A346 Prospective Study of Serum FLC and Other M-Protein Assays: When and How to Measure Response?

Drayson, MT; Morgan, GJ; Jackson, GH; Davies, FE; Owen, RG; Ross, FM; Gregory, WM; Navarro-Coy, Nuria; Heatley, F. W.; Bell, SE; Szubert, AJ; Child, J. A.

doi:10.1016/s1557-9190(11)70552-2

Cited by 8 publications

(4 citation statements)

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“…Recently, Hungria et al 20 published a study comparing the sensitivity of the sFLC assays to the total light chain assays for samples obtained from 114 light chain MM (LCMM) patients taken through the course of their disease. In keeping with previous reports 15 , 19 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 the FLC identified clonality in 11/11 samples at presentation and identified persistent disease in 80/103 samples taken throughout the course of the disease. In contrast, the total light chain assay identified only 2/11 samples at presentation and 25/103 samples taken throughout the course of the disease.…”

Section: Differences Between the Freelite And Total Light Chain Assaysupporting

confidence: 89%

Serum free light chain assays not total light chain assays are the standard of care to assess Monoclonal Gammopathies

Hungria

Allen²,

Kampanis³

et al. 2016

Revista Brasileira de Hematologia e Hemoterapia

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The diagnosis of Multiple Myeloma is a challenge to the physician due to the non-specific symptoms (anemia, bone pain and recurrent infections) that are commonplace in the elderly population. However, early diagnosis is associated with less severe disease, including fewer patients presenting with acute renal injury, pathological fractures and severe anemia. Since 2006, the serum free light chain test Freelite® has been included alongside standard laboratory tests (serum and urine protein electrophoresis, and serum and urine immunofixation) as an aid in the identification of monoclonal proteins, which are a cornerstone for the diagnosis of Multiple Myeloma. The serum free light chain assay recognizes the light chain component of the immunoglobulin in its free form with high sensitivity. Other assays that measure light chains in the free and intact immunoglobulin forms are sensitive, but unfortunately, due to the nomenclature used, these assays (total light chains) are sometimes used in place of the free light chain assay. This paper reviews the available literature comparing the two assays and tries to clarify hypothetical limitations of the total assay to detect Multiple Myeloma. Furthermore, we elaborate on our study comparing the two assays used in 11 Light Chain Multiple Myeloma patients at presentation and 103 patients taken through the course of their disease. The aim of this article is to provide a clear discrimination between the two assays and to provide information to physicians and laboratory technicians so that they can utilize the International Myeloma Working Group guidelines.

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Section: Differences Between the Freelite And Total Light Chain Assaysupporting

confidence: 89%

Serum free light chain assays not total light chain assays are the standard of care to assess Monoclonal Gammopathies

Hungria

Allen²,

Kampanis³

et al. 2016

Revista Brasileira de Hematologia e Hemoterapia

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“…Although molecular techniques cannot strictly detect entire (tumor) cells, including CTPC, quantitation of some unique genetic (e.g., DNA) tumor markers such as patient-specific IGH-V(D)J gene rearrangements of CTPC has been long proven to closely reflect the tumor cell load [ 114 , 118 , 129 ]. This is in contrast with techniques that measure the M-component (e.g., immunofixation and/or mass spectrometry) [ 130 , 131 ], because the serum levels of the monoclonal protein produced by the tumor PC depend on several parameters other than the number of CTPC, such as the tumor load in other tissues (e.g., BM), the (highly variable) amount of protein produced by individual tumor PC among different plasma cell neoplasms patients, and its half-life [ 132 ]. So far, most studies in which molecular techniques have been used for CTPC detection in plasma cell neoplasms have focused on MM patients evaluated at diagnosis and/or after starting therapy [ 133 ].…”

Section: Detection Of Circulating Tumor Plasma Cellsmentioning

confidence: 99%

Detection of Circulating Tumor Plasma Cells in Monoclonal Gammopathies: Methods, Pathogenic Role, and Clinical Implications

Sanoja-Flores

Flores‐Montero

Pérez-Andrés

et al. 2020

Cancers

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Cancer dissemination and distant metastasis most frequently require the release of tumor cells into the blood circulation, both in solid tumors and most hematological malignancies, including plasma cell neoplasms. However, detection of blood circulating tumor cells in solid tumors and some hematological malignancies, such as the majority of mature/peripheral B-cell lymphomas and monoclonal gammopathies, has long been a challenge due to their very low frequency. In recent years, the availability of highly-sensitive and standardized methods for the detection of circulating tumor plasma cells (CTPC) in monoclonal gammopathies, e.g., next-generation flow cytometry (NGF), demonstrated the systematic presence of CTPC in blood in virtually every smoldering (SMM) and symptomatic multiple myeloma (MM) patient studied at diagnosis, and in the majority of patients with newly-diagnosed monoclonal gammopathies of undetermined significance (MGUS). These methods set the basis for further detailed characterization of CTPC vs. their bone marrow counterpart in monoclonal gammopathies, to investigate their role in the biology of the disease, and to confirm their strong impact on patient outcome when measured both at diagnosis and after initiating therapy. Here, we review the currently available techniques for the detection of CTPC, and determine their biological features, physiopathological role and clinical significance in patients diagnosed with distinct diagnostic categories of plasma cell neoplasms.

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“…In contrast, a significant fraction of our CTPC 2 cases were BM MRD 1 and/or sIF 1 , supporting the notion that MM is a BM disease with greater levels of infiltration by (usually) functional PC in BM vs PB. Prolonged half-life (;23 days) and complete clearance (;29 weeks) of the M-protein for the most prevalent immunoglobulin G subclass, 17 in addition to persistence of extramedullary disease 18 and/or the administration of monoclonal antibody-therapy (eg, daratumumab) 19 for MM patients, might also explain sIF positivity in at least a subset of BM MRD 2 /sIF 1 cases. Additionally, poor BM sample quality (eg, from hemodilution) might also play a role because abnormally low (#0.002%) 4 mast cell counts were detected here in 5/10 BM MRD 2 /sIF 1 cases.…”

mentioning

confidence: 99%

Blood monitoring of circulating tumor plasma cells by next generation flow in multiple myeloma after therapy

Sanoja-Flores

Flores‐Montero

Puig

et al. 2019

Blood

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A346 Prospective Study of Serum FLC and Other M-Protein Assays: When and How to Measure Response?

Cited by 8 publications

References 0 publications

Serum free light chain assays not total light chain assays are the standard of care to assess Monoclonal Gammopathies

Serum free light chain assays not total light chain assays are the standard of care to assess Monoclonal Gammopathies

Detection of Circulating Tumor Plasma Cells in Monoclonal Gammopathies: Methods, Pathogenic Role, and Clinical Implications

Blood monitoring of circulating tumor plasma cells by next generation flow in multiple myeloma after therapy

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