The assay measures the two types of free light chains, kappa and lambda, which are made by plasma cells, and. Multiple myeloma early detection, diagnosis, and staging 1. The sflca is an important advance in the diagnosis and monitoring of. My blood draw results, and also the free light chain test, show that i am in the normal range for igg protein. We report three cases of light chain escape lce at a single institution in poland, including an interesting case of biclonal monoclonal gammopathy of undetermined significance mgus that satisfied the criteria for progression to light chain multiple myeloma lcmm with a rapid rise in serum free light chain flc levels, following steroidal treatment for simultaneous temporal. The monoclonal protein secreted by clonal plasma cells in multiple myeloma typically is made up of an intact immunoglobulin consisting of heavy chains, most commonly igg or iga, bound to a kappa or lambda light chain. Stage 3 light chain multiple myeloma cancer survivors. The type of immunoglobulin this is varies from person to person. Protein electrophoresis strip showing 1 normal plasma, 2 polyclonal hypergammaglobulinaemia, 3 serum m protein, and 4 urine m protein bence jones proteinuria and albuminuria. Most people have a type of myeloma that causes the abnormal plasma. As many as 18 percent of all multiple myeloma cancer patients have the light chain myeloma variety. Help you understand more about the serum free light chain assay describe the role of the serum free light chain assay in the diagnosis and monitoring of myeloma answer some of the questions you may have about the serum free light chain assay myeloma uk provides a range of infoguides and infosheets on specific treatment. Immunoglobulins can be classified into one of 5 types depending on their heavy chains. These patients are less likely to have a diagnosis of light chain cast nephropathy.
Sep 26, 2019 light chain deposition disease lcdd is the deposition of monoclonal light chains in multiple organs. It is a rare disease characterized by deposition of nonamyloid immunoglobulin light chains, and they do not stain with congo red and do not exhibit a fibrillar structure when examined ultrastructurally. Serum free light chain measurement aids the diagnosis of. The most common myeloma type was light chain flc only 41% followed by igg 36% and iga 21%. Imwg guidelines for serum free light chain analysis in multiple myeloma and related disorders1 for the more than 3% of myeloma patients who have nonsecretory or oligosecretory disease, and for the majority of. There are also some other conditions related to myeloma that affect plasma cells. However, disease evolution, induced with long disease duration and extensive pretreatment, has resulted in changes in the biological behaviour of mm and unusual relapse emergence, such as of extramedullary em disease or a shift in secretion. Multiple myeloma drug improves survival in multiple myeloma. The serum free light chain assay sflca is a blood test that measures the levels of light chains and can be used to determine al amyloidosis activity and response to treatment. Free light chains are found in the serum blood before they are detected in the. Director of scientific affairs the binding site, inc. In caucasian populations the annual incidence is approximately 60 per million, and this increases with age.
Myeloma cast nephropathy mcn is a common cause of severe renal impairment in multiple myeloma mm. Light chain multiple myeloma, clinic features, responses. Kidney disease is common in patients with multiple myeloma. Sserum free light chain infoguide april 2016 dd 7erum free light chain infoguide april 2016 dd 7 221042016 17. Jul 31, 2005 i am 44 yo female with light chain myeloma that started with mgus in 122003. Comparison of serum free light chain and urine electrophoresis for the detection of the light chain component of monoclonal immunoglobulins in light chain and intact immunoglobulin multiple. The search bar will automatically populate results. Serum free light chain level at diagnosis in myeloma cast. My husband was diagnosed in april 2010 with stage 3 lightchain multiple myeloma after several months of debilitating back and rib pain. In all of these abnormal patients the abnormal kappalambda ratio was caused by abnormalities in the kappa light.
The next most common is iga and igm, igd and ige are very rare. Kappa light chain multiple myeloma treatment multiple myeloma is a rare form of cancer that begins in the bone marrow, when abnormal plasma cells accumulate and crowd out healthy blood cells. The value of serum free light chain assay in patients with. Multiple myeloma mm constitutes for 10% of all hematological malignancies and 1% of all malignancies 12. These can be measured by an assay called the free light chain assay. He kept going downhill and finally went back to our family doctor who ran a lot of tests.
