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Blood, 15 May 2008, Vol. 111, No. 10, pp. 4908-4915. Prepublished online as a Blood First Edition Paper on March 25, 2008; DOI 10.1182/blood-2008-02-138602. This Article Full Text (PDF) All Versions of this Article: blood-2008-02-138602v1 111/10/4908    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 Dispenzieri, A. Articles by Greipp, P. R. Search for Related Content PubMed PubMed Citation Articles by Dispenzieri, A. Articles by Greipp, P. R. Social Bookmarking                   What's this?  Previous Article  |  Next Article  Submitted February 11, 2008 Accepted March 17, 2008 Appraisal of immunoglobulin free light chain as a marker of response Angela Dispenzieri*, Lijun Zhang, Jerry A. Katzmann, Melissa Snyder, Emily Blood, Roberta DeGoey, Kim Henderson, Robert A. Kyle, Martin M. Oken, Arthur R. Bradwell, and Philip R. Greipp Departments of Hematology and Laboratory Medicine, Mayo Clinic, Rochester, MN, United States Biostatistics, ECOG, Boston, MA, United States Laboratory Medicine, Mayo Clinic, Rochester, MN, United States Laboratory Medicine, Mayo Clinic, Rocheter, MN, United States Dartmouth Medical School, Lebanon, NH, United States Hematology, Mayo Clinic, Rochester, MN, United States University of Minnesota, Minneapolis, MN, United States Immunology, The Medical School Edgbaston, Birmingham, United Kingdom Departments of Hematology and Laboratory Medicine, Mayo Clinic, Rochester, MN * Corresponding author; email: dispenzieri.angela{at}mayo.edu. The immunoglobulin free light chain (FLC) assay is an invaluable tool for following patients with oligosecretory plasma cell dyscrasia. Baseline values have also been shown to be prognostic in all plasma cell disorders tested. A looming question, however, is the role it should play in following myeloma patients with disease that is measurable using serum and urine electrophoresis. We used the data and stored samples from a mature ECOG clinical trial (E9486) to assess serum levels of FLC at baseline and after 2 months of alkylator based therapy. For serial determinations, the absolute level of involved serum FLC or the difference of the involved and uninvolved FLC is preferred over the ratio of involved to uninvolved FLC. FLC response after 2 months of therapy was superior to early M-protein measurement to predict overall response. The ideal cut point for FLC change appears to be between 40 and 50% reduction. The correlation between serial measurements of serum FLC and urine M-protein is inadequate to abolish the serial 24 hour urine protein. Although baseline values of FLC are prognostic in newly diagnosed myeloma patients, serial measurements do not appear to have added value in patients who have M-proteins measurable by electrophoresis. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: R. B Fulton and S. L Fernando Serum free light chain assay reduces the need for serum and urine immunofixation electrophoresis in the evaluation of monoclonal gammopathy Ann Clin Biochem, September 1, 2009; 46(5): 407 - 412. [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] D. L. Murray, E. Ryu, M. R. Snyder, and J. A. Katzmann Quantitation of Serum Monoclonal Proteins: Relationship between Agarose Gel Electrophoresis and Immunonephelometry Clin. Chem., August 1, 2009; 55(8): 1523 - 1529. [Abstract] [Full Text] [PDF] D. S. Siegel, L. McBride, E. Bilotti, N. Lendvai, J. Gonsky, T. Berges, D. Schillen, A. McNeill, L. Schmidt, and K. H. van Hoeven Inaccuracies in 24-Hour Urine Testing for Monoclonal Gammopathies: Serum Free Light Chain Analysis Provides a More Accurate Measure of Light Chain Burden Than Urine Protein Electrophoresis Lab Med, June 1, 2009; 40(6): 341 - 344. [Abstract] [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] G. Palladini, P. Russo, T. Bosoni, L. Verga, G. Sarais, F. Lavatelli, M. Nuvolone, L. Obici, S. Casarini, S. Donadei, et al. Identification of Amyloidogenic Light Chains Requires the Combination of Serum-Free Light Chain Assay with Immunofixation of Serum and Urine Clin. Chem., March 1, 2009; 55(3): 499 - 504. [Abstract] [Full Text] [PDF] A. Solomon, S. D. Macy, C. Wooliver, D. T. Weiss, and P. Westermark Splenic plasma cells can serve as a source of amyloidogenic light chains Blood, February 12, 2009; 113(7): 1501 - 1503. [Abstract] [Full Text] [PDF] J. A. Katzmann and A. Dispenzieri Screening Algorithms for Monoclonal Gammopathies Clin. Chem., November 1, 2008; 54(11): 1753 - 1755. [Full Text] [PDF] M. R. Snyder, R. Clark, S. C. Bryant, and J. A. Katzmann Quantification of Urinary Light Chains Clin. Chem., October 1, 2008; 54(10): 1744 - 1746. [Full Text] [PDF] N. C. Munshi Investigative Tools for Diagnosis and Management Hematology, January 1, 2008; 2008(1): 298 - 305. [Abstract] [Full Text] [PDF]

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