Myeloma cells produce monoclonal proteins of varying types, most commonly immunoglobulins antibodies and free light chains, resulting in abnormally high levels of these proteins in the blood. Using data from the medical research council myeloma ix trial, a multicentre, randomized, openlabel, phase iii and factorialdesign. In particular, free light chain nephrotoxicity accounts for the high prevalence of renal impairment seen in lcmm. Immunoassay of these light chains has been a reputable diagnostic monitoring modality for light chain multiple myeloma 4. But myeloma cells can cause fatigue, easy bleeding and lowered resistance to infections. Kappa light chain multiple myeloma treatment mercy. Myeloma cast nephropathy mcn is a common cause of severe renal impairment in multiple myeloma mm. This type of myeloma is usually more severe than the classic kind. It is a rare disease characterized by deposition of nonamyloid immunoglobulin light chains, and they do not stain with congo red and do not exhibit a fibrillar structure when examined ultrastructurally. Prognostic value of serum free light chain in multiple myeloma article pdf available in the egyptian journal of immunology egyptian association of immunologists 222. Serumfree light chain analysis for the diagnosis, management. Comparison of three different serumfree lightchain assays. Jul 28, 2014 we intended to investigate the longterm clinical characteristics, responses to therapy and survival in patients with lightchain multiple myeloma mm. Serum free light chain assays have been used in a number of published studies which have indicated superiority over the urine tests, particularly for patients producing low levels of monoclonal free light chains, as seen in nonsecretory multiple myeloma and al amyloidosis.
L l f flc i t d ith th b flevels of flcs are associated with the number of. This is most helpful in the rare cases of myeloma in which no m protein is found by spep. The total light chain assay is not useful for myeloma patients and can sometimes get confused with the freelite test. We intended to investigate the longterm clinical characteristics, responses to therapy and survival in patients with lightchain multiple myeloma mm. Sebia, a world leader in multiple myeloma diagnostics and monitoring, announces today the launch of two newgeneration serum free light chain assays for multiple myeloma testing. International myeloma working group guidelines for serumfree light chain analysis in multiple myeloma and related disorders. The immunoassay for quantifying free immunoglobin light chains in serum sflc has been a valuable tool for diagnosing and monitoring light chain multiple myeloma mm 1, amyloid light chain. Immunoglobulin free light chain ratio is an independent risk factor for progression of smoldering asymptomatic multiple myeloma. It has a poorer prognosis when compared to immunoglobulin ig g or iga variant. Jan 15, 2008 an abnormal serum immunoglobulin free light chain flc ratio at baseline could help to further refine prognosis in smm based on the predictive power demonstrated for the flc ratio in patients with other plasma cell disorders. Light chain multiple myeloma lcmm constitutes approximately 15% of patients with multiple myeloma mm. Immunoglobulin free light chain ratio is an independent risk.
Cureus an overview of light chain multiple myeloma. A serum panel using serum free light chain analysis in combination with either serum protein electrophoresis or serum immunofixation has been shown in several studies to be a highly sensitive approach to screening for most plasma cell disorders. If the myeloma cells in the bone marrow are secreting lambda free light chains, then the freelite. Serum free light chains for monitoring multiple myeloma. Pdf international myeloma working group guidelines for. After a detailed screening, six studies involving a total of 1054 lcmm patients were included. The immunoassay for quantifying free immunoglobin light chains in serum sflc has been a valuable tool for diagnosing and monitoring lightchain multiple myeloma mm 1. Hematologic response is measured using the serum and urine electrophoresis and immunofixation tests, and the free lightchain assay. Among them, 66 patients received velcade bortezomib treatment. All the patients werestage iii in the duriesalmonstaging system.
