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Immunoglobulin (Ig) heavy/light chain ( HLC ) assays enable the separate quantification of the different light chain types of each Ig class. We retrospectively analyzed the correlation of heavy/light chain ratio ( HLCR ) with clinical status and its impact on outcome in 120 patients with multiple myeloma ( MM ). Abnormal  HLCR  was seen more frequently in patients with poorer myeloma response, and it appeared to be more sensitive for detecting clonality in IgA myeloma compared to IgG myeloma after treatment. Among the 85 patients who achieved ≥ VGPR , the patients remained  HLCR  abnormal were showed significantly shorter overall survival ( OS ) compared to those achieving a normal  HLCR  (not reached  vs  55.5 months,  P  = 0.032). This correlation was seen in IgA myeloma patients (not reached  vs  30.1 months,  P  = 0.014), but not in IgG myeloma patients when patients were analyzed separately. Univariate and multivariate analysis of factors that may affect survival identified abnormal  HLCR  at the best response as the only independent risk factor (hazard ratio, 4.7; 95% confidence interval, 1.4 – 15.26;  P  = 0.012) for shorter  OS  in this subset of patients. This study highlighted the  HLC  assay as a prognostic predictor in patients with IgA myeloma.

Abnormal heavy/light chain ratio after treatment is associated with shorter survival in patients with IgA myeloma