Polyclonal serum free light chain elevation is associated with increased risk of monoclonal gammopathies

Shaji K Kumar, Dirk R. Larson, Angela Dispenzieri, Terry M Therneau, David L. Murray, Peter Leif Bergsagel, Robert A. Kyle, S Vincent Rajkumar

Research output: Contribution to journalArticle

Abstract

Monoclonal gammopathies (MG) constitute a spectrum of disorders starting from a monoclonal gammopathy of undetermined significance (MGUS) to active disease requiring therapy such as multiple myeloma. MG are characterized by proliferation of clonal plasma cells (PC) secreting a monoclonal protein either as intact immunoglobulin or free kappa or lambda free light chains (FLC). We hypothesized that a polyclonal elevation of serum FLC may indicate an inflammatory state that precedes development of MG. We studied 15,630 individuals from Olmsted county, who did not have MGUS based on baseline screening studies. At a median follow-up of 18.1 years, 264 patients had developed a clonal PC disorder; 252 with MGUS, 1 with SMM, 8 with MM, and 3 with amyloidosis, translating to an annual incidence of development of a MG of 0.1%. We examined the baseline polyclonal ΣFLC (kappa + lambda FLC) from the initial screening and grouped them into deciles. The highest decile group had a 2.6-fold (95% CI; 1.8, 3.7) increase in the risk of developing a MG, P < 0.001. We demonstrate for the first time, the increased risk of developing MG in patients with elevated serum FLC, suggesting that an underlying inflammatory state may play an etiologic role.

Original languageEnglish (US)
Article number49
JournalBlood cancer journal
Volume9
Issue number6
DOIs
StatePublished - Jun 1 2019

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Paraproteinemias
Monoclonal Gammopathy of Undetermined Significance
Light
Serum
Plasma Cells
Amyloidosis
Multiple Myeloma
Immunoglobulins
Incidence
Proteins

ASJC Scopus subject areas

  • Hematology
  • Oncology

Cite this

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title = "Polyclonal serum free light chain elevation is associated with increased risk of monoclonal gammopathies",
abstract = "Monoclonal gammopathies (MG) constitute a spectrum of disorders starting from a monoclonal gammopathy of undetermined significance (MGUS) to active disease requiring therapy such as multiple myeloma. MG are characterized by proliferation of clonal plasma cells (PC) secreting a monoclonal protein either as intact immunoglobulin or free kappa or lambda free light chains (FLC). We hypothesized that a polyclonal elevation of serum FLC may indicate an inflammatory state that precedes development of MG. We studied 15,630 individuals from Olmsted county, who did not have MGUS based on baseline screening studies. At a median follow-up of 18.1 years, 264 patients had developed a clonal PC disorder; 252 with MGUS, 1 with SMM, 8 with MM, and 3 with amyloidosis, translating to an annual incidence of development of a MG of 0.1{\%}. We examined the baseline polyclonal ΣFLC (kappa + lambda FLC) from the initial screening and grouped them into deciles. The highest decile group had a 2.6-fold (95{\%} CI; 1.8, 3.7) increase in the risk of developing a MG, P < 0.001. We demonstrate for the first time, the increased risk of developing MG in patients with elevated serum FLC, suggesting that an underlying inflammatory state may play an etiologic role.",
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AU - Kumar, Shaji K

AU - Larson, Dirk R.

AU - Dispenzieri, Angela

AU - Therneau, Terry M

AU - Murray, David L.

AU - Bergsagel, Peter Leif

AU - Kyle, Robert A.

AU - Rajkumar, S Vincent

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