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

scholarly journals Multiple myeloma can be accurately diagnosed in acute kidney injury patients using a rapid serum free light chain test

2017 ◽  
Vol 18 (1) ◽  
Author(s):  
Jennifer L. J. Heaney ◽  
John P. Campbell ◽  
Punit Yadav ◽  
Ann E. Griffin ◽  
Meena Shemar ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Acute Kidney Injury ◽  
Light Chain ◽  
Kidney Injury ◽  
Free Light Chain ◽  
Serum Free ◽  
Serum Free Light Chain

scholarly journals High serum-free light chain levels and their rapid reduction in response to therapy define an aggressive multiple myeloma subtype with poor prognosis

Blood ◽  
2007 ◽  
Vol 110 (3) ◽  
pp. 827-832 ◽  
Author(s):  
Frits van Rhee ◽  
Vanessa Bolejack ◽  
Klaus Hollmig ◽  
Mauricio Pineda-Roman ◽  
Elias Anaissie ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Light Chain ◽  
Prognostic Significance ◽  
Complete Response ◽  
High Serum ◽  
Free Light Chain ◽  
Response To Therapy ◽  
Rapid Reduction ◽  
Serum Free ◽  
Serum Free Light Chain

Abstract Serum-free light chain (SFLC) levels are useful for diagnosing nonsecretory myeloma and monitoring response in light-chain–only disease, especially in the presence of renal failure. As part of a tandem autotransplantation trial for newly diagnosed multiple myeloma, SFLC levels were measured at baseline, within 7 days of starting the first cycle, and before both the second induction cycle and the first transplantation. SFLC baseline levels higher than 75 mg/dL (top tertile) identified 33% of 301 patients with higher near-complete response rate (n-CR) to induction therapy (37% vs 20%, P = .002) yet inferior 24-month overall survival (OS: 76% vs 91%, P < .001) and event-free survival (EFS: 73% vs 90%, P < .001), retaining independent prognostic significance for both EFS (HR = 2.40, P = .008) and OS (HR = 2.43, P = .016). Baseline SFLC higher than 75 mg/dL was associated with light-chain–only secretion (P < .001), creatinine level 176.8 μM (2 mg/dL) or higher (P < .001), beta-2-microglobulin 297.5 nM/L (3.5 mg/L) or higher (P < .001), lactate dehydrogenase 190 U/L or higher (P < .001), and bone marrow plasmacytosis higher than 30% (P = .003). Additional independent adverse implications were conferred by top-tertile SFLC reductions before cycle 2 (OS: HR = 2.97, P = .003; EFS: HR = 2.56, P = .003) and before transplantation (OS: HR = 3.31, P = .001; EFS: HR = 2.65, P = .003). Unlike baseline and follow-up analyses of serum and urine M-proteins, high SFLC levels at baseline—reflecting more aggressive disease—and steeper reductions after therapy identified patients with inferior survival.

Prognostic value of serum free light chain ratio in Multiple Myeloma

Pathology ◽  
2009 ◽  
Vol 41 ◽  
pp. 76
Author(s):  
Nani Nordin ◽  
P. Sthaneshwar ◽  
Veera S. Nadarajan
Keyword(s):  
Multiple Myeloma ◽  
Light Chain ◽  
Prognostic Value ◽  
Free Light Chain ◽  
Serum Free ◽  
Serum Free Light Chain

Changes in Serum Free Light Chain and Biochemical Markers in Patients with Multiple Myeloma Receiving Bortezomib Treatment.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5028-5028
Author(s):  
Chang-Ki Min ◽  
Ki-Seong Eom ◽  
Seok Lee ◽  
Jong-Wook Lee ◽  
Woo-Sung Min ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Light Chain ◽  
Biochemical Markers ◽  
Objective Response ◽  
Chemotherapeutic Agents ◽  
Free Light Chain ◽  
Response To Treatment ◽  
Serum Free ◽  
Serum Free Light Chain ◽  
Bortezomib Treatment