This is most helpful in the rare cases of myeloma in which no m protein is found by spep. As many as 18 percent of all multiple myeloma cancer patients have the lightchain myeloma variety. Ppt multiple myeloma powerpoint presentation free to. San diego, ca some of the subject matter and data contained or addressed in the following. A case of multiple myeloma presenting with uric acid kidney stones. Lightchain deposition disease lcdd is the deposition of monoclonal light chains in multiple organs. Nephropathy was anatomopathologically diagnosed due to kappa free light chain kflc casts figure 1a and duriesalmon stage iiib igakappa mm, and the. Pdf serum free light chain only myeloma with cytoplasmic igm. Free light chain results can be converted back and forth in terms of units easily just by dividing or multiplying by 10. I am 44 yo female with light chain myeloma that started with mgus in 122003. Multiple myeloma mm is a cancer of plasma cells in the bone marrow. A test called the serum free light chain assay sflc assay or.
Myeloma academy imwg guidelines for serum free light chain. Jan 26, 2009 if you have been diagnosed with multiple myeloma, a blood test called a serum free light chain assay freelite played an important role in your diagnosis and will continue to be important in. Light chain multiple myeloma represents approximately 15% of myelomas and is considered a poor prognosis subtype. To gauge the significance of this elevation, it would be valuable to know what.
Imwg guidelines for serum free light chain analysis in multiple myeloma and related disorders this paper, written by an expert panel on behalf of the international myeloma working group, provides consensus guidelines for the use of the serum free light chain assay in the diagnosis and management of clonal plasma cell disorders. This type of myeloma is usually more severe than the classic kind. Comparison of serum free light chain and urine electrophoresis for the detection of the light chain component of monoclonal immunoglobulins in light chain and intact immunoglobulin multiple myeloma. The authors concluded that light chain mgus is a relatively benign disorder with a high rate of monoclonal protein disappearance. Lightchain multiple myeloma how is lightchain multiple myeloma abbreviated. Nonsecretory myeloma in less than two out of 100 2% people with myeloma, little or no immunoglobulin is produced, making diagnosis more difficult. Light chain deposition disease neuropathy resembling. Multiple myeloma is a complex disease characterized by periods of remission and relapse 16. Bence jones myeloma multiple myeloma in which the malignant plasma cells excrete only light chains of one type either kappa or lambda. Clonality can be identified by the demonstration of an abnormal ratio of.
Multiple myeloma mm, also known as plasma cell myeloma, is a cancer of plasma cells, a type of white blood cell that normally produces antibodies. Sserum free light chain infoguide april 2016 dd 8erum free light chain infoguide april 2016 dd 8 221042016 17. Since the spep measures the levels of intact whole antibodies, it cannot. L chain myeloma bence jones proteins proteins with unusual thermosolubility found in the urine of patients with multiple myeloma, consisting of monoclonal immunoglobulin light. Understanding serum free light chain freelite and heavy chainlight chain hevylite tests judith a. Understanding multiple myeloma pathogenesis in the bone marrow to identify new therapeutic targets. Lightchain myeloma, also known as lightchain disease, is a type of multiple myeloma in which the malignant bone marrow cells produce free monoclonal light chain proteins. Involveduninvolved heavylight chain index can predict. The treatment for multiple myeloma, a type of bone marrow cancer, doesnt address the cause of the disease, according to a new study.
Dejoie t, attal m, moreau p, harousseau jl, avetloiseau h. Complications may include amyloidosis the cause of multiple myeloma is unknown. The treatment you need is usually the same whichever type you have but the type can change how it affects you. The freelite test is useful for patients with any type of myeloma 10. Serum free light chain assay for the detection and. A 65yearold man with igg lambda multiple myeloma developed severe polyneuropathy with prominent thermalpain sensory impairment and autonomic failure. Oct 15, 2010 my husband was diagnosed in april 2010 with stage 3 light chain multiple myeloma after several months of debilitating back and rib pain. Serum free light chains for monitoring multiple myeloma monoclonal immunoglobulin free light chains flc are found in the serum and urine of patients with a number of bcell proliferative. Chronic kidney disease ckd some patients with multiple myeloma may experience a gradual or progressive increase in serum creatinine over a period of six months or more. Effects of paraprotein heavy and light chain types and free light chain load on survival in myeloma. Serum free light chain measurement aids the diagnosis of myeloma in patients with severe renal failure. Early reduction of serumfree light chains associates with renal.
