Role of Free Light Chain Assay Ratio to Distinguish Between CR According EBMT Criteria or Stringent Complete Remission (sCR) According IMWG in Multiple Myeloma Patients.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1787-1787
Author(s):  
Svetlana Asenova ◽  
Ulrike Bacher ◽  
Andreas Gerritzen ◽  
Axel R. Zander ◽  
Nicolaus Kröger
Keyword(s):  
Multiple Myeloma ◽  
Complete Remission ◽  
Light Chain ◽  
Partial Remission ◽  
Conflicts Of Interest ◽  
Free Light Chain ◽  
Normal Range ◽  
Light Chain Immunoglobulin ◽  
Definition Of ◽  
Additional Value

Abstract Abstract 1787 Poster Board I-813 Introduction The qualitative assay for free light chain has been reported to be sensitive and specific for detecting and monitoring diseases caused by monoclonal gammopathies such as multiple myeloma. More recently the International Myeloma Working Group proposed uniform response criteria including a new definition of stringent complete remission (sCR). The definition of stringent complete remission requires beside absence of clonal cells in bone marrow by immunohistochemistry or immunofluorescence also normalization of free light chain ratio in serum. Patients and Methods We evaluate the value of free light chain assay to determine stringent CR by monitoring 87 patients with multiple myeloma who achieved complete remission (n=52) or very good partial remission (n=35) between January 2003 and December 2008. Free light chain measurements were performed with the commercially available Free liteTM Kit (Binding Site, Heidelberg, Germany). Because of the shorter half-life of free light chain assay ratio, only patients were included, if the complete or very good partial remission remains stable for at least 3 months. The comparison between immunofixation and free light chain ratio was performed at least 6 weeks after immunofixation becomes negative for the first time. 87 patients (50 mal and 37 female) were included, 67 had intact immunoglobulin and 11 had light chain immunoglobulin at time of diagnosis. The remission status was determined either after allogeneic (n = 73) or autologous (n = 7) stem cell transplantation or after conventional bortezomib or lenalidomide containing chemotherapy (n = 7). Results 35 out of 87 patients achieved a very good partial or near complete remission with still positive immunofixation. In 22 out of those 35 patients the free light chain kappa ratio was within the normal range of 0.26 – 1.65 mg/l (63 %). Only in 13 patients with persistent immunofixation positivity the free light chain ratio was outside the normal range (37%). 52 patients achieved complete remission according to the EBMT criteria with negative immunofixation for at least 3 months. In those patients all (100 %) had a normal free light chain kappa/lambda ratio. In a subgroup of patients (n = 10) who relapsed during follow-up from complete remission sequential monitoring of immunofixation and free light assay was performed as recently described [4]. In 9 out of 10 patients a free light chain ratio became abnormal at a median 90 days before immunofixation became positive. Conclusions The free light chain assay ratio is a useful marker for a faster detection of remission or progression in myeloma patients. However, these results do not support additional value of free light chain ratio to determine the depth of remission in immunofixation negative patients. More sensitive methods such as imunophenotyping analysis by FACS or molecular primer should be used to determine depth of complete remission since these methods have shown relevant clinical impact. Disclosures No relevant conflicts of interest to declare.

Improving Outcomes in Patients with Renal Failure Secondary to Multiple Myeloma: Results From ChAR2M2.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1875-1875
Author(s):  
Colin Hutchison ◽  
Parisa Airia ◽  
Mark Cook ◽  
Daniel Grima
Keyword(s):  
Multiple Myeloma ◽  
Renal Failure ◽  
Side Effects ◽  
Light Chain ◽  
De Novo ◽  
Conflicts Of Interest ◽  
Treatment Patterns ◽  
Free Light Chain ◽  
High Rate ◽  
Sustained Reduction

