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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. This Article Full Text (PDF) All Versions of this Article: 2005-03-1038v1 106/3/812    most recent Alert me when this article is cited Alert me if a correction is posted 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 Rajkumar, S V Articles by Katzmann, J. A Search for Related Content PubMed PubMed Citation Articles by Rajkumar, S V Articles by Katzmann, J. A Related Collections Related Article in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Next Article  Submitted March 15, 2005 Accepted April 10, 2005 Serum free light chain ratio is an independent risk factor for progression in monoclonal gammopathy of undetermined significance (MGUS) S V Rajkumar*, Robert A Kyle, Terry M Therneau, L J Melton III, Arthur R Bradwell, Raynell J Clark, Dirk R Larson, Matthew F Plevak, Angela Dispenzieri, and Jerry A Katzmann Division of Hematology, Mayo Clinic College of Medicine, Rochester, MN, USA Division of Biostatistics, Mayo Clinic College of Medicine, Rochester, MN, USA Division of Epidemiology, Mayo Clinic College of Medicine, Rochester, MN, USA University of Birmingham, Birmingham, United Kingdom; The Binding Site Ltd, Birmingham, United Kingdom Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA * Corresponding author; email: rajks{at}mayo.edu. 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 MGUS patients 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 has 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 to patients with a normal ratio (hazard ratio, 3.5; 95% CI, 2.3-5.5; p< 0.001) and was independent of the size and type of the serum monoclonal (M) protein. Patients with an abnormal serum FLC ratio, non-IgG MGUS, and a high serum M protein level (1.5 gm/dL) had a risk of progression at 20 years of 58% (high-risk MGUS) versus 37% with any two 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: 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] 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. 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. 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Med., December 28, 2006; 355(26): 2765 - 2770. [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] 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]

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