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Blood, 15 September 2006, Vol. 108, No. 6, pp. 1979-1983.
Prepublished online as a Blood First Edition Paper on June 1, 2006; DOI 10.1182/blood-2006-04-015784.
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Submitted April 10, 2006
Accepted April 13, 2006
Immunoglobulin free light chains and solitary
plasmacytoma of bone
David Dingli, Robert A Kyle*, S V Rajkumar, Grzegorz S Nowakowski, Dirk R Larson, John P Bida, Morie A Gertz, Terry M Therneau, L J Melton, III, Angela Dispenzieri, and Jerry A Katzmann
Division of Hematology, Mayo Clinic College of Medicine, Rochester, MN, USA
Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA
Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
* Corresponding author; email: kyle.robert{at}mayo.edu.
An abnormal serum immunoglobulin free light (FLC) ratio
at diagnosis may identify risk of progression to myeloma
in patients with solitary bone plasmacytoma (SBP). In
the cohort of 116 patients, 43 have progressed to
myeloma; with a median time to progression of 1.8 years.
The FLC ratio was determined in all 116 patients on
serum collected at time of diagnosis, and was abnormal
in 54 patients (47%). An abnormal FLC ratio was
associated with a higher risk of progression to myeloma
(p=0.039). The risk of progression at 5 years was 44% in
patients with an abnormal serum FLC ratio at diagnosis
compared to 26% in those with a normal FLC ratio. One to
two years following diagnosis, a persistent serum M
protein  0.5gm/dL was an additional risk factor for
progression. A risk stratification model was constructed
using these two variables: patients with a normal FLC
ratio at baseline and M protein <0.5gm/dL one to two
years following diagnosis (low-risk; n=31), either risk
factor abnormal (intermediate-risk, n=26), and both an
abnormal FLC ratio and M protein 0.5gm/dL (high-risk,
n=18). The corresponding progression rates at 5 years
were significantly different in the 3 groups, 13%, 26%,
and 62%, respectively, P < 0.001.
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