Abstract Abstract 1875 Poster Board I-900 Study purpose: To explore how free light chain (FLC) removal by high cut-off haemodialysis (HCO-HD) has been adopted into clinical practice for the management of renal failure secondary to multiple myeloma. Describing treatment patterns and the laboratory and clinical outcomes associated with its use. Methods: A chart audit of patients treated with FLC removal by HCO-HD, using the Gambro HCO 1100 dialyser, was performed in 16 dialysis centers across 9 countries. Patient demographics, treatment patterns and dialysis side-effects were recorded. In addition, the following outcomes were measured: dialysis independence and reductions in serum FLCs concentrations at 12 and 21 days. Results: Data for 66 patients was entered. Patients had an average age of 65.1 (SD×10.1); 42 of them (63.64%) were male and 24 (36.36%) were female. Sixteen (24%) presented with relapsing myeloma and 50 (76%) had de novo disease. On average, each patient received 13 HCO-HD sessions (SD×8). Forty-one patients became dialysis independent (62.12%), after an average of 12 sessions. Dialysis related side-effects were reported in 6% of all patients. Forty patients (60.61%) were reported to have a sustained reduction in serum FLC concentrations by day 12. By day 21 this had increased to forty-one (62.12%). Among the patients who achieved a sustained reduction in serum FLC concentrations, 28 (70%) had a decline in FLC levels of more than 50% by day 12 and 34 (82.93%) by day 21. Among patients who achieved sustained reduction of more than 50% in serum FLC concentrations by day 12, 75% became dialysis independent. In comparison only 53% of those with a reduction of less than 50% became dialysis independent (p×0.007). Furthermore, among patients who achieved sustained FLC reduction of greater than 75%, 81% became dialysis independent. The rate of dialysis independence was also significantly higher in patients with de novo disease compared with those with relapsing myeloma (64% versus 56%, p×0.04). Conclusion: Free light chain removal by HCO-HD was well tolerated and associated with a very high rate of dialysis independence in patients with renal failure secondary to multiple myeloma. Rates of renal recovery were greater in patients with de novo myeloma and those who achieved an early reduction in serum FLC concentrations. Disclosures: No relevant conflicts of interest to declare.

No Recurrent Mutation of SF3B1, U2AF1 and SRSF2 Spliceosomal Gene in Multiple Myeloma but Polymorphisms of These Genes Are Associated with the Prediction of Worse Prognosis

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3958-3958
Author(s):  
Trang Nguyen Thi Dai ◽  
Hye-Ran Kim ◽  
Min-Gu Kang ◽  
Stephanie J. Won ◽  
Hwan-Young Kim ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Light Chain ◽  
Somatic Mutations ◽  
Conflicts Of Interest ◽  
Bone Lesion ◽  
Disease Free Survival ◽  
Free Light Chain ◽  
Immunoglobulin Level ◽  
Exon 2 ◽  
Number Of Patients

Abstract Abstract 3958 Background: Recently, a striking example of the effects on acquired somatic mutations in splicing factors such as SF3B1, U2AF1, and SRSF2 has been described. The sequencing of the DNA from abnormal blood cells from patients with several types of leukemia such as AML, CLL, CMML, pre-leukemic syndromes, and MDS, has shown that a high proportion of these cases are associated with somatic mutations in spliceosomal proteins. Also, evidence of cancer-specific alternative splicing and oncogenic somatic mutations in spliceosome subunits has been steadily growing. However, there is not much research regarding aberrant splicing pathways in Multiple myeloma (MM) patients. Therefore, we tried to investigate the presence and prognostic implication of mutation of the SF3B1 and U2AF1 protein in these patients in South Korea. Materials and Methods: We examined a cohort of 87 MM patients and 100 healthy controls for somatic mutations in SF3B1, U2AF1 and SRSF2 by using direct sequencing method. The medical records were reviewed for age, sex, plasma cell percentage, serum M protein, immunoglobulin level, free light chain ratio, calcium, creatinine, hemoglobin, bone lesion, albumin, beta 2 microglobulin, lactate dehydrogenase, treatment outcome, and so on. The collected data was analyzed by SPSS for Windows version 18.0. We performed Pearson's chi-square tests, one way ANOVA analysis, and Student t-test. Survival rates of myeloma patients according to the result of SF3B1, U2AF1 and SRSF2 sequencing were analyzed using Kaplan-Meier log-rank test. Results: Our 87 MM patients showed no mutation including known recurrent ones in SF3B1, U2AF1 and SRSF2 genes. However, the patients displayed 39198T>T/C polymorphism (70.1%) in exon 18 of SF3B1, 8345T>T/G polymorphism (13.8%) in exon 2 of U2AF1 and 5399C/T polymorphism (100%) in exon 1 of SRSF2. In the entire cohort, the number of patients with no polymorphism, one polymorphism, two polymorphisms and three polymorphisms was counted up to 0%, 24.1%, 67.8% and 8.0%, respectively. The T/C polymorphism at position 39198 of SF3B1 exon 18 and the T/G polymorphism at position 8345 of U2AF1 exon 2 were analyzed by allele-specific PCR using normal control. Results in 100 normal controls, polymorphism of SF3B1 exon 18 was taken into account of 82.0%, the remaining is non polymorphism while U2AF1 exon 2 showed 10.0% polymorphism and 90.0% non polymorphism. Sex (p=0.048) and free light chain ratio (p=0.002) showed significant results according to polymorphism status while other clinical characteristics were not associated. The patient with polymorphisms in both SF3B1 and U2AF1 had worse overall survival (P=0.042) and disease-free survival (P<0.01), compared to patients without polymorphism. Conclusion: Our results show no recurrent SF3B1, U2AF1 and SRSF2 mutations in MM patients rather polymorphisms in SF3B1 and U2AF1 gene were significantly implicated in the prediction of poor prognosis. Disclosures: No relevant conflicts of interest to declare.

