Format

Send to

Choose Destination
Blood. 2016 Dec 22;128(25):2941-2948. doi: 10.1182/blood-2016-07-726778. Epub 2016 Oct 11.

Serum free light chains, not urine specimens, should be used to evaluate response in light-chain multiple myeloma.

Author information

1
Biochemistry Laboratory and Hematology Department, Centre Hospitalier Universitaire (CHU), Nantes, France.
2
Institut Universitaire du Cancer, CHU, Centre de Recherche en Cancérologie de Toulouse, INSERM 1037, Toulouse, France.
3
Hematology Department, CHU, Bordeaux, France.
4
Hematology Department, CHU, Nancy, France.
5
Hematology Department, CHU, Dijon, France.
6
Hematology Department, CHU, Lille, France.
7
Hematology Department, CHU, Besancon, France.
8
Hematology Department, CHU, Creteil, France.
9
Hematology Department, CHU, Bobigny, France.
10
Internal Medicine, CHU, Rennes, France.
11
Centre Hospitalier William Morey, Departmental Hospital, Chalon, France.
12
Clinical Research Unit, Centre Hospitalier de Périgueux, Departmental Hospital, Perigueux, France.
13
Hematology Department, Polyclinique Bordeaux-Nord, Bordeaux, France.
14
Centre Hospitalier Departemental, Bayonne, France.
15
Hôpital Bretonneau, CHU, Tours, France.
16
Centre Hospitalier Departemental, La Roche sur Yon, La Roche/Yon, France.
17
Centre Hospitalier Departemental, Vannes, France.
18
Centre Hospitalier Departemental, Lorient, France.
19
Centre Hospitalier Departemental, Saint-Brieuc, France.
20
Centre Hospitalier Departemental, Dunkerque, France.
21
Internal Medicine, CHU, Nice, France.
22
Hematology Department, Institut Paoli Calmette, Marseille, France.
23
Hematology Department, CHU, Angers, France.
24
Hematology Department, CHU, Grenoble, France.
25
Hematology Department, Centre Hospitalier Departemental, Annecy, France.
26
Hematology Department, CHU, Lyon, France.
27
Immunopathology Service, Saint-Louis University Hospital, Paris, France.
28
Hematology Department, Saint-Antoine University Hospital, Paris, France.
29
Department of Clinical and Experimental Hematology, Jules Bordet Institute, Brussels, Belgium.
30
Department of Clinical and Experimental Research, Clinique Universitaire Mont-Godinne, Yvoir, Belgium.
31
Hematology Department, Centre Henri Becquerel, Rouen, France.
32
Hematology Department, CHU, Caen, France; and.
33
Hematology Department, CHU, Poitiers, France.

Abstract

Guidelines for monitoring multiple myeloma (MM) patients expressing light chains only (light-chain MM [LCMM]) rely on measurements of monoclonal protein in urine. Alternatively, serum free light chain (sFLC) measurements have better sensitivity over urine methods, however, demonstration that improved sensitivity provides any clinical benefit is lacking. Here, we compared performance of serum and urine measurements in 113 (72κ, 41λ) newly diagnosed LCMM patients enrolled in the Intergroupe Francophone du Myélome (IFM) 2009 trial. All diagnostic samples (100%) had an abnormal κ:λ sFLC ratio, and involved (monoclonal) FLC (iFLC) expressed at levels deemed measurable for monitoring (≥100 mg/L). By contrast, only 64% patients had measurable levels of monoclonal protein (≥200 mg per 24 hours) in urine protein electrophoresis (UPEP). After 1 and 3 treatment cycles, iFLC remained elevated in 71% and 46% of patients, respectively, whereas UPEP reported a positive result in 37% and 18%; all of the patients with positive UPEP at cycle 3 also had elevated iFLC levels. Importantly, elevated iFLC or an abnormal κ:λ sFLC ratio after 3 treatment cycles associated with poorer progression-free survival (P = .006 and P < .0001, respectively), whereas positive UPEP or urine immunofixation electrophoresis (uIFE) did not. In addition, patients with an abnormal κ:λ sFLC ratio had poorer overall survival (P = .022). Finally, early normalization of κ:λ sFLC ratio but not negative uIFE predicted achieving negative minimal residual disease, as determined by flow cytometry, after consolidation therapy (100% positive predictive value). We conclude that improved sensitivity and prognostic value of serum over urine measurements provide a strong basis for recommending the former for monitoring LCMM patients.

PMID:
27729323
PMCID:
PMC5179336
DOI:
10.1182/blood-2016-07-726778
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for HighWire Icon for PubMed Central
Loading ...
Support Center