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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.


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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).


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