Immunoglobulin Heavy/Light Chain Immunoassays for Response Evaluation in Multiple Myeloma: Comparison with Immunofixation, Serum Free Light Chain, and Multicolor Flow- Cytometry

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 3366-3366 ◽  
Author(s):  
Yasuhito Suehara ◽  
Keisuke Seike ◽  
Kouta Fukumoto ◽  
Manabu Fujisawa ◽  
Masafumi Fukaya ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Flow Cytometry ◽  
Light Chain ◽  
Conflicts Of Interest ◽  
Free Light Chain ◽  
Multicolor Flow Cytometry ◽  
Serum Free ◽  
Serum Free Light Chain ◽  
Normal Ranges ◽  
Best Response

Abstract BACKGROUND: Monitoring of multiple myeloma (MM) patients is required to assess and determine the treatment response. The serum immunoglobulin (Ig) heavy/light chain immunoassays are a new method that enables separate quantification of the different light chain types of each Ig class, i.e., IgGk, IgGl, IgAk, and IgAl. Although the contribution of these tests to disease evaluation has been assessed, available data are still limited. Here, we compared the serum Ig heavy/light chain immunoassays with the conventional methods for disease evaluation. PATIENTS AND METHODS: Three hundred and three samples were obtained from a total of 101 patients with IgG and IgA type MM recruited at Kameda Medical Center and Kanazawa University Hospital. The median age of the patients was 68 years (range: 44 – 89). The median follow-up was 36 months (range: 2.5 – 189.6). The proportions of patients in International Scoring System (ISS) stages I, II, and III were 25%, 35%, and 40%, respectively. Paraprotein type was IgG in 64 patients (44 Gk, 20 Gl) and IgA in 37 (20 Ak, 17 Al). Samples were taken at various times after treatment and analyzed retrospectively with serum Ig heavy/light chain immunoassays (Hevylite®; Binding Site, Birmingham, UK) on a SPAPLUS® turbidimeter. The heavy/light chain ratio (HLCR) was calculated with the Ig' k (either G or A) as the numerator and compared to normal ranges (IgGk:3.84-12.07g/L; IgGl:1.91-6.74g/L; IgGk/IgGl: 1.12-3.21; IgAk:0.57-2.08g/L; IgAl:0.44-2.04g/L; IgAk/IgAl:0.78-1.94). Results were compared to serum protein electrophoresis (SPEP), immunofixation electrophoresis (IFE), and serum free light chain immunoassays (FLC). HLC-pair suppression was defined as the uninvolved immunoglobulin of the same isotype 50% below the lower limit of the normal range (IgGk, IgGl, IgAk, IgAl). Residual neoplastic plasma cells (MM-PCs) in bone marrow samples were assessed by multicolor flow cytometry (MFC) simultaneously in 140 samples from 64 patients at very good partial response (VGPR), complete response (CR), and stringent CR (sCR). The MFC negativity was defined at a level of < 10-4 MM-PCs. Overall survival (OS) and progression-free survival (PFS) were estimated by the Kaplan–Meier method, and survival was compared using the log rank test. RESULTS: Myeloma responses were assessed serially after induction therapy and were assigned according to international response criteria. Patients' samples at various responses were: sCR, n = 86 (28%); CR, n = 31 (10%); VGPR, n = 116 (38%); and PR, n = 70 (23%). Normal HLCR was obtained at sCR, CR, and VGPR in 73 (85%), 28 (90%), and 69 (59%) cases, respectively. Discordance in the depth of response between standard electrophoretic methods and HLCR was more commonly seen in IgG compared to IgA MM; possibly reflecting the dose dependent half life of IgG immunoglobulins. In the sera from patients who achieved a CR or better, abnormal HLCR and FLC ratio were seen at rates of 12.8% and 26.5%, respectively. Discordance between normalization of HLCR and FLC ratio was seen in 42% of patients with a CR or better; however, a good correlation between normalization of HLCR and FLC ratio was still observed (Fisher's exact test, P = 0.004). Among the 71 sera from patients with a CR or better in which simultaneous MFC