Can serum free light chains replace urine electrophoresis in the detection of monoclonal gammopathies?

Beetham, Robert; Wassell, Julie; Wallage, Michael; Whiteway, Alastair; James, Jacky A

doi:10.1258/000456307782268084

Cited by 54 publications

(40 citation statements)

References 19 publications

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“…In the large screening studies by Hill et al (2006) and Katzmann et al (2006) two such patients were identified but none required medical intervention. Beetham et al (2007) also identified similar patients but did not correlate this with any clinical outcomes. These patients are likely to have MGUS with a small monoclonal FLC together with normal polyclonal FLC leaking into the urine presumably through damaged renal tubules.…”

Section: Serum Flc As a Marker Of Residual Diseasementioning

confidence: 92%

The evolving use of serum free light chain assays in haematology

Pratt

2008

Br J Haematol

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SummaryOver the last few years new immunoassays have emerged that allow the measurement of free immunoglobulin light chains (FLCs) in serum to a level of 2–4 mg/l and provide a much greater sensitivity than older methods, such as immunofixation, which is able to detect FLCs at a minimum concentration of 100–150 mg/l. The new FLC assay has enabled the detection of monoclonal protein in some patients with non‐secretory myeloma and amyloidosis that were previously undetectable. FLC measurements are quantitative, correlating with disease activity, and are an advance in monitoring light chain only multiple myeloma, AL amyloidosis, non‐secretory and oligo‐secretory multiple myeloma. Serum FLC concentrations also reflect the disease course in the majority of myeloma patients producing intact monoclonal immunoglobulin proteins and have been incorporated into the new response criteria. The rapid half life of λ and κ free light chains means that FLC assays may provide a more rapid indication of the response to treatment but their clinical utility in this setting needs further study. An abnormal FLC ratio has been shown to be a risk factor for progression of monoclonal gammopathy of undetermined significance, smouldering myeloma and solitary plasmacytoma of bone and is prognostic in multiple myeloma.

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Section: Serum Flc As a Marker Of Residual Diseasementioning

confidence: 92%

The evolving use of serum free light chain assays in haematology

Pratt

2008

Br J Haematol

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“…In the study by Hill et al 23 in the UK, there was an additional cost of $9 per patient to include the FLC assay. Since in many laboratories the initial blood sample is accompanied by urine Table 2 Rates of abnormal FLC ratio in different plasma cell disorders 21 there may be cost increases. Both patients and physicians are reluctant to do 24-h urine collections because of the inconvenience posed, but depending on the indication for the original monoclonal protein study of the blood, they could be missing at least 10-17% of cases with either AL amyloidosis or LCMM by doing serum IFE alone.…”

Section: Urine Flc Assaymentioning

confidence: 99%

International Myeloma Working Group guidelines for serum-free light chain analysis in multiple myeloma and related disorders

Dispenzieri

Kyle

Merlini³

et al. 2008

Leukemia

678

506

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“…Since we were intrigued by the potential use of the FLC analysis alone as a sensitive and rapid screening tool for Mproteinemia, as suggested in the paper from Abadie and Bankson (22), we studied the efficiency of the FLCs assay as a screening tool. It has been reported previously that reference values might be platform dependent (24,25). Thus, as a first step, we established local reference values using our Modular P analyzer.…”

Section: Discussionmentioning

confidence: 99%

“…However, the reference ranges have been shown to be dependent on the platform used (24,25). To establish local reference values for the FLC assays, we selected samples from patients with a normal pattern assessed with SPE, and the absence of monoclonal bands in the IFE with pentavalent antiserum.…”

Section: Reference Valuesmentioning

confidence: 99%

Screening for M-proteinemia: serum protein electrophoresis and free light chains compared

Bakker

Bierma-Ram

Werf

et al. 2009

Clinical Chemistry and Laboratory Medicine

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Background: The objective of this study was to evaluate the efficiency of free light chain (FLC) analysis in comparison to serum protein electrophoresis (SPE) for detecting M-proteinemia. Methods: A total of 553 consecutive patients for whom evaluation of M-proteinemia was requested were included in this study. For all patients, serum FLC analysis and SPE followed by pentavalent immunofixation analysis was performed. Identification of monoclonal bands was performed using specific antisera. FLC analysis was performed using the Modular P analyzer in accordance with the manufacturer's recommendations. Local reference ranges for FLCs on this platform were established based on samples from patients with a normal electrophoretic pattern wno monoclonal bands, no hypo-or hypergammaglobulinemia, no acute phase pattern and normal kidney function, i.e., estimated glomerular filtration rate (eGFR) )60 mL/minx. Results

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Can serum free light chains replace urine electrophoresis in the detection of monoclonal gammopathies?

Abstract: AddressesBackground We investigated how sensitive serum free light chain (FLC) analysis was for the detection of Bence-Jones protein (BJP) and whether a serum k/l ratio could replace urine electrophoresis as part of the investigation algorithm for monoclonal gammopathy.

Cited by 54 publications

References 19 publications

The evolving use of serum free light chain assays in haematology

The evolving use of serum free light chain assays in haematology

International Myeloma Working Group guidelines for serum-free light chain analysis in multiple myeloma and related disorders

Screening for M-proteinemia: serum protein electrophoresis and free light chains compared

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