TY - JOUR
T1 - Prognostic value of the serum free light chain ratio in newly diagnosed myeloma
T2 - Proposed incorporation into the international staging system
AU - Snozek, C. L.H.
AU - Katzmann, J. A.
AU - Kyle, R. A.
AU - Dispenzieri, A.
AU - Larson, D. R.
AU - Therneau, T. M.
AU - Melton, L. J.
AU - Kumar, S.
AU - Greipp, P. R.
AU - Clark, R. J.
AU - Rajkumar, S. V.
PY - 2008
Y1 - 2008
N2 - 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.
AB - 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.
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U2 - 10.1038/leu.2008.171
DO - 10.1038/leu.2008.171
M3 - Article
C2 - 18596742
AN - SCOPUS:54049096663
VL - 22
SP - 1933
EP - 1937
JO - Leukemia
JF - Leukemia
SN - 0887-6924
IS - 10
ER -