Serum Free Light Chain Response After 2 Courses of Induction Chemotherapy Predicts Prognosis in Myeloma Patients

Yağcı, Münci; Karakaya, Fatih; Suyanı, Elif; Haznedar, Rauf

doi:10.1016/j.clml.2014.08.007

Cited by 6 publications

(5 citation statements)

References 27 publications

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“…We hypothesize that the kinetics of light chain reduction show similar dynamics. Accordingly, a significant decrease of iFLC/sFLCr after two cycles was shown to be a prognostic factor for ORR (Hassoun et al 2005) and OS (Dispenzieri et al 2008;Yağcı et al 2015) in conventional chemotherapy studies. In contrast, bortezomib containing therapies lead to a more rapid reduction of sFLC (van Rhee et al 2007;Tessenow et al 2017).…”

Section: Discussionmentioning

confidence: 95%

“…Our own results confirm this, suggesting that the high efficacy of bortezomib-containing therapies can overcome the poor prognosis caused by an unfavorable clonal evolution of light chain-predominant secretory MM. Owing to the short half life of FLCs (2-6 h, compared with 3-25 days for intact immunoglobulins), monitoring the iFLC is attractive to derive markers of disease response (Pratt et al 2006;Tosi et al 2013;Yağcı et al 2015). Various studies have investigated the prognostic significance of an iFLC reduction during the first treatment cycles.…”

Section: Discussionmentioning

confidence: 99%

“…However, these studies are difficult to compare, because they employed different therapy regimens with heterogenous response kinetics. An additional issue is the heterogeneity of drug combinations considered in some of these studies (Kyrtsonis et al 2007;Hansen et al 2014;Yağcı et al 2015). Although conventional chemotherapy alone usually requires at least six cycles to achieve maximum response, bortezomib-containing therapies only require 2-4 cycles.…”

Section: Discussionmentioning

confidence: 99%

“…The prognostic effect of sFLC response after two courses of induction therapy was evaluated in two other studies. In the first study, the 5-years OS was 97.4% versus 55.8% in patients with sFLCr ≤ 10 and > 10, respectively (p = 0.001) (Yağcı et al 2015). In contrast, Dispenzieri et al (2008) found no significant difference in PFS or OS between patients with more or less than 50% reduction of iFLC after two cycles of conventional chemotherapy.…”

Section: Introductionmentioning

confidence: 93%

“…A disadvantage of these evaluations is the diversity of therapy combinations that were commonly applied in these studies (Dispenzieri et al 2008;Hansen et al 2014;Yağcı et al 2015). Because the rate of myeloma protein reduction likely differs between treatment protocols, studies of single regimes are advantageous to clarify the predictive value.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic impact of rapid reduction of involved free light chains in multiple myeloma patients under first-line treatment with Bendamustine, Prednisone, and Bortezomib (BPV)

Holzhey

Pönisch

Wang

et al. 2021

J Cancer Res Clin Oncol

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Introduction Light chain involvement is observed in almost every patient (pt) with newly diagnosed multiple myeloma (MM). Owing to a relatively short half-life, rapid reduction in the involved free light chain (iFLC) is of potential prognostic value. Methods This retrospective analysis included 92 pts with newly diagnosed MM treated with bendamustine, prednisone, and bortezomib (BPV). Results After a median number of two (range 1–5) BPV cycles, the majority of pts (n = 86; 93%) responded with either sCR (n = 21), CR (n = 1), nCR (n = 25), VGPR (n = 20), or PR (n = 19). PFS and OS at 48 months were 39% and 67%, respectively. At baseline, 79 out of 92 pts (86%) had iFLC levels above the upper standard level and an abnormal ratio of involved to uninvolved free light chain ≥ 8. In a subgroup analysis of these pts, we evaluated the prognostic importance of an early reduction of the iFLC during the first two BPV cycles. A reduction ≥ 50% of the iFLC on day 8 of the first cycle was observed in 31 of 69 pts. These pts had a significantly better median PFS of 49 months as compared to 20 months in 38 pts with a lower iFLC reduction (p = 0.002). In contrast, OS did not differ significantly with a 48 months survival of 77% vs 69% (p > 0.05). Conclusion These results indicate that a rapid decrease in the iFLC on day 8 is an early prognostic marker for newly diagnosed MM pts undergoing BPV treatment.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Prognostic impact of rapid reduction of involved free light chains in multiple myeloma patients under first-line treatment with Bendamustine, Prednisone, and Bortezomib (BPV)

Holzhey

Pönisch

Wang

et al. 2021

J Cancer Res Clin Oncol

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Serum Free Light Chain Assay and κ/λ Ratio Performance in Patients Without Monoclonal Gammopathies

Singh

2016

Am J Clin Pathol

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Usual κ/λ ratio was abnormal in 36.4% of the observations in patients without evidence of monoclonal gammopathy, and an abnormal κ/λ ratio should not be used as the sole indicator for diagnosis of neoplastic proliferation of the lympho-plasmacytic system. Hypergammaglobulinemia is associated with a higher rate of false-positive abnormal κ/λ ratios. Examination of urine for monoclonal immunoglobulins may be underused, and recommendations by some to use serum free light chain assay in place of, rather than as an adjunct to, urine electrophoresis are not warranted.

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Early Normalization of Free Light Chains Predicts Better Outcomes in Patients with Multiple Myeloma

Benson¹,

Nair²,

Narayanan³

2020

IJHOSCR

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Background: The half-life of free light chain is short and can be used as an early marker for tumor response in patients with multiple myeloma [MM]. This prospective study is aimed at evaluating whether early light chain response can predict response to treatment in patients with MM. Materials and Methods: Thirty six patients with a diagnosis of MM and with an abnormal to normal light chain ratio of > 10 were included in this study. Results: The median age at presentation was 56 years. Fourteen patients had lambda light chain disease, whereas 22 patients had kappa light chain disease. Twenty-four patients [66.6%] had reduction of abnormal to normal light chain ratio to < 10 after 2 cycles, of whom 15 [62.5%] achieved a CR or VGPR after 6 cycles. Among 12 patients who did not have reduction of abnormal to normal light chain ratio to < 10, only 1 patient achieved CR while 11 patients [91.6%] achieved a PR or less[Fishers exact p=0.004]. Median follow-up was 13 months. Median progression-free survival for the entire cohort was 15 months. One-year Progression-Free Survival was 77% vs 57.1%, [p= 0.008], respectively for patients with early normalization and those who did not show early normalization. Conclusion: Early light chain response after 2 cycles of chemotherapy is a good predictor for treatment response in patients with MM treated with bortezomib based chemotherapy. Treatment intensification based on early light chain response merits further evaluation in a prospective trial

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Serum Free Light Chain Response After 2 Courses of Induction Chemotherapy Predicts Prognosis in Myeloma Patients

Cited by 6 publications

References 27 publications

Prognostic impact of rapid reduction of involved free light chains in multiple myeloma patients under first-line treatment with Bendamustine, Prednisone, and Bortezomib (BPV)

Prognostic impact of rapid reduction of involved free light chains in multiple myeloma patients under first-line treatment with Bendamustine, Prednisone, and Bortezomib (BPV)

Serum Free Light Chain Assay and κ/λ Ratio Performance in Patients Without Monoclonal Gammopathies

Early Normalization of Free Light Chains Predicts Better Outcomes in Patients with Multiple Myeloma

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