Published by the IC
nternational M I
yeloma FT
oundation
ING
Special ASH EdiS
tion: 2010
Serum Free Light Chain Assays
ASH 2010 / 2nd Half of 2010 Issue
The International Myeloma Foundation (IMF) presents this edition of Citings, our premiere publication
featuring the most up-to-date information on myeloma treatment and supportive care. This edition focuses on the
FreeliteTM test, an established immunoassay panel that analyzes free light chains, as well as the new HevyliteTM test,
a novel immunoassay panel that analyzes heavy chain / light chain pairs.
It is our hope that CITINGS will help keep you abreast of the latest developments in myeloma treatment. As always, we
welcome your feedback; you may contact the IMF at (800) 452-CURE (2873) or at our website www.myeloma.org.
Susie Novis, President, IMF
ASH PRESENTATIONS
SATURDAY, DECEMBER 4th
Patterns of Serum Free Light Chain (FLC) Recovery After Reduced Intensity Conditioning (RIC) Allogeneic
Transplant for Multiple Myeloma (MM) Predict Long Term Outcomes
Veerpal Singh, Frank Cornell, Sirisha Paruchuri, Marc Sala, Ayman Saad, Christopher Bredeson, Jeanne Palmer
and Parameswaran Hari
Poster Session: Clinical Care - Recurrence, Secondary Neoplasia and Late Complications after Transplantation: Poster I
Time: 5:30 PM-7:30 PM
Location: Hall A3/A4 (Orange County Convention Center)
Abstract No.: 1301
Poster Board: I-281
The authors' data suggest that after reduced intensity conditioning, with immunosuppressive conditioning, late recovery of uninvolved free
light chain (UFLC) is a marker of the efficacy of the allogeneic effect. The antineoplastic effect of donor alloimmunity likely explains the delayed
recovery of UFLC (mediated by clinical /subclinical graft vs. host disease activity) and paradoxically, better anti-myeloma effect in the late UFLC
recovery group. Rapid progression of myeloma clone and non-establishment of a donor anti-myeloma effect explains the rapid relapse in those
with no UFLC recovery.
Predicting Disease Progression to Multiple Myeloma (MM) From MGUS/SMM In SWOG-0120 Observational Trial
Madhav Dhodapkar, John Shaughnessy Jr., Antje Hoering, Bijay Nair, Vanessa Bolejack, Frits van Rhee, John Crowley and Bart Barlogie
Poster Session: Myeloma - Biology and Pathophysiology, excluding Therapy: Poster I
Time: 5:30 PM-7:30 PM
Location: Hall A3/A4 (Orange County Convention Center)
Abstract No.: 1932
Poster Board: I-912
These data demonstrate, in the context of a large prospective multicenter trial, that abnormal free light chain ratio (FLCR) is a dominant
predictor of clinical malignancy in asymptomatic plasmaproliferative disorders. These findings support the need to understand the biology of
abnormal FLCR and incorporate novel criteria based on imaging, genetics and host response.
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Funded by an unrestricted educational grant from Binding Site.
SUNDAY, DECEMBER 5th
Have Clinicians Adopted the International Uniform Response Criteria (IURC) for Multiple Myeloma (MM)?
Adherence to the IURC for Posttransplant Evaluations In Patients with Multiple Myeloma
Kenneth Utz, Bonita Neumon, Brenda L. Frye, Ju-Hsien Chao, Juan Toro, David Haile and Cesar Freytes
Oral Session: Health Services and Outcomes Research: Normal Values and Patterns of Care
Time: 5:45 PM
Location: 340 (Orange County Convention Center)
Abstract No.: 84
The authors seek to determine adherence to the International Uniform Response Criteria (IURC) set forth by the International Myeloma
Working Group in defining the tests necessary to evaluate patients depending on the magnitude of the response and incorporate the serum
free light chain (SFLC) assay during post autologous hematopoietic stem cell transplantation (AHSCT) in patients with myeloma. The authors
find that only 16% of patients with myeloma underwent posttransplant evaluations that adhered to the IURC guidelines and that laboratory
tests not included in the IURC are frequently obtained.