Abstract Bortezomib alone or in combination with chemotherapeutic agents produce a rapid disease control in patients with multiple myeloma (MM). However, laboratory factors predictive of outcome with bortezomib remain obscure. The aim of this study is to determine whether serum free light chain (SFLC) measurements could be a new sensitive test for the early detection of response to treatment with bortezomib and to perform an analysis of biochemical markers to determine their value in predicting response. Data from evaluable 49 patients receiving 2–7 cycles (median, 4) of bortezomib were analyzed. During the first and second cycles of bortezomib treatment, serial serum samples were prospectively collected for simultaneous measurement of SFLC, intact immunoglobulin (Ig) and biochemical markers such as lactic dehydrogenase (LDH), alkaline phosphatase (ALP), uric acid, calcium and phosphorus. SFLC and Ig were measured on day 0 and 12 each cycle and the biochemical markers on day 0, 2, 5, 9 and 12. Twenty-seven patients, 10, 1, 1 and 8 were IgG, IgA, IgM, IgD myelomas and light chain disease (LCD), respectively. Two patients did not secrete monoclonal protein. Patients received bortezomib alone (n=25) 1.0–1.3 mg/m2 for 3–4 week cycles along with various combinations including dexamethasone, thalidomide and/or doxorubicin (n=24). Forty of 49 patients (81.6%) showed an objective response (CR+PR) response upon completion of bortezomib treatment while 9 patients had &lt;PR by EBMT criteria according to monoclonal Ig concentration. Thirty-two of 39 patients (82.1%) with intact Ig MM patients had an abnormal SFLC concentration kinetics after the second bortezomib treatment. All 8 patients with LCD and 2 patients with non-secretory MM showed elevated concentrations of one or both SFLC. In comparison to the intact Ig levels, SFLC concentrations fell more rapidly in response to bortezomib treatment and the pattern of initial SFLC response seems to be an early indication of tumor response or resistance (see the figure; the response after the second cycle was assessed by concentrations of intact Ig or SFLC, respectively). The increase of LDH levels from baseline between two groups during and upon completion of two cycles of therapy was statistically significant (P=0.001). The increase of UA levels from baseline exhibited a marginal significance (P=0.081). In addition, we observed significantly higher mean ALP elevation in the responder group compared with the non-responder group during the two cycles (P=0.027). The monitoring of SFLC provides a unique opportunity to follow the kinetics of tumor kill especially when the monoclonal Ig was not detected. In addition, changes in SFLC concentrations can be used as an early biomarker to assess a rapid response to bortezomib treatment. Biochemical marker assays showed that the response to bortezomib might be associated with tumor lysis and/or osteoblastic activation. Response to bortezomib treatment Response to bortezomib treatment

Early Normalization of Serum Free Light Chain Is Associated with Prolonged Time to Progression Following Bortezomib ± Pegylated Liposomal Doxorubicin Treatment of Relapsed/Refractory Multiple Myeloma.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2735-2735 ◽  
Author(s):  
Robert Orlowski ◽  
Heather Sutherland ◽  
Joan Bladé ◽  
Jesús San Miguel ◽  
Roman Hájek ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Light Chain ◽  
Liposomal Doxorubicin ◽  
Pegylated Liposomal Doxorubicin ◽  
Response Rates ◽  
Free Light Chain ◽  
Time To Progression ◽  
Serum Free ◽  
Refractory Multiple Myeloma ◽  
Serum Free Light Chain

Abstract Multiple myeloma (MM), like other monoclonal gammopathies, frequently causes impairment of the κ/λ serum free light chain (sFLC) ratio. Based on a short serum half-life of FLC as compared to the complete immunoglobulin (hours versus days), early normalization of κ/λ could predict for response to treatment. As part of a randomized, controlled study, we examined the association between normalization of the κ/λ ratio after one or two 21-day cycles of treatment with bortezomib (B) ± pegylated liposomal doxorubicin (PLD) among patients with relapsed/refractory multiple myeloma. Patients with ≥1 prior therapy were randomized to receive PLD 30 mg/m2 on day 4 and B 1.3 mg/m2 on days 1, 4, 8, and 11, or B alone for up to eight 21-day cycles, or at least 2 cycles beyond complete response (CR) or optimal response, unless disease progression or unacceptable toxicities occurred (Orlowski, JCO 2007). κ/λ measurements were carried out prior to the start of therapy and at the end of each cycle through the entire study period using an immunoassay (Freelite, The Binding Sites, Birmingham, UK). Serial sFLC κ/λ measurements were available on sera from 487 patients with baseline values out of a total of 646 study patients. At baseline, 458/487 patients (94%) had an abnormal κ/λ ratio (<0.26 or >1.65). The percentage of patients with normal κ/λ ratio increased from 6% at baseline to 12% after cycle 1, 17% after cycle 2 and 23% by the end of the study. Among patients with a normal κ/λ ratio after cycle 1 (n=54), the median time to progression (TTP) was 345 days compared to 225 days in patients with abnormal ratios (n=395, p=0.0005, HR=0.47 favoring normalization). Following cycle 2, TTP was 325 days vs. 224 days (p≤0.001) in patients with normal (n=72) vs. abnormal (n=348) ratios, respectively. Additionally, patients with normalized sFLC ratios showed significantly higher overall response rates as compared to those with persistently abnormal ratios (≥ partial response [PR] 73% vs. 47%, p=0.001 following cycle 1, and 77% vs. 48%, p<0.0001 following cycle 2, respectively). Similarly, CR + very good PR rates were significantly higher among patients with normalized sFLC ratios after cycles 1 and 2 (p<0.0001 and p<0.001 respectively). As reported previously, both treatments, B + PLD and B alone, were well tolerated (Orlowski, JCO 2007). Normalization of the sFLC ratio as early as after cycle 1 of B + PLD, or B alone, was associated with a prolonged TTP and higher response rates. Additional analyses are undertaken to evaluate whether Freelite data: predict treatment outcome earlier than electrophoresis, and correlate with 24-hour urine M-protein.

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