Serum free light chain assays serum free light chain assays freelite are recommended by the nccn clinical practice guidelines in oncology and the international myeloma working group for use in the initial diagnostic workup of multiple myeloma and related disorders. Each patient with myeloma has one of the 10 different antibody subtypes as shown in the accompanying table. One particularly interesting aspect of serum flcs involves their short halflives in the blood. The two new assays aim to provide more consistent results by overcoming the challenges in analytical performance and coherence. Renal impairment ri is common in multiple myeloma mm and is associated with poor survival. Imwg guidelines for serum free light chain analysis in multiple myeloma and related disorders1 for the more than 3% of myeloma patients who have nonsecretory or oligosecretory disease, and for the majority of. In 2014, the international myeloma working group imwg updated the diagnostic criteria for mm to add three specific biomarkers that can be used to diagnose the disease in patients who did not have crab features.
Clinical manifestation is often heralded by hyperalcaemia, c renal impairment, normocytic normochromic naemia and one lesions, b a. May 20, 2015 my husband was diagnosed with multiple myeloma in january. Light chain multiple myeloma, clinic features, responses to. This study will evaluate patients with multiple myeloma and severe renal failure treated with kidney therapy previously called supra hfr to remove free light. In patients with multiple myeloma, the free light chain assay is important in predicting response to therapy and for predicting early signs of relapse, gasparetto says.
We performed a comprehensive literature search on lcmm and identified a total of 390 articles. Multiple myeloma early detection, diagnosis, and staging. With time, they can also cause bones to weaken and break. Mgus, monoclonal gammopathy of undetermined significance flc, free light. Serum free light chain measurements move to center stage. Serum free light chain ratio as a biomarker for highrisk smoldering multiple myeloma. Multiple myeloma mm is a prototypic monoclonal bcell malignancy with a terminally differentiated plasma cell phenotype and monoclonal immunoglobulin secretion in the majority of cases.
Free light chains circulate in the blood atfree light chains circulate in the blood at abnormally highabnormally high levels in many patients with al amyloidosis. When a light chain is not attached to a heavy chain, it is known as a free light chain. About 20 out of 100 people with myeloma 20% do not produce complete immunoglobulins. Since the spep measures the levels of intact whole antibodies, it cannot. The sflca is an important advance in the diagnosis and monitoring of al amyloidosis.
The increasing evidence for clonal diversity and evolution in multiple myeloma highlights the importance of laboratory algorithms that measure both intact immunoglobulins and monoclonal flcs, at diagnosis and when monitoring response to. This study reports the associations between renal function and disease characteristics including serum free light chain flc level at diagnosis in patients with mm. They only produce part of the immunoglobulin called the light chain. Sserum free light chain infoguide april 2016 dd 7erum free light chain infoguide april 2016 dd 7 221042016 17. In all of these abnormal patients the abnormal kappalambda ratio was caused by abnormalities in. They may also be useful in patients producing intact immunoglobulins. As many as 18 percent of all multiple myeloma cancer patients have the light chain myeloma variety. Free light chain results can be converted back and forth in terms of units easily just by dividing or multiplying by 10. An abnormal serum immunoglobulin free light chain flc ratio at baseline could help to further refine prognosis in smm based on the predictive power demonstrated for the flc ratio in patients with other plasma cell disorders. Sep 26, 2019 light chain deposition disease lcdd is the deposition of monoclonal light chains in multiple organs. It is a malignant disease characterized by abnormal proliferation of plasma cells and monoclonal immunoglobulins or free light chains flc. My husband was diagnosed with multiple myeloma in january.
This study aims to guide the integration of serum free light chain sflc tests into clinical practice, including a new rapid test seralite. When abnormal amounts of free light chain bence jones protein are present in urine, they are normally detected by urine protein electrophoresis upep and immunofixation. Since the spep measures the levels of intact whole antibodies, it cannot measure the amount of light. Lightchain myeloma, also known as lightchain disease, is a type of multiple myeloma in which the malignant bone marrow cells produce free monoclonal light chain proteins. Serum free light chain ratio in correlation with serum protein electrophoresis in. Living with abnormal free light chain ratios the myeloma. In addition, it has been the mainstay of diagnosis for disorders such as al amyloidosis and lcmm, in which the. Apr 03, 2020 light chain myeloma, also known as light chain disease, is a type of multiple myeloma in which the malignant bone marrow cells produce free monoclonal light chain proteins. Blood and urine analysis from 5573 newly diagnosed myeloma patients identi.