Assessment of the Performance of Serum Heavy Chains Immunoassay to Monitor Response to Treatment and
Its Correlation with Other Tumor Measurements In Serial Samples From Patients with Newly Diagnosed MM
Attaya Suvannasankha, Sherif Farag, Stephen Harding, Brian GM Durie and Rafat Abonour
Poster Session: Myeloma - Biology and Pathophysiology, excluding Therapy: Poster II
Time: 6:00 PM-8:00 PM
Location: Hall A3/A4 (Orange County Convention Center)
Abstract No.: 2986
Poster Board: II-866
The authors evaluate the correlation of serum heavy light chain (HLC) assays with free light chain assays, serum monoclonal protein measure-
ment by electrophoresis (M spike), and total immunoglobulin G or A, in serial samples of patients with newly diagnosed myeloma undergoing
a lenalidomide containing induction regimen. They find that the HLC / ratio, which takes into account the changes of the uninvolved chain,
is an appealing tool for disease monitoring once HLC of the involved chain normalized; HLC is complimentary to other tumor assessment tools
and needs to be further explored in a larger patient cohort.
Quantification of Serum IgM and IgM In Patients with Waldenstrom's Macroglobulinemia (WM) at Diagnosis
and During Disease Course; Clinical Correlations
Efstathios Koulieris, Marie-Christine Kyrtsonis, Dimitris Maltezas, Tatiana Tzenou, Ladan Mirbahai, Nikolitsa Kafassi,
Vassiliki Bartzis, Maria Dimou, George Georgiou, Charis Matsouka, Gerasimos Pangalis, Panayiotis Panayiotidis, Arthur Bradwell
and Stephen Harding
Poster Session: Myeloma - Pathophysiology and Pre-Clinical Studies, excluding Therapy: Poster I
Time: 6:00 PM-8:00 PM
Location: Hall A3/A4 (Orange County Convention Center)
Abstract No.: 3004
Poster Board: II-884
The authors evaluate the prognostic value IgM/IgM ratios (HLCR) at diagnosis and the role of HLCR in disease monitoring. They find that
HL IgM and IgM free light chain ratio seems to separate patients with a more aggressive disease; further studies will be needed to evaluate
their utility for monitoring Waldenstrom's macroglobulinemia patients.
The Role of Serum Immunoglobulin Free Light Chain In Response and Progression
In Waldenstrom Macroglobulinemia
Xavier Leleu, Wanling Xie, Meghan Rourke, Ranjit Banwait, Renee Leduc, Nitin Roper, Edie Weller and Irene Ghobrial
Poster Session: Non-Hodgkin Lymphoma - Biology, excluding Therapy: Poster II
Time: 6:00 PM-8:00 PM
Location: Hall A3/A4 (Orange County Convention Center)
Abstract No.: 3095
Poster Board: II-975
The authors examine the role of serum free light chain (sFLC) in the response and progression of patients with Waldenstrom macroglobu-
linemia (WM) and find that serum immunoglobulin FLC may be a useful marker of tumor measurement that correlates well with IgM and
M spike measurements.
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Serum Kappa/Lambda Ratio, An Independent Prognostic Factor at Diagnosis and
Serum Free-Light Chains Level, An Early Indicator of Relapse/Progression In Multiple Myeloma
Mohamad Sobh, Stephane Morisset, Taoufik Guilli, Sophie Ducastelle-Lepretre, Fiorenza Barraco, Youcef Chelghoum,
Giovanna Cannas, Xavier Thomas, Aline Praire, Helene Labussiere, Franck E Nicolini, Colette Chapuis-Celier
and Mauricette Michallet
Poster Session: Myeloma - Biology and Pathophysiology, excluding Therapy: Poster II
Time: 6:00 PM-8:00 PM
Location: Hall A3/A4 (Orange County Convention Center)
Abstract No.: 2954
Poster Board: II-834
The authors aim to evaluate the impact of serum free light chain ratio (sFLCR), measured at diagnosis in myeloma patients, on the progres-
sion free survival (PFS) and overall survival (OS), as well as assess the importance of sFLC analysis during the follow-up, especially for relapse/
progression detection comparing to concomitant monoclonal-protein (M-p) traditional serum protein electrophoresis (sPE). They show that
abnormal sFLCR at diagnosis affects OS and more strongly the PFS independently of any other concomitant variable. Additionally, in 81% of
patients, sFLC analysis enabled an earlier detection of relapse/progression compared to sPE.