data were available, 16 (22.5%) sera were MFC-negative. Among the patients who achieved a VGPR or better, patients with a normal HLCR had fewer MM-PCs than those with an abnormal HLCR (median 9.8x10-4vs. 46.0x10-4, respectively, P=0.062), although the difference was not statistically significant. Abnormal HLCR in CR samples was seen more frequently in patients with IgA type (19%) than IgG type (7.7%). Longer PFS and OS were observed in patients who achieved HLCR normalization at best response than in those who did not (PFS; 83.8 months vs. 41.8 month, respectively, P = 0.016 and OS; not reached vs. not reached, P = 0.018). When patients at best response were divided into with or without uninvolved HLC pair suppression, the latter group showed significantly better OS compared to the former group (not reached vs. not reached, P=0.019). CONCLUSIONS: The findings presented here suggest the potential usefulness of heavy/light chain immunoassays for monitoring of myeloma response in patients with IgA myeloma and residual MM-PC assessment at VGPR or better. Presence of abnormal HLCR at best response and HLC pair suppression were also associated with poorer survival. Disclosures No relevant conflicts of interest to declare.

scholarly journals Survival Outcomes of Young Multiple Myeloma Patients: A Single Center Experience

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5766-5766
Author(s):  
Pelin Aytan ◽  
Mahmut Yeral ◽  
Cigdem Gereklioglu ◽  
Aslı Korur ◽  
Funda Tanrıkulu ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Light Chain ◽  
Partial Remission ◽  
Conflicts Of Interest ◽  
Poor Response ◽  
The Elderly ◽  
Clinical Results ◽  
Kappa Light Chain ◽  
Single Center Experience ◽  
Ig G

Abstract Multiple myeloma (MM) is a disease of the elderly. It shows rapidly increasing incidence with increased age. Although MM is rare in young people, patients diagnosed before the age of 50 years account for 10% of the overall incidence and approximately 2% are diagnosed before 40 years of age. The aim of the study was to assess the clinical results of the young MM patients diagnosed at the age of ≤45 years. All the MM patients who were ≤45 years old at the time of diagnosis and who were admitted to our clinic between January 2004 and December 2017 were retrospectively assessed. There was a total of 31 patients and 14 (45.2%) of them were females and 17 (54.8%) of them were males. The mean age was 40.4±3.8 years. The most frequent myeloma types were Ig G Kappa (n:12, 38.7%) and Kappa light chain (n: 10, 32.3%). The remaining types were Ig A lambda (n:4, 12.9%), Ig G lambda (n:2, 6.5%), Lambda light chain (n: 2, 6.5%) and non-secretory myeloma (n:1, 3.2%). Before transplantation 12 patients (38.7%) were in complete remission, 11 patients (35.5%) were in very good partial remission, 4 patients (12.9%) were in partial remission state and 4 patients (12.9%) had refractory disease. VAD + VCD protocol was given to 12 (38.7%) patients. 6 (19.8%) patients had VCD, 3 (9.7%) got VCD + VRD, 2 (6.5%) got VAD and 8 (25.8%) got other chemotherapy protocols. Transplantation was done in 26 patients (83.9%). Overall 9 patients (29%) died during the study period. Second or tandem transplantation was performed to 10 patients and 30% (n:3) of these re-transplanted patients died. The overall survival for these patients was estimated to be 70% (95% CI: 64.2-75.8). In conclusion MM in patients younger than 45 years is rare. In these patients Ig G Kappa and Kappa Light chain types are the most frequent types. Heterogeneous of individual patients may exist within these young myeloma patients. For those who are expected to show a poor response to current treatments despite their young age, the efficacy of an alternative therapeutic strategy such as front line allo-HSTC should be further investigated. Disclosures No relevant conflicts of interest to declare.