Healthy blood cells produce antibodies that help to fight infection. Changes in the amino acid sequence of the light chain may render certain light chain epitopes unrecognizable to the flc reagents. Myeloma academy imwg guidelines for serum free light. He was seeing pain specialists, had kyphoplasty and was getting treatment for spongy muscles. Normally, plasma cells produce antibodies and play a key role in immune function. Serum free light chain analysis for diagnosis, monitoring. Multiple myeloma is characterized by malignant proliferation of plasma cells with an overproduction of monoclonal proteins usually producing igg and iga, but in 20% of cases only light chains are produced, which is termed as light chain myeloma. It is therefore not necessarily the case that there is an increased incidence of light chain escape in multiple myeloma patients, rather that accurate, sensitive and rapid methods of free light chain quantification and characterization have led to increased detection of the light chain escape phenomena. This article is a retrospective study of 142 multiple myeloma patients with 12% having an abnormal serum free light chain ratio but with otherwise no evidence of disease. Pdf comparison of the free and total light chain assays in serum.
Immunoassays which provide quantitative measurement of flcs in serum, have now been adopted into screening algorithms for multiple myeloma and other lymphoproliferative disorders. Current multiple myeloma strategies are moving toward a longterm treatment approach 1114. The kappa and lambda range in the free light chain are a little out of range, but have remained about the same since the first test was done. Bence jones myeloma bents jonz, multiple myeloma in which the malignant plasma cells excrete only light chains of one type either.
But myeloma cells can cause fatigue, easy bleeding and lowered resistance to infections. If you have been diagnosed with multiple myeloma, a blood test called a. Some monoclonal light chains particularly kappa do not dilute in a linear fashion and may be underestimated. About 8 months ago i partially tore a tendon in my my left ankle. More intensive and novel therapy options in multiple myeloma mm hold the promise to improve treatment outcome. In most of these people, the serum free light chain assay can detect small amounts of light chains, but heavy chains are not present. The sflca is an important advance in the diagnosis and monitoring of al amyloidosis. A report of the international myeloma working group. Genetic factors and viral infection may also influence the risk of developing multiple myeloma.
Among them, 66 patients received velcade bortezomib treatment. Lchain myeloma definition of lchain myeloma by medical. Stage 3 light chain multiple myeloma cancer survivors network. Multiple myeloma mm, also known as plasma cell myeloma and simple myeloma, is a cancer of plasma cells, a type of white blood cell that normally produces antibodies. Common questions and answers about revlimid and light chain myeloma. Light chain multiple myeloma, clinic features, responses to therapy and survival in a longterm study.
Learn more about the use of this blood test and how it is used in multiple myeloma therapy. The assays indicate monoclonal flc production by the presence of an abnormal. Kappa light chain multiple myeloma treatment mercy. Mm is the second most common form of haematological malignancy after nonhodgkin lymphoma, and accounts for around 1% of all cancers. The level of free light chain flc that causes mcn varies substantially and there is.
Article information, pdf download for a case of multiple myeloma. However, disease evolution, induced with long disease duration and extensive pretreatment, has resulted in changes in the biological behaviour of mm and unusual relapse emergence, such as of extramedullary em disease or a shift in secretion from intact immunoglobulin ig to free. A free powerpoint ppt presentation displayed as a flash slide show on id. Free light chains circulate in the blood atfree light chains circulate in the blood at abnormally highabnormally high levels in many patients with al amyloidosis. Imwg guidelines for serum free light chain analysis in multiple myeloma and related disorders. Serum free light chains test as the kidneys job is to keep protein. Incidence of free light chain escape in multiple myeloma. Light chain myeloma, also known as light chain disease, is a type of multiple myeloma in which the malignant bone marrow cells produce free monoclonal light chain proteins. Comparing progressionfree survival pfs of the light chain multiple myelomapatients in the velcade group and the group.
