains

scholarly journals Extracorporeal light chains removal – What role does this play in 2020?

2021 ◽  
Vol 34 (4) ◽  
Author(s):  
Inês Coelho ◽  
◽  
Hugo Ferreira ◽  
Teresa Chuva ◽  
Ana Paiva ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Kidney Injury ◽  
Rapid Decrease ◽  
Light Chains ◽  
Free Light Chains ◽  
Monoclonal Immunoglobulin ◽  
Serum Free ◽  
Cast Nephropathy ◽  
Cell Clones ◽  
Serum Free Light Chains

Multiple Myeloma (MM) is characterized by a neoplastic proliferation of plasma cell clones producing monoclonal immunoglobulin. Manifestations of the disease are heterogenous and include dialysis­‑requiring acute kidney injury (AKI) caused mainly by cast nephropathy (CN). It is known that early and rapid decrease in serum free light chains (sFLC) levels is particularly important for renal recovery, which has led to a renewed interest in extracorporeal methods of removal of sFLC. In this review we will discuss the management of light chain CN focusing on extracorporeal light chains removal modalities and their indication.

A Review of Multiple Myeloma Patients on Dialysis Treated with High Cutoff Hemodialysis

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 5002-5002
Author(s):  
Tiina Podymow ◽  
Ahsan Alam ◽  
Murray Vasilevsky ◽  
Roch Beauchemin ◽  
Chaim Shustik ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Kidney Function ◽  
Kidney Failure ◽  
Conflicts Of Interest ◽  
Controlled Trial ◽  
Light Chains ◽  
Free Light Chains ◽  
Serum Free ◽  
Cast Nephropathy ◽  
Serum Free Light Chains

Abstract Abstract 5002 Background: Kidney failure is a major cause of morbidity in patients with Multiple Myeloma (MM). While up to half of MM patients can be shown to have renal impairment, 10% will become dialysis dependent. The main mechanism of kidney failure is cast nephropathy, which is linked to high amounts of circulating free light chains. A proposed strategy to prevent this outcome is the use of extended high cutoff (HCO) dialysis. An ongoing randomized controlled trial is testing the Gambro HCO1100 filter. Here we report the use of another dialyzer (Bellco Phylther), which has a smaller pore size than the Gambro filter, but which may prove to be as effective and is less costly. Methods: We present three patients with symptomatic MM, elevated κ or λ serum free light chains (>500mg/L), biopsy confirmed cast nephropathy, and kidney failure (estimated GFR <15ml/min/1.73 m2) requiring dialysis. In all patients, dialysis consisted of 10 hemodiafiltration dialysis sessions in the first two weeks and three times a week thereafter using a high flux Bellco Phylther HF22SD dialyzer (Bellco, Modena, Italy). All patients received concurrent chemotherapy: bortezomib 1.3mg/m2 IV and dexamethasone 40mg po on days 1, 4, 8 and 11 of a 21 day cycle and liposomal doxorubicin at 30mg/m2 on day 4 of every cycle. Serum free light chains were determined pre- and immediately post-dialysis using a nephelometric immunoassay (FREELITE, The Binding Site, Birmingham UK). Results: We observed significant (>50%) and rapid reductions in sFLCs. These reductions were sustained at 3 months in all cases, likely because of effective anti-myeloma treatment. Two of the three patients had recovery of kidney function and remain dialysis-independent at least 6 months after cessation of dialysis. Interestingly, the only patient that did not recover kidney function was also found to have tubulointerstitial disease on renal biopsy in addition to cast nephropathy. Conclusions: The HCO Bellco Phylther dialyzer appears effective in the rapid reduction of sFLCs in light chain MM patients with cast nephropathy requiring dialysis and concurrent anti-myeloma drug therapy. While the numbers are small, our review suggests that patients with uncomplicated MM cast nephropathy may benefit from aggressive hemodiafiltration with this HCO membrane. This dialysis membrane and protocol are worth considering for further study in patients with MM cast nephropathy. Disclosures: No relevant conflicts of interest to declare.

