Prognostic value of the serum free light chain ratio in newly diagnosed myeloma: Proposed incorporation into the international staging system

C. L.H. Snozek, J. A. Katzmann, R. A. Kyle, A. Dispenzieri, D. R. Larson, T. M. Therneau, L. J. Melton, S. Kumar, P. R. Greipp, R. J. Clark, S. V. Rajkumar

Research output: Contribution to journalArticlepeer-review

128 Scopus citations

Abstract

To determine if the serum free light chain (FLC) ratio has prognostic value in patients with symptomatic multiple myeloma (MM), baseline serum samples from a well-characterized cohort of 790 newly diagnosed MM patients were tested with the FLC assay. FLC ratio was calculated as κ/λ (reference range 0.26-1.65). On the basis of the distribution of values, a cutpoint κ/λ FLC ratio of <0.03 or >32 was chosen for further analysis. Overall survival was significantly inferior in patients with an abnormal FLC ratio of <0.03 or >32 (n = 479) compared with those with an FLC ratio between 0.03 and 32 (n = 311), with median survival of 30 versus 39 months, respectively. We incorporated abnormal FLC ratio with the International Staging System (ISS) risk factors (that is, albumin <3.5 g/dl and serum β2-microglobulin <3.5 g/l), to create a risk stratification model with improved prognostic capabilities. Patients with 0, 1, 2 or 3 adverse risk factors had significantly different overall survival, with median survival times of 51, 39, 30 and 22 months, respectively (P < 0.001). These findings suggest that the serum FLC ratio at initial diagnosis is an important predictor of prognosis in myeloma, and can be incorporated into the ISS for improved risk stratification.

Original languageEnglish (US)
Pages (from-to)1933-1937
Number of pages5
JournalLeukemia
Volume22
Issue number10
DOIs
StatePublished - 2008

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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