MONDAY, DECEMBER 6th
Non-Clonal Serum Immunoglobulin Free Light Chains (FLC) as Markers of Overall Survival
Angela Dispenzieri, Robert Kyle, Jerry A Katzmann, Dirk Larson, Shaji Kumar, Graham Peter Mead, Arthur Bradwell
and S. Vincent Rajkumar
Poster Session: Lymphocytes, Lymphocyte Activation and Immunodeficiency, including HIV and Other Infections: Poster III
Time: 6:00 PM-8:00 PM
Location: Hall A3/A4 (Orange County Convention Center)
Abstract No.: 3893
Poster Board: III-672
The authors seek to identify whether the free light chain (FLC) assay provides information that would be prognostic in a general population
of people 50-years and older. They find that serum FLC above the normal range (i.e. highest decile) is associated with inferior overall survival
among individuals above the age of 50, excluding patients with known monoclonal gammopathy of undetermined significance (MGUS) or light
chain-MGUS; this is important and merits further investigation. Although there is an association between serum FLC, renal function, gender
and age, excess risk of death still exists after adjusting for these risk factors on multivariate analysis.
Polyclonal Free Light Chain Elevation and Mortality In the German Heinz Nixdorf Recall Study
Lewin Eisele, Jan Dürig, Andreas Huttmann, Ulrich Dührsen, Anja Führer, Sabrina Kieruzel, Martina Bröcker-Preuss, Beate Bokhof,
Raimund Erbel, Klaus Mann, Karl-Heinz Jöckel and Susanne Moebus
Poster Session: Lymphocytes, Lymphocyte Activation and Immunodeficiency, including HIV and Other Infections: Poster III
Time: 6:00 PM-8:00 PM
Location: Hall A3/A4 (Orange County Convention Center)
Abstract No.: 3903
Poster Board: III-682
The authors report their first preliminary results of the analysis of polyclonal free light chain (FLC) elevation with regard to all-cause mortality
in the Heinz Nixdorf Recall cohort. They find no associations of total FLC with categorized causes of death and that polyclonal FLC measure-
ments are affected by a variety of health conditions and may thus be subject to fluctuations over time.
The Ratio of Monoclonal to Polyclonal Immunoglobulins Assessed with the HevyliteTM Test Predicts Prognosis,
Is Superior for Monitoring the Course of the Disease and Allows Detection of Monoclonal Immunoglobulin
In Patients with Normal or Subnormal Involved Immunoglobulin Isotype
Heinz Ludwig, Ladan Mirbahai, Niklas Zojer, Arthur Bradwell and Stephen Harding
Poster Session: Myeloma - Biology and Pathophysiology, excluding Therapy: Poster III
Time: 6:00 PM-8:00 PM
Location: Hall A3/A4 (Orange County Convention Center)
Abstract No.: 4038
Poster Board: III-817
In this study, the authors find that the heavy light chain (HLC) ratio is highly prognostic and improves the detection of variations in the course
of the disease and increased the diagnostic accuracy in patients with normal or subnormal levels of the involved isotype and even in patients
shown to be negative in immunofixation; determination of the HLC ratio seems to overcome a hitherto unmet need for improvement in assess-
ment of response and of variations in the production of the monoclonal protein.
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CITINGS FROM THE 2nd HALF OF 2010
NHook effect with lambda free light chain in serum free light chain assay.
Levinson SS.
Clin Chim Acta. 2010 Nov 11;411(21-22):1834-6. [Epub 2010 Jul 25.]
:
http://www.ncbi.nlm.nih.gov/pubmed/20667445
No abstract available.
NCoexistence of myeloma cast nephropathy, light chain deposition disease, and nonamyloid fibrils
in a patient with multiple myeloma.
Qian Q, Leung N, Theis JD, Dogan A, Sethi S.
Am J Kidney Dis. 2010 Nov;56(5):971-6. [Epub 2010 Sep 25.]
:
http://www.ncbi.nlm.nih.gov/pubmed/20870327
The authors describe the unusual kidney biopsy findings of concurrent myeloma cast nephropathy and glomerular nonamyloid fibrillary deposits
composed of immunoglobulin G (IgG) heavy chains and light chains in a myeloma patient who presented with acute renal failure. They show that laser
microdissection and mass spectrometry is an extremely useful ancillary test for the diagnosis of heavy and light chain deposition diseases.
NInhibition of pathologic immunoglobulin-free light chain production by small interfering RNA molecules.
Phipps JE, Kestler DP, Foster JS, Kennel SJ, Donnell R, Weiss DT, Solomon A, Wall JS.
Exp Hematol. 2010 Nov;38(11):1006-13. [Epub 2010 Jul 14.]
:
http://www.ncbi.nlm.nih.gov/pubmed/20637260
This study shows that RNA interference can markedly reduce light chain synthesis and provides the basis for testing the therapeutic potential of this
strategy using in vivo experimental models of myeloma.