Value Of Serum Free Light Chains Ratio As New Biomarker Of High Prognostic Value In Patients With Newly Diagnosed Multiple Myeloma

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1862-1862
Author(s):  
José Luis García de Veas Silva ◽  
Carmen Bermudo ◽  
Stephen Harding ◽  
Rafael Duro Millán
Keyword(s):  
Multiple Myeloma ◽  
Binding Site ◽  
Prognostic Value ◽  
Cox Regression ◽  
Adverse Outcome ◽  
Light Chains ◽  
Newly Diagnosed ◽  
Free Light Chains ◽  
Serum Free ◽  
Serum Free Light Chains

Abstract Background The International Staging System (ISS) is the current standard used for risk stratification of patients with newly diagnosed Multiple Myeloma (MM). Patients are stratified into three categories using the values ​​of serum albumin and beta2-microglobulin (B2M). Recent studies have evaluated the relationship between serum free light chains (sFLC) at diagnosis and the prognosis of these patients. The aim of this study is to evaluate the prognostic value of sFLC ratio at baseline in newly diagnosed multiple myeloma (MM) in a Spanish population. Materials and Methods 79 patients (35 Male : 44 Female) with a median age of 69 years (range 41-91) were recruited and followed for up to 5years. sFLC concentrations were measured nephelometrically (Freelite, The Binding Site, Birmingham, UK) and the sFLC ratio (sFLCr) was calculated using the monoclonal sFLC as the numerator. Patients were stratified into two groups according to the median value of sFLCR: group “low” with sFLCR <26 (39 patients) and group “high” with sFLCR >26 (40 patients). Clinical and laboratory variables (including Albumin, B2M, Creatinine, hemoglobin, calcium, LDH, M-protein size, plasma cell infiltration and presence of lytic bone lesions) were recorded and evaluated for their impact on patient's outcome. Statistical analysis were performed using (SPSS version 20.0) and significant variable were further analyzed by Cox Regression analysis. Results During follow-up there were 25 disease-related deaths: 5 in group “low” and 20 in group “high”. The 5-years OS of all patients was 63.7%, whereas it was 86.4% and 38.1% in groups “low” and “high” respectively (hazard ratio (HR): 5.51, p<0.0001) (Figure). Univariate analysis identified age>65 years old (OR: 3.61, p=0.030), creatinine>2 mg/dL (OR: 4.50, p=0.009), hemoglobin <10 g/dL (OR: 3.87, p=0.006), and ISS stage (p=0.001) as being significantly associated with adverse outcome. There was no significant correlation with the other variables. Multivariate Cox regression identified sFLCR (sFLCR>26, HR: 4.39, p=0.004) and B2M (B2M>3.5 mg/L, HR: 3.42, p=0.008) as independent risk factors for adverse outcome. A combination of ISS stage with high or low sFLCR to check correlation between sFLCR and OS (Table). The sFLCR separated every ISS stages in two subsets; one with low sFLCR and another with high sFLCR. Within ISS stage 2, the presence of high sFLCR was associated with a worse OS (p = 0.003). The OS was 86.5% versus 17.5% for the low and high sFLCR subsets, respectively. In stage 3, the OS of patients with high sFLCR was 0% while the OS of those with low sFLCR was 75%. In ISS stage 1, the two subsets defined by low and high sFLCR had a similar OS. Conclusions The sFLCR value at diagnosis is an important independent risk factor for poor prognosis in patients with newly diagnosed MM. Our results suggest that sFLCR should be included in the ISS System or a new risk model stratification in patients with newly diagnosed MM. Disclosures: Harding: Binding Site: Employment.

scholarly journals Defining the impact of individual sample variability on routine immunoassay of serum free light chains (sFLC) in multiple myeloma

2013 ◽  
Vol 171 (2) ◽  
pp. 201-209 ◽  
Author(s):  
S. H. K. Murng ◽  
L. Follows ◽  
P. Whitfield ◽  
J. A. Snowden ◽  
K. Swallow ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Light Chains ◽  
Individual Sample ◽  
Free Light Chains ◽  
Serum Free ◽  
Serum Free Light Chains ◽  
The Impact

scholarly journals The importance of screening for serum free light chains in suspected cases of multiple myeloma and their impact on the kidney

2014 ◽  
Vol 2014 (oct17 1) ◽  
pp. bcr2014206688-bcr2014206688 ◽  
Author(s):  
B. Talbot ◽  
D. Wright ◽  
K. Basnayake
Keyword(s):  
Multiple Myeloma ◽  
Light Chains ◽  
Free Light Chains ◽  
Serum Free ◽  
Serum Free Light Chains

Serum free light chains for monitoring multiple myeloma

2005 ◽  
Vol 128 (3) ◽  
pp. 405-406 ◽  
Author(s):  
J. Tate ◽  
P. Mollee ◽  
D. Gill
Keyword(s):  
Multiple Myeloma ◽  
Light Chains ◽  
Free Light Chains ◽  
Serum Free ◽  
Serum Free Light Chains
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