Diagnosis and monitoring for light chain only and oligosecretory myeloma using serum free light chain tests.

Autor: Heaney JLJ; Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK., Campbell JP; Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK., Griffin AE; Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK., Birtwistle J; Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK., Shemar M; Abingdon Health Ltd., York, UK., Child JA; Clinical Trials Research Unit, University of Leeds, Leeds, UK., Gregory WM; Clinical Trials Research Unit, University of Leeds, Leeds, UK., Cairns DA; Clinical Trials Research Unit, University of Leeds, Leeds, UK., Morgan G; The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA., Jackson G; University of Newcastle, Newcastle-upon-Tyne, UK., Drayson MT; Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
Jazyk: angličtina
Zdroj: British journal of haematology [Br J Haematol] 2017 Jul; Vol. 178 (2), pp. 220-230. Date of Electronic Publication: 2017 Jun 01.
DOI: 10.1111/bjh.14753
Abstrakt: This study aims to guide the integration of serum free light chain (sFLC) tests into clinical practice, including a new rapid test (Seralite ® ). Blood and urine analysis from 5573 newly diagnosed myeloma patients identified 576 light chain only (LCO) and 60 non-secretory (NS) cases. Serum was tested by Freelite ® and Seralite ® at diagnosis, maximum response and relapse. 20% of LCO patients had urine FLC levels below that recommended for measuring response but >97% of these had adequate sFLC levels (oligosecretory). The recommended Freelite ® sFLC ≥100 mg/l for measuring response was confirmed and the equivalent Seralite ® FLC difference (dFLC) >20 mg/l identified. By both methods, ≥38% of NS patients had measurable disease (oligosecretory). Higher sFLC levels were observed on Freelite ® at all time points. However, good clinical concordance was observed at diagnosis and in response to therapy. Achieving at least a very good partial response according to either sFLC method was associated with better patient survival. Relapse was identified using a Freelite ® sFLC increase >200 mg/l and found 100% concordance with a corresponding Seralite ® dFLC increase >30 mg/l. Both Freelite ® and Seralite ® sensitively diagnose and monitor LCO/oligosecretory myeloma. Rapid testing by Seralite ® could fast-track FLC screening and monitoring. Response by sFLC assessment was prognostic for survival and demonstrates the clinical value of routine sFLC testing.
(© 2017 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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