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

Jennifer L J Heaney, John P Campbell, Anne E Griffin, Jane Birtwistle, Meena Shemar, J Anthony Child, Walter M Gregory, David A Cairns, Gareth J Morgan, Graham H Jackson, Mark T Drayson

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18 Citations (Scopus)
136 Downloads (Pure)

Abstract

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.

Original languageEnglish
Pages (from-to)220-230
Number of pages11
JournalBritish Journal of Haematology
Volume178
Issue number2
Early online date1 Jun 2017
DOIs
Publication statusPublished - 11 Jul 2017

Keywords

  • Journal Article

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