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Blood, 15 January 2008, Vol. 111, No. 2, pp. 785-789. Prepublished online as a Blood First Edition Paper on October 17, 2007; DOI 10.1182/blood-2007-08-108357. This Article Full Text Full Text (PDF) All Versions of this Article: blood-2007-08-108357v1 111/2/785    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 Dispenzieri, A. Articles by Rajkumar, S. V. Search for Related Content PubMed PubMed Citation Articles by Dispenzieri, A. Articles by Rajkumar, S. V. Related Collections Clinical Trials and Observations Immunobiology Neoplasia Related Article in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  NEOPLASIA Immunoglobulin free light chain ratio is an independent risk factor for progression of smoldering (asymptomatic) multiple myeloma Angela Dispenzieri1, Robert A. Kyle1, Jerry A. Katzmann2, Terry M. Therneau3, Dirk Larson3, Joanne Benson3, Raynell J. Clark2, L. Joseph Melton, III4, Morie A. Gertz1, Shaji K. Kumar1, Rafael Fonseca5, Diane F. Jelinek6, and S. Vincent Rajkumar1 1 Department of Internal Medicine, Division of Hematology; 2 Department of Laboratory Medicine and Pathology; 3 Department of Health Sciences Research, Division of Biostatistics; 4 Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic College of Medicine, Rochester, MN; 5 Department of Internal Medicine, Division of Hematology and Oncology, Mayo Clinic College of Medicine, Scottsdale, AZ; and 6 Department of Immunology, Mayo Clinic College of Medicine, Rochester, MN We hypothesized that increased monoclonal free kappa or lambda immunoglobulin light chains in smoldering multiple myeloma (SMM), as detected by the serum free light chain (FLC) assay, indicates an increased risk of progression to active myeloma. Baseline serum samples obtained within 30 days of diagnosis were available in 273 patients with SMM seen from 1970 to 1995. At a median follow-up of surviving patients of 12.4 years, transformation to active disease has occurred in 59%. The best breakpoint for predicting risk of progression was an FLC ratio of 0.125 or less, or 8 or more (hazard ratio, 2.3; 95% CI, 1.6-3.2). The extent of abnormality of FLC ratio was independent of SMM risk categories defined by number of bone marrow plasma cells (BMPCs) and size of serum M proteins (BMPC 10% and serum M protein 3 g/dL; BMPC 10% but serum M protein < 3 g/dL; and serum M protein 3 g/dL but BMPC < 10%). Incorporating the FLC ratio into the risk model, the 5-year progression rates in high-, intermediate-, and low-risk groups were 76%, 51%, and 25%, respectively. The serum immunoglobulin FLC ratio is an important additional determinant of clinical outcome in patients with SMM. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Article in Blood Online: SMM: toward better predictors of progression Joan Bladé and Laura Rosiñol Blood 2008 111: 479-480. [Full Text] [PDF] This article has been cited by other articles: 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]

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