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Potential pitfalls of serum free light chain analysis to assess treatment response for multiple myeloma
Author(s) -
Abbi Kamal Kant Singh,
Silverman Margarida,
Farooq Umar,
Tricot Annick,
Dozeman Lindsey,
Nadiminti Kalyan,
Krasowski Matthew D.,
Tricot Guido J.
Publication year - 2016
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.14081
Subject(s) - immunoglobulin light chain , multiple myeloma , immunofixation , medicine , bone marrow , pathology , flow cytometry , immunofluorescence , plasma cell , monoclonal , gastroenterology , antibody , immunology , monoclonal antibody
Response to treatment in patients with a plasma cell disorder is typically measured by evaluating the bone marrow and myeloma markers, including monoclonal protein spike and immunofixation ( IFE ) in blood and urine, and serum free light chains ( sFLC s). Stringent complete response criteria for Multiple Myeloma ( MM ) patients require a normal FLC ratio and absence of clonal cells in bone marrow by immunohistochemistry or immunofluorescence. We performed a retrospective chart review to further evaluate these criteria. A total of 142 patient charts were analysed. Of these, 17 patients were found to have an abnormal sFLC ratio, but no other evidence of disease, including normal flow cytometry and normal fluorescence in situ hybridization ( FISH ) analysis on highly selected plasma cells. In all patients, the abnormal sFLC ratio was caused by abnormalities in the serum kappa light chains. These results suggest that current definitions may need to be revised to take aberrancies related to abnormal immune recovery into account.