NInterlaboratory study of free monoclonal immunoglobulin light chain quantification.
Vávrová J, Maisnar V, Tichý M, Friedecký B, Cermáková Z, Dastych M, Gottwaldová J, Kucera P, Krotká J, Racek J, Zenková J,
Schneiderka P, Lochman P, Zima T, Benáková H, Büchler T, Spácilová J, Hájek R, Palicka V.
Clin Chem Lab Med. 2010 Oct 29. [Epub ahead of print.]
:
http://www.ncbi.nlm.nih.gov/pubmed/21034251
The authors initiate an interlaboratory study measuring free light chain (FLC) concentrations in 12 serum samples from patients with monoclonal
gammopathies. They find that, due to its impact on the clinical management of patients with gammopathy, FLC quantification needs to become a part of
the regular quality control cycle in myeloma centers.
NUse of serum free light chain analysis and urine protein electrophoresis for detection of monoclonal
gammopathies.
Holding S, Spradbery D, Hoole R, Wilmot R, Shields ML, Levoguer AM, Doré PC.
Clin Chem Lab Med. 2010 Oct 20. [Epub ahead of print.]
:
http://www.ncbi.nlm.nih.gov/pubmed/20961192
The authors assess the effect of replacing urine protein electrophoresis (UPE) with serum free light chain (FLC) analysis and find that using FLC
alongside or in place of UPE can give clinical benefit through earlier diagnosis, and hence treatment earlier in the disease for patients with patients with
monoclonal gammopathies.
NMonoclonal free light chains can be found in heavy chain diseases.
López-Anglada L, Puig N, Díez-Campelo M, Alonso-Ralero L, Barrena S, Aparicio MA, Gutiérrez NC, García-Sanz R.
Ann Clin Biochem. 2010 Oct 7. [Epub ahead of print.]
:
http://www.ncbi.nlm.nih.gov/pubmed/20930031
This case report illustrates a new case of gamma-heavy chain disease, in which serum free light-chain analysis and flow cytometry represent a valuable
tool for diagnosis, a finding that could be very important for the future management of these patients.
NFree Ig light chains interact with sphingomyelin and are found on the surface of myeloma plasma cells
in an aggregated form.
Hutchinson AT, Ramsland PA, Jones DR, Agostino M, Lund ME, Jennings CV, Bockhorni V, Yuriev E, Edmundson AB, Raison RL.
J Immunol. 2010 Oct 1;185(7):4179-88. [Epub 2010 Sep 3.]
:
http://www.ncbi.nlm.nih.gov/pubmed/20817866
The authors show that Free / chains associate with sphingomyelin on the plasma membrane of myeloma cells.
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NDetection of serum free light chains: the problem with antigen excess.
Bosmann M, Kössler J, Stolz H, Walter U, Knop S, Steigerwald U.
Clin Chem Lab Med. 2010 Oct;48(10):1419-22. [Epub 2010 Jul 13.]
:
http://www.ncbi.nlm.nih.gov/pubmed/20626301
In this study, the authors find a significantly higher incidence of falsely low test results due to antigen excess than reported previously, which may
result in erroneous interpretations in sera subjected to nephelometric analysis. Therefore, they conclude that clinical decisions should not be based
solely on a single assay, especially if free light chain testing includes only one dilution of the serum sample. Instead, several parallel dilutions should
be recommended for screening of patients.
NProgress in the management of multiple myeloma introduced by serum free light chain measurement.
[Article in Japanese]
Shimazaki C.
Rinsho Ketsueki. 2010 Oct;51(10):1491-8.
:
http://www.ncbi.nlm.nih.gov/pubmed/20962483
No abstract available.
NProlonged hemodialysis for acute kidney injury in myeloma patients.
Hanf W, Guillaume C, Jolivot A, Chapuis-Cellier C, Guebre-Egziabher F, Fontana A, Fouque D, Juillard L.
Clin Nephrol. 2010 Oct;74(4):319-22.
:
http://www.ncbi.nlm.nih.gov/pubmed/20875387
The authors report two patients presenting with acute kidney injury and high free light chain (FLC) serum concentration and M-components, one with
IgG Kappa and the other with IgD lambda. They find that despite similar range of depuration, serum plasma FLC decreased importantly in the patient
with the kappa type (who recovered) but was unchanged in the lambda type patient who remained under maintenance dialysis.
NSerum free light chain analysis.
Davids MS, Murali MR, Kuter DJ.
Am J Hematol. 2010 Oct;85(10):787-90.
