|
|
Blood, 1 August 2005, Vol. 106, No. 3, pp. 812-817.
Prepublished online as a Blood First Edition Paper on April 26, 2005; DOI 10.1182/blood-2005-03-1038.
 Previous Article | Table of Contents | Next Article 
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Serum free light chain ratio is an independent risk factor for progression in monoclonal gammopathy of undetermined significance
S. Vincent Rajkumar,
Robert A. Kyle,
Terry M. Therneau,
L. Joseph Melton, III,
Arthur R. Bradwell,
Raynell J. Clark,
Dirk R. Larson,
Matthew F. Plevak,
Angela Dispenzieri, and
Jerry A. Katzmann
From the Division of Hematology, Department of Laboratory Medicine and Pathology, Division of Biostatistics and Division of Epidemiology, Mayo Clinic College of Medicine, Rochester, MN; University of Birmingham and The Binding Site Ltd, Birmingham, United Kingdom.
We hypothesized that the presence of monoclonal free kappa or lambda immunoglobulin light chains in monoclonal gammopathy of undetermined significance (MGUS), as detected by the serum free light chain (FLC) assay increases the risk of progression to malignancy. Of 1384 patients with MGUS from Southeastern Minnesota seen at the Mayo Clinic from 1960 to 1994, baseline serum samples obtained within 30 days of diagnosis were available in 1148. At a median follow-up of 15 years, malignant progression had occurred in 87 (7.6%) patients. An abnormal FLC ratio (kappa-lambda ratio < 0.26 or > 1.65) was detected in 379 (33%) patients. The risk of progression in patients with an abnormal FLC ratio was significantly higher compared with patients with a normal ratio (hazard ratio, 3.5; 95% confidence interval [CI], 2.3-5.5; P < .001) and was independent of the size and type of the serum monoclonal (M) protein. Patients with an abnormal serum FLC ratio, non–immunoglobulin G (non-IgG) MGUS, and a high serum M protein level ( 15 g/L) had a risk of progression at 20 years of 58% (high-risk MGUS) versus 37% with any 2 of these risk factors (high-intermediate risk), 21% with one risk factor (low-intermediate risk), and 5% when none of the risk factors were present (low risk).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati What's this?
Related Article in Blood Online:
-
Determining the undetermined
- Nikhil C. Munshi
Blood 2005 106: 767-768.
[Full Text]
[PDF]
This article has been cited by other articles:
|
|
|
|
 
S. V. Rajkumar
Prevention of Progression in Monoclonal Gammopathy of Undetermined Significance
Clin. Cancer Res.,
September 15, 2009;
15(18):
5606 - 5608.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. S. Go and L. M. Doyle
A monoclonal gammopathy in search of clinical significance: 57 years later
Blood,
September 10, 2009;
114(11):
2355 - 2356.
[Full Text]
[PDF]
|
|
|
|
|
|
|
O. Landgren, R. A. Kyle, and V. Rajkumar
Response: Multiple myeloma is universally preceded by a prolonged premalignant stage: novel clinical insights and future directions
Blood,
September 10, 2009;
114(11):
2356 - 2357.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. F. Keren
Heavy/Light-Chain Analysis of Monoclonal Gammopathies
Clin. Chem.,
September 1, 2009;
55(9):
1606 - 1608.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. R. Bradwell, S. J. Harding, N. J. Fourrier, G. L.F. Wallis, M. T. Drayson, H. D. Carr-Smith, and G. P. Mead
Assessment of Monoclonal Gammopathies by Nephelometric Measurement of Individual Immunoglobulin {kappa}/{lambda} Ratios
Clin. Chem.,
September 1, 2009;
55(9):
1646 - 1655.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. M. Giarin, L. Giaccone, R. Sorasio, C. Sfiligoi, B. Amoroso, F. Cavallo, A. Cipriani, A. Palumbo, and M. Boccadoro
Serum Free Light Chain Ratio, Total {kappa}/{lambda} Ratio, and Immunofixation Results Are Not Prognostic Factors after Stem Cell Transplantation for Newly Diagnosed Multiple Myeloma
Clin. Chem.,
August 1, 2009;
55(8):
1510 - 1516.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A. Katzmann, R. A. Kyle, J. Benson, D. R. Larson, M. R. Snyder, J. A. Lust, S. V. Rajkumar, and A. Dispenzieri
Screening Panels for Detection of Monoclonal Gammopathies
Clin. Chem.,
August 1, 2009;
55(8):
1517 - 1522.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Rossi, M. T. Petrucci, A. Guffanti, L. Marcheselli, D. Rossi, V. Callea, F. Vincenzo, M. De Muro, A. Baraldi, O. Villani, et al.
