The correlation between serum free light chain levels and plasma cell ratio in bone marrow biopsy in multiple myeloma
Abstract
Aims: MM (Multiple myeloma) is the second most common hematological malignancy. In addition to the recent advances in treatment, new parameters are used in clinical practice in diagnosis and follow-up. sFLC (free chain kappa and lambda) shows the activation of the disease depending on the rate of MM malignant cell secretion in serum. However, the plasma cell (PC) ratio in bone marrow biopsy is still the gold standard in diagnosis. We examined the dynamic correlation between the PC ratio and the number of sFLC-related cells and the secretion rate. We aimed to examine whether a low PC ratio could be in a more aggressive form with a higher sFLC secretion with too much activity, thus examining the correlation between them.
Methods: A total of 62 newly diagnosed MM patients admitted to Başkent University Faculty of Medicine İstanbul Hospital were included in the study. At the time of diagnosis, sFLC values were requested simultaneously with bone marrow biopsy. Radiological images were obtained with PET CT/MRI or CT.
Results: In all MM groups, bone marrow PH percentages were not correlated with sFLC regardless of subtype. IgG kappa type MM had the highest sFLC values despite the lowest number of PHs, while Lambda light chain MM had the lowest sFLC despite the highest PH rates.
Conclusion: These results showed us that sFLC rates are independent of the percentage of PC in MM. We believe that the two are not correlated and should be followed up together in the follow-up of the disease.
Keywords
Multiple myeloma bone marrow biopsy serum free light chains radiological involvement plasma cell ratio
Ethical Statement
Our study was approved by Başkent University Medıcal And Health Scıences Research Ethıcs Board with the number KA-23408 /12.12.2023
References
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- Phekoo KJ, Schey SA, Richards MA, et al. A population study to define the incidence and survival of multiple myeloma in a National Health Service Region in UK. Br J Haematol. 2004;127(3):299-304. doi: 10.1111/j.1365-2141.2004.05207.x
- Alyanakian MA, Taes Y, Bensaid M, et al. Monoclonal immunoglobulin with antitransferrin activity: a rare cause of hypersideremia with increased transferrin saturation. Blood. 2007;109(1):359-361. doi: 10.1182/blood-2006-05-023762
- Krish P, Jhaveri KD. The case: hyperbicarbonatemia in a patient with Waldenstrom’s macroglobulinemia. Kidney Int. 2012;81(6):603-605. doi: 10.1038/ki.2011.427
- Kyle RA, Gertz MA, Witzig TE, et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc. 2003;78(1):21-33. doi: 10.4065/78.1.21
- Katzmann JA, Clark RJ, Abraham RS, et al. Serum reference intervals and diagnostic ranges for free kappa and free lambda immunoglobulin light chains: relative sensitivity for detection of monoclonal light chains. Clin Chem. 2002;48(9):1437-1444.
- Katzmann JA, Dispenzieri A, Kyle RA, et al. Elimination of the need for urine studies in the screening algorithm for monoclonal gammopathies by using serum immunofixation and free light chain assays. Mayo Clin Proc. 2006;81(12):1575-1578. doi: 10.4065/81.12.1575
- Abadie JM, van Hoeven KH, Wells JM. Are renal reference intervals required when screening for plasma cell disorders with serum free light chains and serum protein electrophoresis? Am J Clin Pathol. 2009;131(2):166-171. doi: 10.1309/AJCPR2M4EUYNHLGM
- Greipp PR, Leong T, Bennett JM, et al. Plasmablastic morphology--an independent prognostic factor with clinical and laboratory correlates: Eastern Cooperative Oncology Group (ECOG) myeloma trial E9486 report by the ECOG Myeloma Laboratory Group. Blood. 1998;91(7):2501-2507.