In wm, the range of values is not as extreme as in myeloma. Each plasma cell can make only one type of heavy chain and one type of light chain. The serum free light chain assay sflca is a blood test that measures the levels of light chains and can be used to determine al amyloidosis activity and response to. The level of free light chain flc that causes mcn varies substantially and there is.
May 01, 2005 using serum free light chain assays in the myeloma clinic, submitted for publication. International myeloma working group guidelines for serum free light chain analysis in multiple myeloma and related disorders. Distributions of k and l flc in normal, multiple myeloma and polyclonal. Combined use of free light chain and heavylight chain ratios allow. Unlinked light chains are sent into the bloodstream and are known as free light chains. Serum free lightchain assays have been used in a number of published studies which have indicated superiority over the urine tests, particularly for patients producing low levels of monoclonal free light chains, as seen in nonsecretory multiple myeloma and al amyloidosis. Between january 2012 and march 2014, 90 patients were examined. Light chain myeloma sometimes called bence jones myeloma. Hematologic response is measured using the serum and urine electrophoresis and immunofixation tests, and the free light chain assay. Serum free light chain analysis for diagnosis, monitoring. Serum free light chain analysis and urine immunofixation. Imwg guidelines for serum free light chain analysis in multiple myeloma and related disorders for the more than 3% of myeloma patients who have nonsecretory or oligosecretory disease, and for the majority of patients with al amyloidosis al, the traditional methods of measuring circulating monoclonal immunoglobulins electrophoresis. Potential pitfalls of serum free light chain analysis to assess treatment response for multiple myeloma. The most common cause of kidney failure in multiple myeloma is due to proteins secreted by the malignant cells.
Updated diagnostic criteria and staging system for multiple. Light chains are proteins that link up with other proteins called heavy chains to form antibodies. Light chain multiple myeloma malaysian journal of pathology. Monitor response to treatment sonora quest laboratories. With this disorder, theres an overabundance of a specific antibody protein the kappa light chain protein. If the myeloma cells are releasing kappa free light chains, the freelite test will show a high level of kappa light chain protein and a normal, or lower than normal, level of lambda light chains. The normal plasmacell production of free light chains is from 0. Kidney therapy for free light chain removal in patients with. The serum free light chain assay sflca is a blood test that measures the levels of light chains and can be used to determine al amyloidosis activity and response to treatment. Abnormal levels of free light chains in the blood can be a sign of multiple myeloma or another serious disorder. The latter, designated as light chain multiple myeloma lcmm makes up almost 20% of myelomas. Serum free light chains this blood test can measure the light chain levels in the blood and is done when looking for myeloma or light chain amyloidosis.
Sebia launches newgeneration serum free light chain sflc. The increasing evidence for clonal diversity and evolution in multiple myeloma highlights the importance of laboratory algorithms that measure both intact immunoglobulins and monoclonal flcs, at diagnosis and when monitoring response to treatment. Multiple myeloma mm constitutes for 10% of all hematological malignancies and 1% of all malignancies 12. Pdf measurement of serum free light chains flcs has recently become available. Imwg guidlines serumfree light chain int myeloma fn. Monoclonal free light chains flcs are important disease biomarkers in patients with plasma cellproliferative disorders. This article is a retrospective study of 142 multiple myeloma patients with 12% having an abnormal serum free light chain ratio but with otherwise no evidence of disease. Serum free light chains in clinical laboratory diagnostics. After a detailed screening, six studies involving a total of 1054 lcmm patients were. Pdf prognostic value of serum free light chain in multiple.
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