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Diagnosis and monitoring for light chain only and oligosecretory myeloma using serum free light chain tests

Lookup NU author(s): Professor Graham Jackson

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Abstract

© 2017 John Wiley & Sons Ltd. This study aims to guide the integration of serum free light chain (sFLC) tests into clinical practice, including a new rapid test (Seralite®). Blood and urine analysis from 5573 newly diagnosed myeloma patients identified 576 light chain only (LCO) and 60 non-secretory (NS) cases. Serum was tested by Freelite® and Seralite® at diagnosis, maximum response and relapse. 20% of LCO patients had urine FLC levels below that recommended for measuring response but >97% of these had adequate sFLC levels (oligosecretory). The recommended Freelite® sFLC ≥100 mg/l for measuring response was confirmed and the equivalent Seralite® FLC difference (dFLC) >20 mg/l identified. By both methods, ≥38% of NS patients had measurable disease (oligosecretory). Higher sFLC levels were observed on Freelite® at all time points. However, good clinical concordance was observed at diagnosis and in response to therapy. Achieving at least a very good partial response according to either sFLC method was associated with better patient survival. Relapse was identified using a Freelite® sFLC increase >200 mg/l and found 100% concordance with a corresponding Seralite® dFLC increase >30 mg/l. Both Freelite® and Seralite® sensitively diagnose and monitor LCO/oligosecretory myeloma. Rapid testing by Seralite® could fast-track FLC screening and monitoring. Response by sFLC assessment was prognostic for survival and demonstrates the clinical value of routine sFLC testing.

Publication metadata

Author(s): Heaney JLJ, Campbell JP, Griffin AE, Birtwistle J, Shemar M, Child JA, Gregory WM, Cairns DA, Morgan G, Jackson G, Drayson MT

Publication type: Article

Publication status: Published

Journal: British Journal of Haematology

Year: 2017

Volume: 178

Issue: 2

Pages: 220-230

Print publication date: 01/07/2017

Online publication date: 01/06/2017

Acceptance date: 06/03/2017

ISSN (print): 0007-1048

ISSN (electronic): 1365-2141

Publisher: Wiley-Blackwell

URL: https://doi.org/10.1111/bjh.14753

DOI: 10.1111/bjh.14753

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