Utility of serum free light chain measurements in multiple myeloma patients not achieving complete response to therapy

Leukemia. 2015 Oct;29(10):2033-8. doi: 10.1038/leu.2015.118. Epub 2015 May 12.

Abstract

Normalization of the serum-free light-chain ratio (FLCr) with the absence of bone marrow monoclonal plasma cells following achievement of a complete response (CR) to therapy denotes a stringent CR in multiple myeloma (MM), and is associated with improved overall survival (OS). However, its value in patients achieving <CR is not clear. We hypothesized that patients achieving a normalization of FLCr with initial therapy of MM will have an improved outcome, even in the absence of a CR. We retrospectively evaluated 449 patients with newly diagnosed MM with measurable disease at baseline, who did not achieve a CR with initial therapy. One hundred and fifty-three patients (34%) had a normal FLCr, whereas 296 (66%) had an abnormal ratio. Patients with a normal FLCr had a longer progression-free survival (29 vs 16 months, P<0.001) and OS (91 vs 58 months, P<0.001). Normalization of FLCr retained its prognostic value in a multivariable model. Our results suggest an important role for sFLC measurement in disease monitoring even in patients who achieve only a partial response to therapy. Obtaining a normal FLCr confers a favorable prognosis independent from other factors, supporting the inclusion of sFLC in all levels of response criteria.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Female
  • Follow-Up Studies
  • Humans
  • Immunoglobulin Light Chains / blood*
  • Male
  • Middle Aged
  • Multiple Myeloma / blood*
  • Multiple Myeloma / drug therapy*
  • Multiple Myeloma / mortality
  • Neoplasm Recurrence, Local / blood*
  • Neoplasm Recurrence, Local / drug therapy*
  • Neoplasm Recurrence, Local / mortality
  • Neoplasm Staging
  • Prognosis
  • Remission Induction
  • Retrospective Studies
  • Survival Rate

Substances

  • Immunoglobulin Light Chains