Extramedullary relapse of multiple myeloma associated with a shift in secretion from intact immunoglobulin to light chains

Dawson, Mark A.; Patil, Sushrut; Spencer, Andrew

doi:10.3324/haematol.10297

Cited by 78 publications

(54 citation statements)

References 7 publications

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“…10,11 The proliferative advantage, and the molecular, genetic and drug sensitivity cellular mechanisms influencing the natural history of MM could be further investigated if the two component populations were separated by flow cytometry. …”

Section: Resultsmentioning

confidence: 99%

Demonstration of changes in plasma cell subsets in multiple myeloma

Ayliffe¹,

Davies²,

Castro³

et al. 2007

Haematologica

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Section: Resultsmentioning

confidence: 99%

Demonstration of changes in plasma cell subsets in multiple myeloma

Ayliffe¹,

Davies²,

Castro³

et al. 2007

Haematologica

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“…Second, when a rise in one marker is detected before the other due to differences in the relative amounts of protein production by the tumour. Third, a minority of myeloma patients produce excess free light chains at relapse with no change in intact monoclonal immunoglobulin, called free light chain breakthrough (Hobbs, 1969;Dawson et al, 2007). With the advent of newer agents and reduced intensity allogeneic transplantation novel manifestations of relapse with extramedullary disease and free light chain breakthrough appear more frequent (Dawson et al, 2007).…”

Section: Review ª 2008 the Authormentioning

confidence: 99%

“…Third, a minority of myeloma patients produce excess free light chains at relapse with no change in intact monoclonal immunoglobulin, called free light chain breakthrough (Hobbs, 1969;Dawson et al, 2007). With the advent of newer agents and reduced intensity allogeneic transplantation novel manifestations of relapse with extramedullary disease and free light chain breakthrough appear more frequent (Dawson et al, 2007). A significant minority of myeloma patients (18%) have two populations of plasma cells, one population expressing intact immunoglobulin and the other light chain only and these patients have a shorter survival (Ayliffe et al, 2007).…”

Section: Review ª 2008 the Authormentioning

confidence: 99%

The evolving use of serum free light chain assays in haematology

Pratt

2008

Br J Haematol

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SummaryOver the last few years new immunoassays have emerged that allow the measurement of free immunoglobulin light chains (FLCs) in serum to a level of 2–4 mg/l and provide a much greater sensitivity than older methods, such as immunofixation, which is able to detect FLCs at a minimum concentration of 100–150 mg/l. The new FLC assay has enabled the detection of monoclonal protein in some patients with non‐secretory myeloma and amyloidosis that were previously undetectable. FLC measurements are quantitative, correlating with disease activity, and are an advance in monitoring light chain only multiple myeloma, AL amyloidosis, non‐secretory and oligo‐secretory multiple myeloma. Serum FLC concentrations also reflect the disease course in the majority of myeloma patients producing intact monoclonal immunoglobulin proteins and have been incorporated into the new response criteria. The rapid half life of λ and κ free light chains means that FLC assays may provide a more rapid indication of the response to treatment but their clinical utility in this setting needs further study. An abnormal FLC ratio has been shown to be a risk factor for progression of monoclonal gammopathy of undetermined significance, smouldering myeloma and solitary plasmacytoma of bone and is prognostic in multiple myeloma.

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“…Without doing periodic urinary evaluations or serum FLC measurements, this phenomenon can be missed. 43 Recommendations for the use of the serum FLC assay in response assessment. Serial FLC ascertainment should be routinely performed in patients with AL amyloidosis and multiple myeloma patients with oligosecretory disease.…”

Section: International Myeloma Working Group Guidelinesmentioning

confidence: 99%