scholarly journals The experience of free light chains of immunoglobulin elimination in patients with monoclonal gammopathies

2019 ◽  
Vol 14 (2) ◽  
pp. 8-12
Author(s):  
E. G. Gromova ◽  
P. A. Zeynalova ◽  
N. V. Lubimova ◽  
Yu. S. Timofeev ◽  
N. E. Kushlinskiy ◽  
...  
Keyword(s):  
Renal Failure ◽  
Tumor Therapy ◽  
Light Chains ◽  
Free Light Chains ◽  
Monoclonal Gammopathies

The objective of study is to estimate the efficiency of extracorporeal free light chains of immunoglobulin elimination in patients with monoclonal gammopathies (n = 12) during hemodialysis using selective filters.Materials and methods. A blood and dialysate free light chains concentrations change was criterion of efficiency.Results and conclusion. The selective free light chains filtration give the possibility of an adequate anti-tumor therapy, could prevent the development of irreversible renal failure and hypoalbuminemia.

scholarly journals Relationship between circulating syndecan-1 levels (CD138s) and serum free light chains in monoclonal gammopathies

2015 ◽  
Vol 34 (1) ◽  
Author(s):  
Giovanni Cigliana ◽  
Eleonora Torti ◽  
Francesca Gulli ◽  
Elena De Santis ◽  
Maria Teresa Dell’Abate ◽  
...  
Keyword(s):  
Light Chains ◽  
Free Light Chains ◽  
Serum Free ◽  
Monoclonal Gammopathies ◽  
Serum Free Light Chains

IgD-λ multiple myeloma with excessive excretion of free light chains: a diagnostic trap in the identification of monoclonal gammopathies

2019 ◽  
Vol 77 (1) ◽  
pp. 107-111
Author(s):  
Hanane Zahir ◽  
Abdelali Tali ◽  
Meryem Rachidi ◽  
Hanane Mouhib ◽  
Hayat Daif ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Light Chains ◽  
Free Light Chains ◽  
Monoclonal Gammopathies

scholarly journals Serum Free Light Chains: An Alternative to the Urine Bence Jones Proteins Screening Test for Monoclonal Gammopathies

2006 ◽  
Vol 52 (9) ◽  
pp. 1743-1748 ◽  
Author(s):  
Peter G Hill ◽  
Julia M Forsyth ◽  
Baldeep Rai ◽  
Stewart Mayne
Keyword(s):  
Light Chain ◽  
False Positive ◽  
False Positive Rate ◽  
Light Chains ◽  
Free Light Chains ◽  
Serum Free ◽  
Monoclonal Gammopathies ◽  
Positive Serum ◽  
Positive Rate ◽  
Serum Free Light Chains

Abstract Background: Retrospective analyses have established the role of quantitative serum free light chains (FLCs) in the diagnosis of monoclonal light chain disorders. The aims of this study were to assess (a) whether the addition of serum FLCs to serum protein electrophoresis (SPEP) identified additional patients with monoclonal gammopathies; (b) whether serum FLC measurements could replace urinalysis for Bence Jones protein (BJP); and (c) the cost/quality implications of routinely measuring serum FLCs. Methods: Serum FLCs were added to consecutive requests for SPEP from August to November 2004 and measured by automated immunoassay. Results: Seventy-one of 923 patients had abnormal serum FLC ratios. Seven patients with monoclonal gammopathies and 1 patient with malignant lymphoma (but no monoclonal band) were detected among 43 patients with negative SPEP but positive serum FLC ratios. Thirty-five patients with negative SPEP had false-positive serum FLC ratios. The false-positive rate for a ratio >1.65 was higher than previously described and associated with polyclonal increases in immunoglobulins and renal impairment. Serum FLC ratios were normal in 2 of 13 patients with low-level persistent urine BJP. However, no significant pathology would have been missed by replacing BJP with serum FLCs. Revenue and manpower savings offset 60% of the costs of serum FLCs. Conclusions: Additional diagnostic information is gained by adding serum FLCs to SPEP as first-line tests for investigating possible B-cell disorders. The quality of the diagnostic service is enhanced by more confident exclusion of light chain disorders and improved interpretive assessment of SPEP and immunofixation electrophoresis.

scholarly journals Recommendations for Use of Free Light Chain Assay in Monoclonal Gammopathies

2010 ◽  
Vol 29 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Vesna Radović
Keyword(s):  
Plasma Cell ◽  
Light Chain ◽  
High Sensitivity ◽  
Protein Electrophoresis ◽  
Free Light Chain ◽  
Light Chains ◽  
Free Light Chains ◽  
Bone Marrow Biopsies ◽  
Monoclonal Gammopathies ◽  
Plasma Cell Disorders

Recommendations for Use of Free Light Chain Assay in Monoclonal GammopathiesThe serum immunoglobulin free light chain assay measures levels of free κ and λ immunoglobulin light chains. There are three major indications for the free light chain assay in the evaluation and management of multiple myeloma and related plasma cell disorders. In the context of screening, the serum free light chain assay in combination with serum protein electrophoresis and immunofixation yields high sensitivity, and negates the need for 24-hour urine studies for diagnoses other than light chain amyloidosis. Second, the baseline free light chains measurement is of major prognostic value in virtually every plasma cell disorder. Third, the free light chain assay allows for quantitative monitoring of patients with oligosecretory plasma cell disorders, including AL, oligosecretory myeloma, and nearly twothirds of patients who had previously been deemed to have non-secretory myeloma. In AL patients, serial free light chains measurements outperform protein electrophoresis and immunofixation. In oligosecretory myeloma patients, although not formally validated, serial free light chains measurements reduce the need for frequent bone marrow biopsies. In contrast, there are no data to support using free light chain assay in place of 24-hour urine electrophoresis for monitoring or for serial measurements in plasma cell disorders with measurable disease by serum or urine electrophoresis.