:
http://www.ncbi.nlm.nih.gov/pubmed/20721885
This article summarizes laboratory testing for serum free light chains, with a particular focus on clinical applications for the test.
NValue of serum free light chains assay in plasma cell disorders. [Article in Spanish]
López-Corral L, García-Sanz R, San Miguel JF.
Med Clin (Barc). 2010 Sep 11;135(8):368-74. [Epub 2010 Jul 3.]
:
http://www.ncbi.nlm.nih.gov/pubmed/20598719
The authors discuss a new assay capable of quantifying free light chains in serum, a great improvement for the diagnosis of non-secretory myeloma
amyloidosis.
NPolyclonal free light chain of Ig may interfere with interpretation of monoclonal free light chain / ratio.
Levinson SS.
Ann Clin Lab Sci. 2010 Fall;40(4):348-53.
:
http://www.ncbi.nlm.nih.gov/pubmed/20947809
This report describes two untreated patients in whom monoclonal free light chains (FLCs) were identified in urine despite normal serum FLC / ratios,
cases that illustrate this likely effect and attest to the continued importance of urine immunofixation electrophoresis for initial screening of patients
for Bence-Jones protein.
NSerum immunoglobulin free light chain measurement in AL amyloidosis: prognostic value and correlations
with clinical features.
Kumar S, Dispenzieri A, Katzmann JA, Larson DR, Colby CL, Lacy MQ, Hayman SR, Buadi FK, Leung N, Zeldenrust SR,
Ramirez-Alvarado M, Clark RJ, Kyle RA, Rajkumar SV, Gertz MA.
Blood. 2010 Aug 26. [Epub ahead of print.]
:
http://www.ncbi.nlm.nih.gov/pubmed/20798235
The authors study the relationship between free light chain (FLC) levels and clinical features in 730 patients with newly diagnosed amyloidosis (AL). They
find that the type of light chain impacts the spectrum of organ involvement and the FLC burden correlates with survival in AL.
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NComparison of serum immunofixation electrophoresis and free light chain assays in the detection
of monoclonal gammopathies.
Wood PB, McElroy YG, Stone MJ.
Clin Lymphoma Myeloma Leuk. 2010 Aug 1;10(4):278-80.
:
http://www.ncbi.nlm.nih.gov/pubmed/20709664
This study seeks to compare immunofixation electrophoresis (IFE) with serum free light chain (FLC) assays in the detection of monoclonal gammopathies
(MG). The authors conclude that for screening purposes, serum IFE should be carried out in patients with suspected MG.
NDetermination of light chains in serum. [Article in Danish]
Hansen CT, Nielsen L, Münster AM, Abildgaard N.
Ugeskr Laeger. 2010 Aug 23;172(34):2302-5.
:
http://www.ncbi.nlm.nih.gov/pubmed/20727297
The authors discuss the potential power of the power of measurement of free light chains in serum, as well as the unsolved aspects that still must be
considered in order for it to be used optimally in a daily clinical setting for patients with monoclonal plasma cell disorders.
NRelationship between elevated immunoglobulin free light chain and the presence of IgH translocations
in multiple myeloma.
Kumar S, Zhang L, Dispenzieri A, Van Wier S, Katzmann JA, Snyder M, Blood E, DeGoey R, Henderson K, Kyle RA, Bradwell AR,
Greipp PR, Rajkumar SV, Fonseca R.
Leukemia. 2010 Aug;24(8):1498-505. [Epub 2010 Jun 3.]
:
http://www.ncbi.nlm.nih.gov/pubmed/20520636
The authors hypothesize that presence of immunoglobin heavy chain (IgH) translocations leads to unbalanced production of light chains and more
extreme abnormalities of free light chain (FLC), and may explain the prognostic value of FLC. They conclude that patients with IgH translocations have
higher FLC levels and abnormal ratios, but the prognostic effect of FLC is only partially explained by translocation status; a system including both these
risk factors allows better prediction of outcome.
NTreatment with intravenous melphalan and dexamethasone is not able to overcome the poor prognosis
of patients with newly diagnosed systemic light chain amyloidosis and severe cardiac involvement.
Dietrich S, Schönland SO, Benner A, Bochtler T, Kristen AV, Beimler J, Hund E, Zorn M, Goldschmidt H, Ho AD, Hegenbart U.
Blood. 2010 Jul 29;116(4):522-8. [Epub 2010 Apr 7.]
