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Porównanie metod ilościowego oznaczania wolnych lekkich łańcuchów (FLC), Hevylite™ (HLC) i immunofiksacji (IFE) w ocenie remisji choroby w szpiczaku plazmocytowym
Affiliations- Instytut Hematologii i Transplantologii, Warszawa, Poland
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Abstract
HLC separately measures in pairs light chain types of each intact immunoglobulin (Ig) class generating ratios of monoclonal Ig/non-involved polyclonal Ig concentrations; potentially simplifying assessment of monoclonal protein response. Normalization of FLC ratio is considered higher level of complete remission (CR) in multiple myeloma (MM). To compare IFE, HLC and FLC in assessment of remission we assayed sera from 44 MM patients who underwent autologous stem cell transplantation (ASCT). Of 44 patients in 26 (59%) after ASCT normalization of FLC ratio occurred. In 22 (84.6%) patients with normal FLC ratio also normalization of HLC ratio was noted but in 5 (19%) patients IFE was still positive. Concordance of three tests (IFE negative, HLC ratio normal, FLC normal) was found in 19 (73%) patients. In 21 of 44 (47%) patients after ASCT, normalization of FLC ratio documented sCR. In this group 5 (28%) patients relapsed. Median PFS was 24 months. In patients with CR, VGPR and PR 12 (60%) patients progressed. Median PFS was 12 months. One patient with IgAλ MM, sCR after ASCT and λ FLC clonal escape at relapse and at that time with negative IgAλ IFE and normal IgA HLC ratio illustrates the importance of serum FLC elevation for early detection of clinical relapse, in the absence of any other clinical and laboratory finding. Conclusion. IFE is more sensitive than HLC and FLC assays in detecting residual disease. CR with normalization of HLC and FLC ratios have impact on PFS.
Abstract
HLC separately measures in pairs light chain types of each intact immunoglobulin (Ig) class generating ratios of monoclonal Ig/non-involved polyclonal Ig concentrations; potentially simplifying assessment of monoclonal protein response. Normalization of FLC ratio is considered higher level of complete remission (CR) in multiple myeloma (MM). To compare IFE, HLC and FLC in assessment of remission we assayed sera from 44 MM patients who underwent autologous stem cell transplantation (ASCT). Of 44 patients in 26 (59%) after ASCT normalization of FLC ratio occurred. In 22 (84.6%) patients with normal FLC ratio also normalization of HLC ratio was noted but in 5 (19%) patients IFE was still positive. Concordance of three tests (IFE negative, HLC ratio normal, FLC normal) was found in 19 (73%) patients. In 21 of 44 (47%) patients after ASCT, normalization of FLC ratio documented sCR. In this group 5 (28%) patients relapsed. Median PFS was 24 months. In patients with CR, VGPR and PR 12 (60%) patients progressed. Median PFS was 12 months. One patient with IgAλ MM, sCR after ASCT and λ FLC clonal escape at relapse and at that time with negative IgAλ IFE and normal IgA HLC ratio illustrates the importance of serum FLC elevation for early detection of clinical relapse, in the absence of any other clinical and laboratory finding. Conclusion. IFE is more sensitive than HLC and FLC assays in detecting residual disease. CR with normalization of HLC and FLC ratios have impact on PFS.
Keywords
Heavy/light chain assay; free light chains; multiple myeloma; minimal residual disease; remission; Hevylite; wolne łańcuchy lekkie; szpiczak plazmocytowy; choroba resztkowa; remisja
About this articleTitle
Porównanie metod ilościowego oznaczania wolnych lekkich łańcuchów (FLC), Hevylite™ (HLC) i immunofiksacji (IFE) w ocenie remisji choroby w szpiczaku plazmocytowym
Journal
Issue
Pages
122-131
Published online
2012-09-01
Page views
118
Article views/downloads
118
DOI
10.1016/S0001-5814(12)32007-0
Bibliographic record
Acta Haematol Pol 2012;43(2):122-131.
Keywords
Heavy/light chain assay
free light chains
multiple myeloma
minimal residual disease
remission
Hevylite
wolne łańcuchy lekkie
szpiczak plazmocytowy
choroba resztkowa
remisja
Authors
Maria Kraj
Barbara Kruk
Andrzej Szczepiński
Krzysztof Warzocha