Serum Free Light Chain Assessment Early After Stem Cell Transplantation as a Prognostic Factor in Multiple Myeloma

2015 ◽  
Vol 15 (9) ◽  
pp. 541-545 ◽  
Author(s):  
Kevin Barley ◽  
Sharon Tindle ◽  
Emilia Bagiella ◽  
Sundar Jagannath ◽  
Ajai Chari
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Prognostic Factor ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Light Chain ◽  
Free Light Chain ◽  
Serum Free ◽  
Serum Free Light Chain

scholarly journals Serum Free Light Chain Ratio, Total κ/λ Ratio, and Immunofixation Results Are Not Prognostic Factors after Stem Cell Transplantation for Newly Diagnosed Multiple Myeloma

2009 ◽  
Vol 55 (8) ◽  
pp. 1510-1516 ◽  
Author(s):  
Manuela M Giarin ◽  
Luisa Giaccone ◽  
Roberto Sorasio ◽  
Christian Sfiligoi ◽  
Barbara Amoroso ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Light Chain ◽  
Complete Response ◽  
Free Light Chain ◽  
Disease Response ◽  
Serum Free Light Chain ◽  
Kaplan Meier ◽  
Significant Difference

Abstract Background: The prognostic value of changes in paraprotein markers after stem cell transplantation is unknown. We evaluated disease response using serum immunofixation (s-IFIX), total κ and λ ratio (KLR), and free light chain (FLC) ratio in myeloma patients who underwent autologous or autologous plus allogeneic stem cell transplantation. Methods: We studied s-IFIX, KLR, and FLC ratio in sera from 203 patients, 3 months after transplantation. We evaluated overall and event-free survival (OS and EFS, interval between date of study enrollment and date of death from any cause or date of progression, relapse, or death from any cause, respectively) by the Kaplan–Meier method. Results: Of the 203 patients, 51 were negative by s-IFIX, 99 reached a normal KLR, and 92 had a normal FLC ratio. Of the 51 patients with negative s-IFIX, 40 (78%) also had a normal FLC ratio. The median duration of OS was 54.3 months, and the median EFS was 19.5 months. None of the measured paraprotein parameters showed an association with OS. Only a normal KLR was associated with prolonged EFS (P = 0.016). Even a negative s-IFIX associated with a normal FLC ratio did not show a significant difference in terms of EFS and OS. Conclusions: Our analysis with a small cohort of patients did not show a significant impact of achieving complete response (CR) or stringent CR on patient survival.

Chemotherapy-Based Stem Cell Mobilization Does Not Result in Significant Paraprotein Reduction in Myeloma Patients in the Era of Novel Induction Regimens

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2176-2176
Author(s):  
Anthony Oyekunle ◽  
Evgenii Shumilov ◽  
Philippe Kostrewa ◽  
Andreas Burchert ◽  
Patrick Wuchter ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Light Chain ◽  
Free Light Chain ◽  
Advisory Committees ◽  
Serum Free ◽  
Serum Free Light Chain ◽  
Remission Status ◽  
The Mean ◽  
Cell Mobilization

Abstract Introduction: The introduction of novel induction therapies in the management of multiple myeloma (MM) has led to markedly improved remission rates, resulting in calls to revisit the need for chemotherapeutic agents in the mobilization of CD34+stem cells (SC) for autologous stem cell transplantation (ASCT). We examined the additional benefit over steady-state mobilization with G-CSF alone with regard to optimization of the myeloma remission status and morbidity resulting from chemotherapeutic SC mobilization. Methods: This retrospective multicenter study reviewed 236 consecutive MM pts from4 German centers: Hamburg, Goettingen, Marburg and Heidelberg, who had 1stASCT from 2009 to 03/2016 following chemotherapy-based stem cell mobilization. The median age was 59 (range, 36-75) years, with 152 (64.4%) males. Paraproteins were IgG (n=120, 54.1%), IgA (n=55, 24.8%), or light chains (LC) only (n=47, 21.2%), with LC being mostly kappa (131/221, 59.3%). Response was assessed according to International Myeloma Working Group (IMWG) criteria, and was based on the reduction in free LC and heavy chain (HC) levels before and after chemo-mobilization. Results: 225 (95.3%) pts had received at least 3 cycles of either bortezomib- (n=222, 94.1%) or lenalidomide-based (n=19, 8.1%) induction regimens. Of the 190 pts for which post-induction remission status was known, 170 (89.5%), 73 (38.4%) and 15 (7.9%) had achieved partial remission (PR), very good PR (VGPR), and complete remission (CR), respectively. SC were mobilized with G-CSF combined with cyclophosphamide- (n=212, 93.4%) or etoposide-based (n=15, 6.6%) chemotherapy regimens. There was no significant change in the mean serum free LC and HC levels of pts pre- and post-chemomobilization (Table 1). For pts with kappa myelomas, the mean kappa/lambda ratio (KLr) was 211.1±679.1 before and 360.0±1250.0 post-chemomobilization (P=0.1165); and for lambda myeloma, mean KLr was 0.504±1.143 and 0.810 ± 2.352, respectively (P=0.1348). Analysis of pts with different myeloma subtypes according to the HC and LC concentrations pre- and post-chemomobilization also showed no significant changes. Only 7(3.7%) pts newly attained PR or VGPR following chemomobilization, whereas the remaining pts showed no significant change in the myeloma remission status as compared to the pre-chemomobilization level. A total of 67 (28.4%) pts developed chemotherapy-related complications including neutropenic fever (n=40, 16.9%), sepsis (n=14, 5.9%) and others (n=43, 18.2%), resulting in nine hospital admissions (3.8%, mean=7.1 days). Conclusion: Our study suggests that in spite of the significant morbidity associated with chemotherapy-based mobilization regimens, in the era of novel induction agents, only a minority of myeloma pts attain an improved remission status. Therefore, the value of incorporating additional chemomotherapy for SC mobilization as compared to G-CSF alone should be critically evaluated in the light of modern induction regimens used nowadays for myeloma pts. Table. Mean serum free light chain (FLC) levels pre- and post-chemomobilization according to myeloma subtypes. *All values ± SD are given. Serum concentrations are in g/dL. FLC, free light chain; MM, multiple myeloma; k, kappa; l, lambda. aNegative values represent increases. Table. Mean serum free light chain (FLC) levels pre- and post-chemomobilization according to myeloma subtypes. / *All values ± SD are given. Serum concentrations are in g/dL. / FLC, free light chain; MM, multiple myeloma; k, kappa; l, lambda. / aNegative values represent increases. Disclosures Oyekunle: Novartis: Honoraria. Wuchter:Sanofi-Aventis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Hexal: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees. Kroeger:Sanofi: Honoraria, Research Funding.