:
http://www.ncbi.nlm.nih.gov/pubmed/20375312
The authors report on 61 patients with advanced systemic light chain amyloidosis who were treated with intravenous melphalan-dexamethasone
as first-line therapy. They find that the amount of the involved free light chains in serum and Karnofsky Index at diagnosis significantly influenced
overall survival.
NMonoclonal gammopathy of undetermined significance (MGUS) and smoldering (asymptomatic) multiple
myeloma: IMWG consensus perspectives risk factors for progression and guidelines for monitoring
and management.
Kyle RA, Durie BGM, Rajkumar SV, Landgren O, Blade J, Merlini G, Kröger N, Einsele H, Vesole DH, Dimopoulos M, San Miguel
J, Avet-Loiseau H, Hajek R, Chen WM, Anderson KC, Ludwig H, Sonneveld P, Pavlovsky S, Palumbo A, Richardson PG, Barlogie B,
Greipp P, Vescio R, Turesson I, Westin J, Boccadoro M; International Myeloma Working Group.
Leukemia. 2010 Jun;24(6):1121-7. [Epub 2010 Apr 22.]
:
http://www.ncbi.nlm.nih.gov/pubmed/20410922
The authors discuss the nature of smoldering multiple myeloma and monoclonal gammopathy of undetermined significance, including their testing by
serum protein electrophoresis, immunofixation, and the free light chain (FLC) assay.
NReduction of serum free light chains predict renal recovery.
Hutchison CA.
Ann Hematol. 2010 Jun;89(6):627-8. [Epub 2009 Sep 26.]
:
http://www.ncbi.nlm.nih.gov/pubmed/19784650
Comment on: Ann Hematol. 2010 Mar;89(3):291-7.
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NPrevalence and risk of progression of light-chain monoclonal gammopathy of undetermined significance:
a retrospective population-based cohort study.
Dispenzieri A, Katzmann JA, Kyle RA, Larson DR, Melton LJ 3rd, Colby CL, Therneau TM, Clark R, Kumar SK, Bradwell A,
Fonseca R, Jelinek DF, Rajkumar SV.
Lancet. 2010 May 15;375(9727):1721-8.
:
http://www.ncbi.nlm.nih.gov/pubmed/20472173
This study uses a population-based cohort, previously assembled to estimate monoclonal gammopathy of undetermined significance (MGUS) prevalence,
of 21,463 residents of Olmsted County, MN, USA, aged 50 years and older, including performing a serum free light-chain assay on all samples with
sufficient serum remaining. The authors define a clinical entity representing the light-chain equivalent of conventional MGUS and posing a risk of
progression to light-chain myeloma and related disorders.
NAnalysis of serum levels of selected biological parameters in monoclonal gammopathy of undetermined
significance and multiple myeloma. [Article in Czech]
Scudla V, Budíková M, Petrová P, Minarík J, Pika T, Bacovský J, Adamová D, Langová K; Ceská Myelomová Skupina.
Klin Onkol. 2010;23(3):171-81.
:
http://www.ncbi.nlm.nih.gov/pubmed/20608327
This study aims to evaluate the serum levels of 18 selected parameters in monoclonal gammopathy of undetermined significance (MGUS), and the initial,
asymptomatic phase of myeloma, also from the point of view of the potential contribution to the differentiation of these two units. Statistical analysis
reveals significant differences between MGUS and myeloma in 9 of the 18 evaluated parameters. However, due to the significant overlapping of the
measured values, none of the parameters is unambiguously able to distinguish between the units.
NMultiple myeloma with monoclonal free IgG3 heavy chains and free kappa light chains.
Richter AG, Harding S, Huissoon A, Drayson M, Pratt G.
Acta Haematol. 2010;123(3):158-61. [Epub 2010 Mar 10.]
:
http://www.ncbi.nlm.nih.gov/pubmed/20215741
This is the first description, investigation and treatment of myeloma with a plasma cell population producing truncated gamma(3) heavy chain and kappa
free light chain M-proteins, and illustrates a number of unique immunological and clinical features.
NNew capacities of the diagnosis and monitoring of the course of AL-amyloidosis. [Article in Russian]
No authors listed.
Ter Arkh. 2010;82(6):29-32.
:
http://www.ncbi.nlm.nih.gov/pubmed/20731106
This study aims to define the clinical value of various concentrations of immunoglobulin light chains (ILCs) in patients with AL amyloidosis and finds that
the determination of serum ILC concentration by the Freelite method may be used to diagnose AL amyloidosis and to specify the presence of appropriate
organ dysfunction; this study over time makes it possible to monitor the course of the disease and to estimate its response to therapy.
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