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Blood, 1 August 2007, Vol. 110, No. 3, pp. 827-832. Prepublished online as a Blood First Edition Paper on April 30, 2007; DOI 10.1182/blood-2007-01-067728. This Article Full Text Full Text (PDF) All Versions of this Article: blood-2007-01-067728v1 blood-2007-01-067728v2 110/3/827    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by van Rhee, F. Articles by Barlogie, B. Search for Related Content PubMed PubMed Citation Articles by van Rhee, F. Articles by Barlogie, B. Related Collections Neoplasia Clinical Trials and Observations Related Articles in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  CLINICAL TRIALS AND OBSERVATIONS High serum-free light chain levels and their rapid reduction in response to therapy define an aggressive multiple myeloma subtype with poor prognosis Frits van Rhee1, Vanessa Bolejack2, Klaus Hollmig1, Mauricio Pineda-Roman1, Elias Anaissie1, Joshua Epstein1, John D. Shaughnessy, Jr1, Maurizio Zangari1, Guido Tricot1, Abid Mohiuddin1, Yazan Alsayed1, Gail Woods1, John Crowley2, and Bart Barlogie1 1 Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock; 2 Cancer Research and Biostatistics, Seattle, WA Serum-free light chain (SFLC) levels are useful for diagnosing nonsecretory myeloma and monitoring response in light-chain–only disease, especially in the presence of renal failure. As part of a tandem autotransplantation trial for newly diagnosed multiple myeloma, SFLC levels were measured at baseline, within 7 days of starting the first cycle, and before both the second induction cycle and the first transplantation. SFLC baseline levels higher than 75 mg/dL (top tertile) identified 33% of 301 patients with higher near-complete response rate (n-CR) to induction therapy (37% vs 20%, P = .002) yet inferior 24-month overall survival (OS: 76% vs 91%, P < .001) and event-free survival (EFS: 73% vs 90%, P < .001), retaining independent prognostic significance for both EFS (HR = 2.40, P = .008) and OS (HR = 2.43, P = .016). Baseline SFLC higher than 75 mg/dL was associated with light-chain–only secretion (P < .001), creatinine level 176.8 µM (2 mg/dL) or higher (P < .001), beta-2-microglobulin 297.5 nM/L (3.5 mg/L) or higher (P < .001), lactate dehydrogenase 190 U/L or higher (P < .001), and bone marrow plasmacytosis higher than 30% (P = .003). Additional independent adverse implications were conferred by top-tertile SFLC reductions before cycle 2 (OS: HR = 2.97, P = .003; EFS: HR = 2.56, P = .003) and before transplantation (OS: HR = 3.31, P = .001; EFS: HR = 2.65, P = .003). Unlike baseline and follow-up analyses of serum and urine M-proteins, high SFLC levels at baseline—reflecting more aggressive disease—and steeper reductions after therapy identified patients with inferior survival. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Articles in Blood Online: Response: Top tertile SFLC reduction indeed is an independent feature of myeloma aggressiveness Frits van Rhee, John Crowley, and Bart Barlogie Blood 2008 111: 2491. [Full Text] [PDF] FMC7 is an epitope of CD20 Julie P. Deans and Maria J. Polyak Blood 2008 111: 2492. [Full Text] [PDF] This article has been cited by other articles: J.-L. Harousseau, H. Avet-Loiseau, M. Attal, C. Charbonnel, F. Garban, C. Hulin, M. Michallet, T. Facon, L. Garderet, G. Marit, et al. Achievement of at Least Very Good Partial Response Is a Simple and Robust Prognostic Factor in Patients With Multiple Myeloma Treated With High-Dose Therapy: Long-Term Analysis of the IFM 99-02 and 99-04 Trials J. Clin. Oncol., December 1, 2009; 27(34): 5720 - 5726. [Abstract] [Full Text] [PDF] J.-L. Harousseau, M. Attal, and H. Avet-Loiseau The role of complete response in multiple myeloma Blood, October 8, 2009; 114(15): 3139 - 3146. [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] A. Legg, J. A. R. Hobbs, G. P. Mead, A. R. Bradwell, S. Davern, and A. Solomon Monoclonal vs Polyclonal Free Light Chain Assays Am J Clin Pathol, June 1, 2009; 131(6): 901 - 902. [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] M. J. Feige, S. Groscurth, M. Marcinowski, Z. T. Yew, V. Truffault, E. Paci, H. Kessler, and J. Buchner The structure of a folding intermediate provides insight into differences in immunoglobulin amyloidogenicity PNAS, September 9, 2008; 105(36): 13373 - 13378. [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] A. Dispenzieri Is early, deep free light chain response really an adverse prognostic factor? Blood, February 15, 2008; 111(4): 2490 - 2491. [Full Text] [PDF] F. van Rhee, J. Crowley, and B. Barlogie Response: Top tertile SFLC reduction indeed is an independent feature of myeloma aggressiveness Blood, February 15, 2008; 111(4): 2491 - 2491. [Full Text] [PDF] N. C. Munshi Investigative Tools for Diagnosis and Management Hematology, January 1, 2008; 2008(1): 298 - 305. [Abstract] [Full Text] [PDF] J.-L. Harousseau Induction Therapy in Multiple Myeloma Hematology, January 1, 2008; 2008(1): 306 - 312. [Abstract] [Full Text] [PDF] B. Barlogie, G. Tricot, J. Haessler, F. van Rhee, M. Cottler-Fox, E. Anaissie, J. Waldron, M. Pineda-Roman, R. Thertulien, M. Zangari, et al. Cytogenetically defined myelodysplasia after melphalan-based autotransplantation for multiple myeloma linked to poor hematopoietic stem-cell mobilization: the Arkansas experience in more than 3000 patients treated since 1989 Blood, January 1, 2008; 111(1): 94 - 100. [Abstract] [Full Text] [PDF] J. Haessler, J. D. 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