Proposal and Validation of Prognostic Scoring Systems for IgG and IgA Monoclonal Gammopathies of Undetermined Significance
Clin. Cancer Res.,
July 1, 2009;
15(13):
4439 - 4445.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. J.D. Robson, J. Taylor, C. Beardsmore, S. Basu, G. Mead, and T. Lovatt
Utility of Serum Free Light Chain Analysis When Screening for Lymphoproliferative Disorders: The Experience at a District General Hospital in the United Kingdom
Lab Med,
June 1, 2009;
40(6):
325 - 329.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Siegel, E. Bilotti, and K. H. van Hoeven
Serum Free Light Chain Analysis for Diagnosis, Monitoring, and Prognosis of Monoclonal Gammopathies
Lab Med,
June 1, 2009;
40(6):
363 - 366.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
O. Landgren, R. A. Kyle, R. M. Pfeiffer, J. A. Katzmann, N. E. Caporaso, R. B. Hayes, A. Dispenzieri, S. Kumar, R. J. Clark, D. Baris, et al.
Monoclonal gammopathy of undetermined significance (MGUS) consistently precedes multiple myeloma: a prospective study
Blood,
May 28, 2009;
113(22):
5412 - 5417.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. M. Weiss, J. Abadie, P. Verma, R. S. Howard, and W. M. Kuehl
A monoclonal gammopathy precedes multiple myeloma in most patients
Blood,
May 28, 2009;
113(22):
5418 - 5422.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Iwanaga, M. Tagawa, K. Tsukasaki, T. Matsuo, K.-i. Yokota, Y. Miyazaki, T. Fukushima, T. Hata, Y. Imaizumi, D. Imanishi, et al.
Relationship between monoclonal gammopathy of undetermined significance and radiation exposure in Nagasaki atomic bomb survivors
Blood,
February 19, 2009;
113(8):
1639 - 1650.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M. Abadie, K.H. van Hoeven, and J. M. Wells
Are Renal Reference Intervals Required When Screening for Plasma Cell Disorders With Serum Free Light Chains and Serum Protein Electrophoresis?
Am J Clin Pathol,
February 1, 2009;
131(2):
166 - 171.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A. Katzmann and A. Dispenzieri
Screening Algorithms for Monoclonal Gammopathies
Clin. Chem.,
November 1, 2008;
54(11):
1753 - 1755.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Y. Kristinsson, T. R. Fears, G. Gridley, I. Turesson, U.-H. Mellqvist, M. Bjorkholm, and O. Landgren
Deep vein thrombosis after monoclonal gammopathy of undetermined significance and multiple myeloma
Blood,
November 1, 2008;
112(9):
3582 - 3586.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Dispenzieri, L. Zhang, J. A. Katzmann, M. Snyder, E. Blood, R. DeGoey, K. Henderson, R. A. Kyle, M. M. Oken, A. R. Bradwell, et al.
Appraisal of immunoglobulin free light chain as a marker of response
Blood,
May 15, 2008;
111(10):
4908 - 4915.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Blade and L. Rosinol
SMM: toward better predictors of progression
Blood,
January 15, 2008;
111(2):
479 - 480.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Dispenzieri, R. A. Kyle, J. A. Katzmann, T. M. Therneau, D. Larson, J. Benson, R. J. Clark, L. J. Melton III, M. A. Gertz, S. K. Kumar, et al.
Immunoglobulin free light chain ratio is an independent risk factor for progression of smoldering (asymptomatic) multiple myeloma
Blood,
January 15, 2008;
111(2):
785 - 789.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Sackmann, M. A. Pavlovsky, C. Corrado, M. Pizzolato, M. Alejandre, and S. Pavlovsky
Prognostic factors in monoclonal gammopathy of undetermined significance
Haematologica,
January 1, 2008;
93(1):
153 - 154.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. C. Munshi
Investigative Tools for Diagnosis and Management
Hematology,
January 1, 2008;
2008(1):
298 - 305.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. C. Munshi
Monoclonal Gammopathy of Undetermined Significance: Genetic vs Environmental Etiologies
Mayo Clin. Proc.,
December 1, 2007;
82(12):
1457 - 1459.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Daval, A. Tridon, N. Mazeron, J.-M. Ristori, and B. Evrard
Risk of Antigen Excess in Serum Free Light Chain Measurements
Clin. Chem.,
November 1, 2007;
53(11):
1985 - 1986.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Perez-Persona, M.-B. Vidriales, G. Mateo, R. Garcia-Sanz, M.-V. Mateos, A. G. de Coca, J. Galende, G. Martin-Nunez, J. M. Alonso, N. de las Heras, et al.
