Immunoglobulin free light chain ratio is an independent risk factor for progression of smoldering (asymptomatic) multiple myeloma

Angela Dispenzieri, Robert A. Kyle, Jerry A. Katzmann, Terry M Therneau, Dirk Larson, Joanne Benson, Raynell J. Clark, L. Joseph Melton, Morie Gertz, Shaji K Kumar, Rafael Fonseca, Diane F Jelinek, S Vincent Rajkumar

Research output: Contribution to journalArticle

275 Citations (Scopus)

Abstract

We hypothesized that increased monoclonal free kappa or lambda immunoglobulin light chains in smoldering multiple myeloma (SMM), as detected by the serum free light chain (FLC) assay, indicates an increased risk of progression to active myeloma. Baseline serum samples obtained within 30 days of diagnosis were available in 273 patients with SMM seen from 1970 to 1995. At a median follow-up of surviving patients of 12.4 years, transformation to active disease has occurred in 59%. The best breakpoint for predicting risk of progression was an FLC ratio of 0.125 or less, or 8 or more (hazard ratio, 2.3; 95% CI, 1.6-3.2). The extent of abnormality of FLC ratio was independent of SMM risk categories defined by number of bone marrow plasma cells (BMPCs) and size of serum M proteins (BMPC ≥ 10% and serum M protein ≥ 3 g/dL; BMPC ≥ 10% but serum M protein < 3 g/dL; and serum M protein ≥ 3 g/dL but BMPC < 10%). Incorporating the FLC ratio into the risk model, the 5-year progression rates in high-, intermediate-, and low-risk groups were 76%, 51%, and 25%, respectively. The serum immunoglobulin FLC ratio is an important additional determinant of clinical outcome in patients with SMM.

Original languageEnglish (US)
Pages (from-to)785-789
Number of pages5
JournalBlood
Volume111
Issue number2
DOIs
StatePublished - Jan 15 2008

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Immunoglobulin Light Chains
Plasma Cells
Multiple Myeloma
Bone Marrow Cells
Immunoglobulins
Blood Proteins
Bone
Light
Plasmas
Immunoglobulin lambda-Chains
Immunoglobulin kappa-Chains
Serum
Proteins
Cell Size
Odds Ratio
Assays
Hazards

ASJC Scopus subject areas

  • Hematology

Cite this

Immunoglobulin free light chain ratio is an independent risk factor for progression of smoldering (asymptomatic) multiple myeloma. / Dispenzieri, Angela; Kyle, Robert A.; Katzmann, Jerry A.; Therneau, Terry M; Larson, Dirk; Benson, Joanne; Clark, Raynell J.; Melton, L. Joseph; Gertz, Morie; Kumar, Shaji K; Fonseca, Rafael; Jelinek, Diane F; Rajkumar, S Vincent.

In: Blood, Vol. 111, No. 2, 15.01.2008, p. 785-789.

Research output: Contribution to journalArticle

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abstract = "We hypothesized that increased monoclonal free kappa or lambda immunoglobulin light chains in smoldering multiple myeloma (SMM), as detected by the serum free light chain (FLC) assay, indicates an increased risk of progression to active myeloma. Baseline serum samples obtained within 30 days of diagnosis were available in 273 patients with SMM seen from 1970 to 1995. At a median follow-up of surviving patients of 12.4 years, transformation to active disease has occurred in 59{\%}. The best breakpoint for predicting risk of progression was an FLC ratio of 0.125 or less, or 8 or more (hazard ratio, 2.3; 95{\%} CI, 1.6-3.2). The extent of abnormality of FLC ratio was independent of SMM risk categories defined by number of bone marrow plasma cells (BMPCs) and size of serum M proteins (BMPC ≥ 10{\%} and serum M protein ≥ 3 g/dL; BMPC ≥ 10{\%} but serum M protein < 3 g/dL; and serum M protein ≥ 3 g/dL but BMPC < 10{\%}). Incorporating the FLC ratio into the risk model, the 5-year progression rates in high-, intermediate-, and low-risk groups were 76{\%}, 51{\%}, and 25{\%}, respectively. The serum immunoglobulin FLC ratio is an important additional determinant of clinical outcome in patients with SMM.",
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AU - Rajkumar, S Vincent

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