Heavy/light chain specific immunoglobulin ratios provides no additional information than serum proteins electrophoresis and immunofixation for the diagnosis and the follow-up of intact immunoglobulin multiple myeloma patients

Beaumont-Epinette, Marie-Pascale; Moreau, C.; Besnard, Sophie; Collet, Nicolas; Sebillot, M.; Grosbois, B.; Bendavid, Claude; Guenet, L.; Decaux, Olivier

doi:10.1016/j.patbio.2015.06.001

Cited by 8 publications

(5 citation statements)

References 19 publications

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“…The discordance rates between results of SIFE and SFLC in these studies are quite variable, ranging from approximately 17% to as high as 50% ( Table 3 ). 3 4 14 15 16 17 Our study revealed a discordance rate of 28.7%, which is comparable to the rates reported by Wood at el and Singhal et al, respectively. 4 The normal range of SFLC ratio is 0.3 to 1.2; an abnormal ratio outside the acceptable reference range is considered to favor monoclonal over polyclonal elevations of SFLC.…”

Section: Discussionsupporting

confidence: 87%

“…20 Thus, it can be concurred, that SFLC ratio does not always score above SIFE for diagnosis and monitoring in a subset of MM patients. [2][3][4]12,[15][16][17] For any suspected case, an abnormal SFLC ratio must be confirmed by electrophoretic studies. An electrophoretic evidence of M protein is a reliable diagnostic marker of MM.…”

Section: Discussionmentioning

confidence: 99%

“… 2 In the current study, we noted an increased number of λ-associated MM cases on follow-up when SFLC was within normal limits, however, SIFE reported positive ( Table 4 ). 2 3 4 15 16 17 Interestingly, κ-associated SFLC ratios may be seen in λ chain–associated MM postautologous stem cell transplantation contributing to unexpected results. 20 Thus, it can be concurred, that SFLC ratio does not always score above SIFE for diagnosis and monitoring in a subset of MM patients.…”

Section: Discussionmentioning

confidence: 99%

“…20 Thus, it can be concurred, that SFLC ratio does not always score above SIFE for diagnosis and monitoring in a subset of MM patients. 2 3 4 12 15 16 17 …”

Section: Discussionmentioning

confidence: 99%

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Understanding the Constraints and Optimization of Serum Immunofixation Electrophoresis and Serum Free Light Chains for Detecting Monoclonal Proteins: A Single-Center Experience

et al. 2023

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Background Serum immunofixation electrophoresis (SIFE) and serum free light chain (SFLC) assay are imperative investigations in diagnosis and follow-up of multiple myeloma (MM). SFLC assays are reported to have higher sensitivity than SIFE. However, discrepancies have been reported between them. The current study was aimed at assessing concordance and discordance between SIFE and SFLC results in MM. Methods A total of 450 observations of both SIFE and SFLC were obtained from treatment-naive and follow-up MM patients. Results One hundred and twenty-nine (28.7%) values were observed as discordant, that is, positive SIFE with normal SFLC ratio or negative SIFE with abnormal SFLC ratio (p-value < 0.00001). Proportion of discordance was higher in SIFE positive-SFLC normal cases than SIFE negative-SFLC abnormal cases. Discordance was more frequent in follow-up cases. Conclusion Negative SFLC alone may not be reliable for MM follow-up. Algorithm may be based on SFLC measurements on each follow-up till attainment of normal SFLC ratio. Once SFLC normalizes, follow-up may be done with SIFE. If SIFE is positive, further follow-up with SIFE may be initiated.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…20 Thus, it can be concurred, that SFLC ratio does not always score above SIFE for diagnosis and monitoring in a subset of MM patients. 2 3 4 12 15 16 17 …”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Understanding the Constraints and Optimization of Serum Immunofixation Electrophoresis and Serum Free Light Chains for Detecting Monoclonal Proteins: A Single-Center Experience

et al. 2023

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“…Measurement of IgA Hevylite chain has been stated to provide a better estimate of the monoclonal immunoglobulin, as monoclonal IgA is often present in the beta region and may overlap the transferrin and complement bands. The clinical advantage of measuring IgA Hevylite chain over densitometric quantitation of the monoclonal band along with the underlying normal protein has yet to be demonstrated [66-69]. …”

Section: Discussionmentioning

confidence: 99%

Serum Free Light Chain Assay and κ/λ Ratio: Performance in Patients With Monoclonal Gammopathy-High False Negative Rate for κ/λ Ratio

Singh

2017

J Clin Med Res

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BackgroundSerum free light chain assay (SFLCA) and κ/λ ratio, and protein electrophoretic methods are used in the diagnosis and monitoring of monoclonal gammopathies.MethodsResults for serum free light chains, serum and urine protein electrophoreses and immunofixation electrophoreses in 468 patients with a diagnosis of monoclonal gammopathy were compared. The results of the two methods were graded as concordant, non-concordant or discordant with the established diagnoses to assess the relative performance of the methods. Results of κ/λ ratio in samples with monoclonal protein detectable by electrophoretic methods were also analyzed.ResultsProtein electrophoreses results were concordant with the established diagnoses significantly more often than κ/λ ratio. The false negative rate for κ/λ ratio was higher than that for electrophoretic methods. κ/λ ratio was falsely negative in about 27% of the 1,860 samples with detectable monoclonal immunoglobulin. The false negative rate was higher in lesions with lambda chains (32%) than those with kappa chains (24%). The false negative rate for κ/λ ratio was over 55% in samples with monoclonal gammopathy of undetermined significance. Even at first encounter, the false negative rates for κ/λ ratios for monoclonal gammopathy of undetermined significance, smoldering myeloma and multiple myeloma were 66.98%, 23.08%, and 30.15%, respectively, with false negative rate for lambda chain lesions being higher.ConclusionsElectrophoretic studies of serum and urine are superior to SFLCA and κ/λ ratio. Abnormal κ/λ ratio, per se, is not diagnostic of monoclonal gammopathy. A normal κ/λ ratio does not exclude monoclonal gammopathy. False negative rates for lesions with lambda chain are higher than those for lesions with kappa chains. Electrophoretic studies of urine are underutilized. Clinical usefulness and medical necessity of SFLCA and κ/λ ratio is of questionable value in routine clinical testing.

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Gamma gap as a prognostic marker of treatment response in patients with multiple myeloma

Hassan,

Hameed

2024

Ir J Med Sci

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Heavy/light chain specific immunoglobulin ratios provides no additional information than serum proteins electrophoresis and immunofixation for the diagnosis and the follow-up of intact immunoglobulin multiple myeloma patients

Cited by 8 publications

References 19 publications

Understanding the Constraints and Optimization of Serum Immunofixation Electrophoresis and Serum Free Light Chains for Detecting Monoclonal Proteins: A Single-Center Experience

Understanding the Constraints and Optimization of Serum Immunofixation Electrophoresis and Serum Free Light Chains for Detecting Monoclonal Proteins: A Single-Center Experience

Serum Free Light Chain Assay and κ/λ Ratio: Performance in Patients With Monoclonal Gammopathy-High False Negative Rate for κ/λ Ratio

Gamma gap as a prognostic marker of treatment response in patients with multiple myeloma

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