Use of a mathematical model of serum-free light chain decline to identify a kinetic predictive marker of survival in patients with newly diagnosed multiple myeloma treated with bortezomib plus dexamethasone and autologous stem cell transplantation.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e19515-e19515
Author(s):  
Heiblig Mael ◽  
Lachenal Florence ◽  
Olivier Colomban ◽  
Lionel Karlin ◽  
Benoit You
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Kinetic Parameters ◽  
Production Rate ◽  
Light Chain ◽  
Newly Diagnosed ◽  
Predictive Values ◽  
Serum Free ◽  
Serum Free Light Chain

e19515 Background: According to 2011 International Myeloma Working Group recommandations, serum-free light chain (sFLC) assessment is indicated in non secretory Multiple Myeloma (MM). sFLC monitoring is now routinely used for diagnosis and early response treatment assessment but its actual prognosis values regarding survival is not clear. Based on mathematical modeling, this study aimed at evaluate the predictive value on progression free survival (PFS) of modeled sFLC kinetics during frontline treatment. Methods: Model-based analysis of sFLC kinetics from 28 newly diagnosed MM patients treated at a single institution with 4 cycles of bortezomib and dexamethasone plus autologous stem cell transplantation (ASCT). MONOLIX program was used to fit Box-Cox transformed [sFLC] concentration-time profiles to the equation : [sFLC(t) = [sFLC1*exp(-KDEC1*t)]+[sFLC2*exp(-KDEC2*t)]+[sFLC3*exp(KPROD*t)] ] where KDEC1 and KDEC2 represent the decline rates of sFLC while KPROD is the involved light chain production rate observed after the end of the decrease. The predictive values of the modeled kinetic parameters , regarding PFS were tested using logistic regression, and survival analysis. Results: Median PFS was 17.9 months . Three modeled kinetic parameters categorized by their medians had strong predictive values regarding PFS using univariate tests: sFLC decline rate KDEC1 (median PFS = 38.6 months if KDEC1 ≥ median vs 14 months if KDEC1 < median, P=0.01); light chain production rate KPROD (median PFS = 24.9 months if KPROD < median vs 7.8 months if KPROD ≥ median, p=0.01); and initial SFLC production slope sFLC3 (median PFS = 24.9 months if sFLC3 < median vs 14 months if sFLC3 ≥ median, p=0.03). The same kinetic model for M-protein decline was not significant (p=0.53). Using multivariate analysis, the only remaining significant predictive factor of PFS was: KDEC1 (HR, 0.11; 95% CI 0.01-0.88; P=0.04). Conclusions: The modeled kinetic parameter of sFLC decline KDEC1, may be easily used as an early predictor of survival after frontline ASCT in MM. Validation in larger studies is warranted.

scholarly journals Serum free light chain measurements to reduce 24-h urine monitoring in patients with multiple myeloma with measurable urine monoclonal protein

2018 ◽  
Vol 93 (10) ◽  
pp. 1207-1210 ◽  
Author(s):  
Marcella Tschautscher ◽  
Vincent Rajkumar ◽  
Angela Dispenzieri ◽  
Martha Lacy ◽  
Morie Gertz ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Light Chain ◽  
Free Light Chain ◽  
Serum Free ◽  
Monoclonal Protein ◽  
Serum Free Light Chain
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