Serum free light chain level at diagnosis in myeloma cast nephropathy—a multicentre study
| Autor: | Paul Cockwell, Nelson Leung, Paul W. Sanders, Insara Jaffer Sathick, Punit Yadav, Mark Cook, Elizabeth E. Brown |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment 030232 urology & nephrology Urology 030204 cardiovascular system & hematology Kidney Glomerulonephritis Membranous lcsh:RC254-282 Article 03 medical and health sciences chemistry.chemical_compound Medical research 0302 clinical medicine Serum free hemic and lymphatic diseases medicine Humans Prospective Studies Prospective cohort study Myeloma cast nephropathy Dialysis Multiple myeloma Aged Aged 80 and over Creatinine business.industry Hematology Translational research Middle Aged medicine.disease lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens 3. Good health Oncology chemistry Female Immunoglobulin Light Chains Multiple Myeloma business Light chain level Cohort study |
| Zdroj: | Blood Cancer Journal, Vol 10, Iss 3, Pp 1-8 (2020) Blood Cancer Journal |
| ISSN: | 2044-5385 |
| DOI: | 10.1038/s41408-020-0295-4 |
| Popis: | Myeloma cast nephropathy (MCN) is a common cause of severe renal impairment in multiple myeloma (MM). The level of free light chain (FLC) that causes MCN varies substantially and there is uncertainty about the threshold level that should be used to inform clinical practice. In a multicentre cohort study of 103 patients with a diagnosis of MM and biopsy-confirmed MCN made between 2002–2014, we report prospectively measured levels of serum FLC at diagnosis obtained using a single nephelometric assay (Freelite®) and we explore the relationship between serum FLC level at diagnosis with renal outcome and patient survival. Using a landmark approach, overall survival (OS) was compared between patients who achieved independence from dialysis compared to those who remained dialysis dependent at 3-month, 6-month, 9-month, and 12-month time points. The median serum FLC level at diagnosis was 7531 mg/L (range 107–114600). Serum creatinine was 535 μmol/L (range 168–2993) and eGFR 7 ml/min/1.73 m2 (range 1–34). Six patients (5.8%) had an FLC level P = 0.003), 6-months (P = 0.035) and 9-months (P = 0.014); there was no survival benefit observed beyond 12 months (P = 0.146). Serum FLC level at diagnosis was neither associated with renal function recovery nor with OS. This is the largest reported cohort of patients with biopsy-confirmed MCN and prospectively measured serum FLC levels. These results indicate that a serum monoclonal FLC > 500 mg/L should be considered the threshold level associated with the development of MCN. |
| Databáze: | OpenAIRE |
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