Significance of serum free immunoglobulin light chains measurements in the diagnosis and activity evaluation of multiple myeloma and some monoclonal gammopathies

Česká verzia

Authors: V. Ščudla ¹; J. Minařík ¹; P. Schneiderka ²; M. Kouřil ²; M. Kapustová ²; M. Vytřasová ¹; J. Bačovský ¹; T. Pika ¹
Authors place of work: III. interní klinika Lékařské fakulty UP a FN, Olomouc, přednosta prof. MUDr. Vlastimil Ščudla, CSc. ¹; Oddělení klinické biochemie FN, Olomouc, přednosta doc. MUDr. Petr Schneiderka, CSc. ²
Published in the journal: Vnitř Lék 2005; 51(11): 1249-1259
Category: Original Contributions

Předneseno na Bratislavských hematologických a transfuziologických dnech, Bratislava, 18.-19. listopadu 2004.

Summary

Objective:
The objective of the study is to assess the practical benefit of the determination of serum levels of free immunoglobulin chains in the serum (S-FCH) in patients with different types of monoclonal gamapathies (MG), in particular with regard to multiple myelome (MM).

Patient set and method:
The analysed set of 196 patients contained 119 patients with MM (27 patients examined for diagnosis and 92 „under treatment“ assessed in different phases of MM), 52 patients with monoclonal gamapathy of uncertain significance (MGNV), 8 patients with solitary plasmocytoma, 9 patients with AL-amyloidosis, and 8 patients with primary macroglobulinaemia. S-FCH levels were examined with the use of quantitative immunochemical analysis (Freelite System Binding Site), and statistical examination was carried out using the U-text according to Manna-Whitney (p < 0,05).

Results:
The percentage of higher levels of S-FCH, diverse values for the κ/λ (K/L) index and abnormal value of one of the two indicators for the same person was 40 %, 48 % and 56 % for MGNV, 81 %, 76 % and 84 %, respectively, for the complete set of patients with MM, and 89 %, 92 % and 96 %, respectively, for the set examined for myelome diagnosis, while the percentage for the set of „pre-treated“ patients was 78 %, 71 % and 80 %, respectively. Comparison of changes in S-FCH levels present in MGNV vs. MM, type κ, has shown the following differences: the complete MM set – p = 0.005, MM at diagnosis – p = 0.0003, MM continuous – p = 0.034; comparison of K/L monoclonality index: the complete MM set – p = 0.0001, MM at diagnosis – p = 0.00003, MM continuous – p = 0.001. Comparison of changes in S-FCH levels found in MGNV vs. MM, type λ, has shown the following differences: the complete MM set – p = 0.012, MM at diagnosis – p = 0.001, MM continuous – p insignificant; comparison of K/L monoclonality index: the complete MM set – p = 0.001, MM at diagnosis – p = 0.0002, MM continuous – p = 0.013. Comparison of S-FCH levels for patients with active vs. stable form of MM has shown significant differences within the complete MM set and in the „pre-treated“ patient set with MM, type κ (p = 0.0002 and p = 0.0002), as well as in the λ type MM set (p = 0.004 and p = 0.046). Differences of a higher statistical significance were detected in the comparison of the K/L index values, both for the complete MM set and for the „pre-treated“ patients in the MM, type κ (p < 0.0001 a p < 0.0001), as well as in the λ type MM set (p = 0.001 a p = 0.040). Both patients with solitary plasmocytoma and with focal type of AL-amyloidosis proved to have low values of S-FCH and normal values of the K/L index, as compared with patients with disseminated forms of the disease. Patients with advanced, clinically active form of primary macroglobulinaemia were characterised by higher values of S-FCH and abnormal values of the K/L index as compared with the „latent“/stable form.

Conclusion:
Assessment of monoclonal S-FCH levels is a beneficial, easily accessible and ready to use method which constitutes a significant contribution to the existing range of conventional examinations used in diagnostics, activity assessment and monitoring of the course and effect of treatment of patients with MM, as well as of other types of MG. In the case of normal S-FCH values or K/L index, the probability of MM diagnosis is low, however, abnormal values of one of the two indicators do not allow for distinguishing between the MM and MGNV thresholds.

Key words:
monoclonal gammopathy – monoclonal gammopathy of undetermined significance – multiple myeloma – free lights chains – active and stable multiple myeloma phase

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