Discrepancies in Serum Free Light Chain Assays and Immunofixation for Response Evaluation and Prognostication in Plasma Cell Proliferative Disorders

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 5099-5099
Author(s):  
Nasir Bakshi ◽  
Nahlah AlGhasham ◽  
Maha Alharbi ◽  
Jalaluddin Bhuiyan ◽  
Ghada Elgohary ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Complete Remission ◽  
Plasma Cell ◽  
Light Chain ◽  
Free Light Chain ◽  
Response To Therapy ◽  
Oligoclonal Bands ◽  
M Spike ◽  
Serial Samples

Abstract Abstract 5099 Plasma cell proliferative disorders are monitored by a variety of methods. Serum protein electrophoresis (SPE), M-spike quantitation and Immunoelectrophoresis (IFE) are commonly assessed in patients with monoclonal gammopathy of undetermined significance (MGUS), smoldering multiple myeloma (SMM), and multiple myeloma (MM) to determine disease progression, response, or relapse. sFLC quantitation provides a rapid indicator of response, detects the rare occurrence of FLC escape, and also allows disease monitoring in the absence of a measurable serum or urine M-spike. To improve sensitivity of response assessment in MM, the International Myeloma Working Group (IMWG) has recently introduced the stringent CR category. However, no formal studies have validated this criterion. Indeed, the role of the sFLC assay has recently been questioned because of the presence of discordant abnormal sFLC ratios in a significant proportion of patients in CR. This could be at least partly explained by the presence of oligoclonal bands in response to therapy, potentially leading to false-positive results. Accordingly it has been recommended that the serum M-spike be used to monitor disease, and that FLC quantitation be used only if there is no measurable disease by electrophoresis and if the monoclonal sFLC concentration is greater than 10 mg/dL in the context of an abnormal FLC ratio. By analyzing serial samples in our patient population we aim to help usefully interpret the sFLC results and in the long run validate the prognostic impact of attaining CR versus CR plus normal sFLC ratio (stringent CR) after therapy in MM. From a total of 566 samples submitted for FLC analysis over 24-month period at our institution, 94 cases were monoclonal (abnormal FLC ratio) with kappa being the involved chain in 63 and lambda in 31 cases. Serial data from 35 multiple myeloma patients were identified by the availability of 3 serum test results (SPE/IFE/sFLC) in at least 3 serial samples that were obtained 3 months to 6 months apart along with treatment outcome details. Kappa and lambda FLC were quantitated using a Siemens BNII® nephelometer and Freelite® reagent sets from The Binding Site, Birmingham, UK; M-spikes were quantitated Capillarys® system and reagent sets (Sebia Electrophoresis, Norcross, GA). The FLC data was analyzed as the involved FLC concentration (iFLC), the difference between the involved and uninvolved FLC concentration (dFLC), and the FLC K/L ratio (rFLC). Treatment modalities included allogeneic, or autologous stem cell transplantation, conventional, bortezomib or lenalidomide containing chemotherapy. There were 16 (45%) cases in which discordance was observed between the three techniques (sFLC/SPE/IFE) during the follow-up. 11/16 (68%) patients were found to have abnormal sFLC with both abnormal FLC ratio and involved chain (FLCi), while no M-band was detected by SPE/IFE. In two cases (13%) the pattern of discrepancy was opposite with IFE found to be positive while rFLC results were within normal range of 0.26 – 1.65 mg/l. In three cases (19%) abnormal FLC ratio was detected with SPE/IFE being normal but the sFLC ratio did not match the myeloma isotype (sFLC ratio <0.26 for kappa and >1.65 for lambda isotype). In a subgroup of patients (n = 4) who relapsed during follow-up from complete remission sequential monitoring of immunofixation and free light chain assays revealed normalization of SPE/IFE with only faint/ doubtful band detected in one while FLC results were abnormal. The variability of the serum M-spike, IFE and FLC measurements confirm the IMWG recommendations for patient monitoring. The free light chain assay ratio is widely reported as a useful marker for a faster detection of remission or progression in myeloma patients. These techniques in reality complement each other and the FLC results need to be interpreted with caution in context of the electrophoresis results in order to determine the status of remission. More sensitive methods such as multiparametric imunophenotyping analysis for minimal residual disease by multiparametric flowcytometry or molecular primer assays may be useful to determine the depth of complete remission as choosing the type of screening test will likely have a relevant impact in clinical decision making in MM. Disclosures: No relevant conflicts of interest to declare.