New criteria to identify risk of progression in monoclonal gammopathy of uncertain significance and smoldering multiple myeloma based on multiparameter flow cytometry analysis of bone marrow plasma cells
Blood,
October 1, 2007;
110(7):
2586 - 2592.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A. Katzel, P. Hari, and D. H. Vesole
Multiple Myeloma: Charging Toward a Bright Future
CA Cancer J Clin,
September 1, 2007;
57(5):
301 - 318.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. van Rhee, V. Bolejack, K. Hollmig, M. Pineda-Roman, E. Anaissie, J. Epstein, J. D. Shaughnessy Jr, M. Zangari, G. Tricot, A. Mohiuddin, et al.
High serum-free light chain levels and their rapid reduction in response to therapy define an aggressive multiple myeloma subtype with poor prognosis
Blood,
August 1, 2007;
110(3):
827 - 832.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Rosinol, M. T. Cibeira, S. Montoto, M. Rozman, J. Esteve, X. Filella, and J. Blade
Monoclonal Gammopathy of Undetermined Significance: Predictors of Malignant Transformation and Recognition of an Evolving Type Characterized by a Progressive Increase in M Protein Size
Mayo Clin. Proc.,
April 1, 2007;
82(4):
428 - 434.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Cook and D. H C Macdonald
Management of paraproteinaemia
Postgrad. Med. J.,
April 1, 2007;
83(978):
217 - 223.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. v. Rhee
Idiotype Vaccination Strategies in Myeloma: How to Overcome a Dysfunctional Immune System
Clin. Cancer Res.,
March 1, 2007;
13(5):
1353 - 1355.
[Full Text]
[PDF]
|
|
|
|
|
|
|
U. Mosbauer, F. Ayuk, H. Schieder, M. Lioznov, A. R. Zander, and N. Kroger
Monitoring serum free light chains in patients with multiple myeloma who achieved negative immunofixation after allogeneic stem cell transplantation
Haematologica,
February 1, 2007;
92(2):
275 - 276.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. Ramasamy
Serum Free Light Chain Analysis in B-cell Dyscrasias
Ann. Clin. Lab. Sci.,
January 1, 2007;
37(3):
291 - 294.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J-E Gottenberg, F Aucouturier, J Goetz, C Sordet, I Jahn, M Busson, J-M Cayuela, J Sibilia, and X Mariette
Serum immunoglobulin free light chain assessment in rheumatoid arthritis and primary Sjogren's syndrome
Ann Rheum Dis,
January 1, 2007;
66(1):
23 - 27.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Blade
Monoclonal Gammopathy of Undetermined Significance
N. Engl. J. Med.,
December 28, 2006;
355(26):
2765 - 2770.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A. Katzmann, A. Dispenzieri, R. A. Kyle, M. R. Snyder, M. F. Plevak, D. R. Larson, R. S. Abraham, J. A. Lust, L. J. Melton III, and S. V. Rajkumar
Elimination of the Need for Urine Studies in the Screening Algorithm for Monoclonal Gammopathies by Using Serum Immunofixation and Free Light Chain Assays
Mayo Clin. Proc.,
December 1, 2006;
81(12):
1575 - 1578.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Dingli, R. A. Kyle, S. V. Rajkumar, G. S. Nowakowski, D. R. Larson, J. P. Bida, M. A. Gertz, T. M. Therneau, L. J. Melton III, A. Dispenzieri, et al.
Immunoglobulin free light chains and solitary plasmacytoma of bone
Blood,
September 15, 2006;
108(6):
1979 - 1983.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. V. Rajkumar, A. Dispenzieri, and R. A. Kyle
Monoclonal Gammopathy of Undetermined Significance, Waldenstrom Macroglobulinemia, AL Amyloidosis, and Related Plasma Cell Disorders: Diagnosis and Treatment
Mayo Clin. Proc.,
May 1, 2006;
81(5):
693 - 703.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. A. Kyle, T. M. Therneau, S. V. Rajkumar, D. R. Larson, M. F. Plevak, J. R. Offord, A. Dispenzieri, J. A. Katzmann, and L. J. Melton III
Prevalence of monoclonal gammopathy of undetermined significance.
N. Engl. J. Med.,
March 30, 2006;
354(13):
1362 - 1369.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. R. Nowrousian, D. Brandhorst, C. Sammet, M. Kellert, R. Daniels, P. Schuett, M. Poser, S. Mueller, P. Ebeling, A. Welt, et al.
Serum Free Light Chain Analysis and Urine Immunofixation Electrophoresis in Patients with Multiple Myeloma
Clin. Cancer Res.,
December 15, 2005;
11(24):
8706 - 8714.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. V. Rajkumar
MGUS and Smoldering Multiple Myeloma: Update on Pathogenesis, Natural History, and Management
Hematology,
January 1, 2005;
2005(1):
340 - 345.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