scholarly journals Method comparison of three serum free light chain assays on the Roche Cobas 6000 c501 chemistry analyzer

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Dieuwertje Augustijn ◽  
Joannes F. M. Jacobs ◽  
Henk Russcher
Keyword(s):  
Method Comparison ◽  
Therapy Response ◽  
Reference Intervals ◽  
Light Chains ◽  
Reference Ranges ◽  
Free Light Chains ◽  
Monoclonal Gammopathies ◽  
Serum Free Light Chain ◽  
Roche Diagnostics ◽  
Roche Cobas

Abstract Objectives Free light chains (FLC) are important in the diagnosis, prognosis and monitoring of therapy response of patients with monoclonal gammopathies. In this study, we performed a method comparison of three FLC assays on the Cobas 6000 c501 chemistry analyzer of Roche Diagnostics. Methods Samples of 119 patients with various monoclonal gammopathies and 26 control patients were measured with the Freelite (The Binding Site), Diazyme (Diazyme Laboratories) and KLoneus (Trimero Diagnostics) FLC assays. A method comparison was performed and reference intervals of the three assays were validated. Results The analysis of the Bland-Altman agreement showed bias between the three FLC assays, ranging from −62.7 to 5.1% for κFLC and between −29.2 to 80.5% for λFLC. The Freelite and Diazyme assays have the highest agreement. The concordance of the FLC-ratio ranges from 41 to 75%, with the highest concordance between the Freelite and KLoneus assays. The FLC-ratio in 25 sera from healthy controls were within the reference ranges of the Freelite and KLoneus assays. The FLC-ratio was elevated in all 25 samples tested with the Diazyme assay. Conclusions The agreement for the free light chains is highest between the Freelite and the Diazyme assay and fair for the KLoneus assay. However, concordance of the FLC-ratio is highest when the Freelite and KLoneus assays were compared. Our data suggest that concordance for the Diazyme assay could be improved by recalibration. Because of absolute differences between the three methods in individual patients, none of the three FLC assays can be used interchangeably.

Efficient Removal of Immunoglobulin Free Light Chains by Hemodialysis in Multiple Myeloma: In-Vitro and In-Vivo Studies.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5112-5112
Author(s):  
Colin A. Hutchison ◽  
Paul Cockwell ◽  
Steven Reid ◽  
Katie Chandler ◽  
Graham P. Mead ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Renal Failure ◽  
Plasma Exchange ◽  
Serum Proteins ◽  
In Vivo Studies ◽  
Light Chains ◽  
Free Light Chains ◽  
Clinical Value ◽  
Low Efficiency

Abstract Of newly diagnosed patients with multiple myeloma, 12–20% present with acute renal failure caused by monoclonal free light chains (FLCs). Plasma exchange can reduce the pre-renal load of FLCs but randomised controlled trials have shown no clinical benefit. This disappointing outcome can be explained by the low efficiency of the procedure. A model of FLC production, distribution and metabolism in myeloma patients indicated that plasma exchange might remove only 5–10% of the total body FLCs over a three-week period. To improve removal rates we have used prolonged hemodialysis with a protein leaking dialyser. In-vitro studies indicated that the Gambro HCO 1100 dialyser, with pores of 100kDa, was the most efficient of seven tested. This dialyser was used in 10 patients with myeloma and renal failure, as part of their hemodialysis treatment, to assess FLC removal efficiency. Three of the patients were studied at initial clinical presentation with biopsy proven FLC cast nephropathy. Routine chemotherapy was used, together with prolonged daily hemodialysis and multiple measurements of FLCs in serum, urine and dialysate fluid. Serum FLCs were reduced by 40 to 70% within one hour then reduction slowed as extravascular re-equilibration occurred. FLC concentrations rebounded on successive days until chemotherapy was effective. 1.5kg of FLCs was removed from one patient over 6 weeks and another became independent of dialysis. Prolonged hemodialysis allowed removal of 5–10 times more FLCs than plasma exchange without attendant clotting problems and removal of many serum proteins (Figure 1). Proof of clinical value will require further studies. Simulations of aFLC removal by plasma exchange versus hemodialysis on the Gambro HCO 1100. Simulations: 1) 100% tumor kill on day one with only reniculoendothetial removal; 2) 10% tumor kill per day reniculoendothetial removal alone; 3) 10% tumor kill per day with plasma exchange (3.5 liters exchange in 1.5 hrs × 6 over 10 days); 4) 10% tumor kill per day with hemodialysis for 4 hours, 3 times a week; 5) 10% tumor kill per day with hemodialysis for 4 hours per day; 6) 10% tumor kill per day with hemodialysis for 12 hours per day; 7) No tumor kill with 8 hours hemodialysis on alternate days 8) No tumor kill with no direct removal. Simulations of aFLC removal by plasma exchange versus hemodialysis on the Gambro HCO 1100. Simulations: 1) 100% tumor kill on day one with only reniculoendothetial removal; 2) 10% tumor kill per day reniculoendothetial removal alone; 3) 10% tumor kill per day with plasma exchange (3.5 liters exchange in 1.5 hrs × 6 over 10 days); 4) 10% tumor kill per day with hemodialysis for 4 hours, 3 times a week; 5) 10% tumor kill per day with hemodialysis for 4 hours per day; 6) 10% tumor kill per day with hemodialysis for 12 hours per day; 7) No tumor kill with 8 hours hemodialysis on alternate days 8) No tumor kill with no direct removal.

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