Response: Free light chain assay and stringent complete remission in multiple myeloma: more questions than answers

Blood ◽  
2010 ◽  
Vol 115 (16) ◽  
pp. 3414-3415
Author(s):  
Carlos Fernández de Larrea ◽  
María Teresa Cibeira ◽  
Montserrat Elena ◽  
Juan Ignacio Arostegui ◽  
Laura Rosiñol ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Complete Remission ◽  
Light Chain ◽  
Free Light Chain

The Serum Free Light Chain Ratio after One or Two Cycles of Treatment Is Highly Predictive of the Magnitude of Final Response in Patients Undergoing Initial Treatment for Multiple Myeloma.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3481-3481
Author(s):  
Hani Hassoun ◽  
Lilian Reich ◽  
Virginia M. Klimek ◽  
Madhav Dhodapkar ◽  
Adam Cohen ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Complete Remission ◽  
Light Chain ◽  
Initial Therapy ◽  
Free Light Chain ◽  
Light Chains ◽  
Al Amyloidosis ◽  
Serum Free ◽  
The Status ◽  
Final Response

Abstract BACKGROUND: The serum free light chains assay (FLC) has recently become commercially available for use in the management of multiple myeloma. This assay is more sensitive for the detection of monoclonal light-chains than previously available tests and has therefore found many unique applications. It can detect two-thirds of non-secretory multiple myelomas that were previously missed by immunofixation; it permits a more sensitive detection of monoclonal FLCs in AL amyloidosis; and it may allow earlier identification of disease recurrence in multiple myeloma and amyloidosis patients after treatment. We have sought to examine the usefulness of this assay as an early predictor of final response in patients with symptomatic multiple myeloma undergoing initial therapy. METHODS: We have performed an analysis of FLC assay in forty-five patients who were enrolled in an IRB approved phase II clinical trial whose main objectives were to determine the efficacy and toxicity of the administration of doxorubicin and dexamethasone, followed by thalidomide and dexamethasone in patients with untreated multiple myeloma (ASH 2004). The response to treatment was assessed based on the EORTC consensus criteria. Using Fisher’s exact test, we have evaluated the association between the status of the FLC ratio after cycle one and cycle two (i.e. normalized or persistently abnormal) and the status of response at the completion of 5 cycles of treatment, in patients with an abnormal FLC ratio at baseline (normal range 0.26 – 1.65). RESULTS: Of the 42 patients evaluable for response, 37 had an abnormal free light chain ratio at baseline (i.e. &lt; 0.26 or &gt; 1.65). Normalization of the FLC ratio after cycle one or cycle two occurred in seven out of 15 patients who achieved near complete remission (nCR) or complete remission (CR), and only in one of 22 patients who achieved partial remission (PR), stable disease (SD), or progression of disease (POD). Among the eight patients who had normalization of the FLC ratio after one or two cycles of treatment, seven achieved nCR or CR and one achieved PR. Normalization of the FLC ratio after one or two cycles of treatment was significantly associated with the achievement of CR or nCR (p=0.003). CONCLUSION: Normalization of the free light chain ratio after the first or the second cycle of treatment is highly predictive of achievement of nCR or CR at the completion of treatment. If this observation is confirmed in larger studies and for other regimens, the assessment of the free light chain ratio after two cycles may become an important milestone in the decision making for patients with multiple myeloma undergoing initial therapy. Since the aim of therapy is to achieve nCR or CR, the addition of alternative drugs might be advisable at an early stage of treatment in patients whose free light chain ratio remains abnormal.