Light chain multiple myeloma, clinic features, responses to. Living with abnormal free light chain ratios the myeloma. Prognostic value of the sflc response in light chain multiple myeloma. In the early 2000s, an assay aimed at evaluating serum free light chains sflcs was made available and subsequently tested in different plasma cell disorders. Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders. Although the clinical presentation suggested amyloid neuropathy, nerve biopsy showed the immunohistochemical and ultrastructural features typical of light chain deposition disease lcdd. Sep 18, 2008 more intensive and novel therapy options in multiple myeloma mm hold the promise to improve treatment outcome. Serum free light chain assay treatments and tests myeloma infoguide series sserum free light chain infoguide april 2016 dd 1erum free light chain infoguide april 2016 dd 1 221042016 17. Apr 03, 2020 light chain myeloma, also known as light chain disease, is a type of multiple myeloma in which the malignant bone marrow cells produce free monoclonal light chain proteins.
All the patients werestage iii in the duriesalmonstaging system. As it progresses, bone pain, bleeding, frequent infections, and anemia may occur. During followup, light chain mgus was a persistent finding in 45% 1431 patients, but in the remaining 55% 1731 of patients the monoclonal protein became undetectable. It is a malignant disease characterized by abnormal proliferation of plasma cells and monoclonal immunoglobulins or free light chains flc. The prognostic value of normal serum free light chains has also been questioned elsewhere. Understanding serum free light chain freelite and heavy. Diagnosis and monitoring of multiple myeloma mm and related conditions are usually carried out by means of serum and urine protein electrophoresis and immunofixation. Extending the remission perioddelaying the disease from.
Monoclonal free light chains flcs frequently cause rapidly progressive renal failure in patients with multiple myeloma. Comparing progressionfree survival pfs of the light chain multiple myelomapatients in the velcade group and the group without velcade p. The authors suggest that the international myeloma working group imwg criteria for stringent complete response be adjusted to reflect that some patients can have scr even when their light chain ratios fall outside the normal range. Only one type of immunoglobulin ig is overproduced when you have myeloma. Serum free light chains this blood test can measure the light chain levels in the blood and is done when looking for myeloma or light chain amyloidosis. Imwg guidlines serumfree light chain int myeloma fn.
A serum panel using serum free light chain analysis in combination with either serum protein electrophoresis or serum immunofixation has been shown in several studies to be a highly sensitive approach to screening for most plasma cell disorders. Jul 28, 2014 we intended to investigate the longterm clinical characteristics, responses to therapy and survival in patients with lightchain multiple myeloma mm. We report three cases of light chain escape lce at a single institution in poland, including an interesting case of biclonal monoclonal gammopathy of undetermined significance mgus that satisfied the criteria for progression to light chain multiple myeloma lcmm with a rapid rise in serum free light chain flc levels, following steroidal treatment for simultaneous temporal artery. Extreme polymerization can cause an overestimation of light chains by as much as 10fold. Freelite test is able to detect minute amounts of light chains in the blood, making the diagnosis. Herman liu feb 2010 discussion 1 basics 2 work up 3 treatment discussion 1 basics 2 work up 3 treatment terminology 1. I also suffer from neuropathy and bone pain which has.
Lightchain multiple myeloma how is lightchain multiple. I just started velcade previously treated with dexmethasone, due to my protein levels increasing. Lambda light chain multiple myeloma presenting as pleural. L l f flc i t d ith th b flevels of flcs are associated with the number of. Involveduninvolved heavy light chain index can predict progression in transplanted multiple myeloma. Serum free light chains for monitoring multiple myeloma. Patient management setting expectations for your patients. Although multiple myeloma is not curable, it is treatable 15. Multiple myeloma early detection, diagnosis, and staging. There are few series showing outcomes in reallife patients.