Clinical Significance of Serum Free Light Chain Test in the First Onset of Multiple Myeloma

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4999-4999
Author(s):  
Pan Hong ◽  
Xiaojian Meng ◽  
Jingsong He ◽  
Wenjun Wu ◽  
Yi Li ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Survival Analysis ◽  
Clinical Significance ◽  
Light Chain ◽  
Conflicts Of Interest ◽  
Free Light Chain ◽  
Serum Free ◽  
Serum Free Light Chain ◽  
Sensitivity Assessment ◽  
First Onset

Abstract Abstract 4999 Objective: Clinical significance of serum free light chain (sFLC) test in the diagnosis, efficacy evaluation, prognosis judgment of first onset of multiple myeloma (MM). Method: Medical records of 39 cases of first-onset MM were gathered in our hospital from 1/2010 to 2/2012, including 25 male and 14 female patients with the median age being 63 years old. sFLC-kappa and sFLC-lambda were determined by immune turbidimetric assay, sFLC-kappa/lambda were calculated and the results were compared with that of immunofixation electrophoresis (IFE) as well as serum protein electrophoresis (SPE) for sensitivity assessment. All patients were treated with chemotherapy followed by sFLC detection and efficacy assessment. Patients with a sFLC results higher than median were marked as high-sFLC, the rest were marked as low-sFLC, and survival analysis were made comparing the two groups. Results: Of the 39 first-onset MM patients, 38 were detected as sFLC- kappa/lambda positive, that's a sensitivity of 97. 4%, higher than IFE (79. 5%), SPE (53. 8%), and uPE (38. 5%). As condition improves after treatment, sFLC gradually decline and sFLC- kappa/lambda level falls back to normal. Evaluation of efficacy by sFLC results has an accuracy of 77. 27%, significantly higher than that of corresponding M protein test£̈ P=0. 009£©. Follow-up survival analysis showed that the OS time and TTP time of low-sFLC group are significantly higher than those of high-sFLC group (P=0. 037, 0. 009 respectively). Conclusion: sFLC detection is a highly sensitive quantitative method, can help the diagnosis of MM, gives a quicker assessment of treatment efficacy, and can predict disease recurrence. When it's the first onset, sFLC level can also roughly forecast the prognosis. Disclosures: No relevant conflicts of interest to declare.

Abnormal serum free light chain ratio in patients with multiple myeloma in complete remission has strong association with the presence of oligoclonal bands: implications for stringent complete remission definition

Blood ◽  
2009 ◽  
Vol 114 (24) ◽  
pp. 4954-4956 ◽  
Author(s):  
Carlos Fernández de Larrea ◽  
María Teresa Cibeira ◽  
Montserrat Elena ◽  
Juan Ignacio Arostegui ◽  
Laura Rosiñol ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Complete Remission ◽  
Confidence Interval ◽  
Light Chain ◽  
Free Light Chain ◽  
Oligoclonal Bands ◽  
Prognostic Impact ◽  
Hematopoietic Stem ◽  
Serum Free ◽  
Serum Free Light Chain

AbstractThe prevalence of an abnormal serum free light chain (FLC) ratio in 34 patients with multiple myeloma in complete response (CR) after hematopoietic stem cell transplantation was studied. Fourteen of 34 patients (41.2%) showed an abnormal FLC ratio. The frequency of abnormal FLC ratio in patients with or without oligoclonal bands was 72.7% versus 26%, respectively (P = .023). The median value of FLC ratio was 2.55 (95% confidence interval, 1.89-3.20) in patients with oligoclonal bands versus 0.87 (95% confidence interval, 0.70-1.04) for those with no oligoclonal bands (P = .011). This is the first report showing that the presence of oligoclonal bands in patients with multiple myeloma in CR frequently results in an abnormal FLC ratio. Because an oligoclonal immune response is associated with a good outcome, our results question the current definition of stringent CR and support that the prognostic impact of oligoclonal bands should be also assessed on multivariate analysis.

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