- Lin P, Owens R, Tricot G, Wilson CS. Flow cytometric immunophenotypic analysis of 306 cases of multiple myeloma. Am J Clin Pathol. 2004;121(4):482-488. doi: 10.1309/74R4-TB90-BUWH-27JX
- Sahara N, Takeshita A, Shigeno K, et al. Clinicopathological and prognostic characteristics of CD56-negative multiple myeloma. Br J Haematol. 2002;117(4):882-885. doi: 10.1046/j.1365-2141. 2002.03513.x
- Tembhare PR, Yuan CM, Venzon D, et al. Flow cytometric differentiation of abnormal and normal plasma cells in the bone marrow in patients with multiple myeloma and its precursor diseases. Leuk Res. 2014;38(3):371-376. doi: 10.1016/j.leukres.2013.12.007
- Lachmann HJ, Gallimore R, Gillmore JD, et al. Outcome in systemic AL amyloidosis in relation to changes in concentration of circulating free immunoglobulin light chains following chemotherapy. Br J Haematol. 2003;122(1):78-84. doi: 10.1046/j. 1365-2141.2003.04433.x
- Mead GP, Carr-Smith HD, Drayson MT, Morgan GJ, Child JA, Bradwell AR. Serum free light chains for monitoring multiple myeloma. Br J Haematol. 2004;126(3):348-354. doi: 10.1111/j.1365-2141.2004.05045.x
- van Rhee F, Bolejack V, Hollmig K, et al. High serum-free light chain levels and their rapid reduction in response to therapy define an aggressive multiple myeloma subtype with poor prognosis. Blood. 2007;110(3):827-832. doi: 10.1182/blood-2007-01-067728
- Zhan F, Huang Y, Colla S, et al. The molecular classification of multiple myeloma. Blood. 2006;108(6):2020-2028. doi: 10.1182/blood-2005-11-013458
- Zhu AY, Zhu FB, Wang FC, Zhang LJ, Ma Y, Hu JG. Analysis of relationship between serum total light chain kappa/lambda ratio and proportion of bone marrow plasma cells in patients with IgG type and IgA type multiple myeloma. Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2017;25(5):1454-1459. doi: 10.7534/j.issn.1009-2137.2017.05.030
Abstract
References
- Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023;73(1):17-48. doi: 10.3322/caac.21763
- SEER Stat Fact Sheets: Myeloma. National Cancer Institute. https://seer.cancer.gov/statfacts/html/mulmy.html. Accessed January 26, 2023.
- Kyle RA, Therneau TM, Rajkumar SV, Larson DR, Plevak MF, Melton III LJ. Incidence of multiple myeloma in Olmsted County, Minnesota: trend over 6 decades. Cancer. 2004;101(11):2667-2674. doi: 10.1002/cncr.20652
- Sant M, Allemani C, Tereanu C, et al. Incidence of hematologic malignancies in Europe by morphologic subtype: results of the HAEMACARE project. Blood. 2010;116(19):3724-3734. doi: 10.1182/blood-2010-05-282632
- Phekoo KJ, Schey SA, Richards MA, et al. A population study to define the incidence and survival of multiple myeloma in a National Health Service Region in UK. Br J Haematol. 2004;127(3):299-304. doi: 10.1111/j.1365-2141.2004.05207.x
- Alyanakian MA, Taes Y, Bensaid M, et al. Monoclonal immunoglobulin with antitransferrin activity: a rare cause of hypersideremia with increased transferrin saturation. Blood. 2007;109(1):359-361. doi: 10.1182/blood-2006-05-023762
- Krish P, Jhaveri KD. The case: hyperbicarbonatemia in a patient with Waldenstrom’s macroglobulinemia. Kidney Int. 2012;81(6):603-605. doi: 10.1038/ki.2011.427
- Kyle RA, Gertz MA, Witzig TE, et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc. 2003;78(1):21-33. doi: 10.4065/78.1.21
- Katzmann JA, Clark RJ, Abraham RS, et al. Serum reference intervals and diagnostic ranges for free kappa and free lambda immunoglobulin light chains: relative sensitivity for detection of monoclonal light chains. Clin Chem. 2002;48(9):1437-1444.
- Katzmann JA, Dispenzieri A, Kyle RA, et al. Elimination of the need for urine studies in the screening algorithm for monoclonal gammopathies by using serum immunofixation and free light chain assays. Mayo Clin Proc. 2006;81(12):1575-1578. doi: 10.4065/81.12.1575
- Abadie JM, van Hoeven KH, Wells JM. Are renal reference intervals required when screening for plasma cell disorders with serum free light chains and serum protein electrophoresis? Am J Clin Pathol. 2009;131(2):166-171. doi: 10.1309/AJCPR2M4EUYNHLGM
- Greipp PR, Leong T, Bennett JM, et al. Plasmablastic morphology--an independent prognostic factor with clinical and laboratory correlates: Eastern Cooperative Oncology Group (ECOG) myeloma trial E9486 report by the ECOG Myeloma Laboratory Group. Blood. 1998;91(7):2501-2507.
- Lin P, Owens R, Tricot G, Wilson CS. Flow cytometric immunophenotypic analysis of 306 cases of multiple myeloma. Am J Clin Pathol. 2004;121(4):482-488. doi: 10.1309/74R4-TB90-BUWH-27JX
- Sahara N, Takeshita A, Shigeno K, et al. Clinicopathological and prognostic characteristics of CD56-negative multiple myeloma. Br J Haematol. 2002;117(4):882-885. doi: 10.1046/j.1365-2141. 2002.03513.x
- Tembhare PR, Yuan CM, Venzon D, et al. Flow cytometric differentiation of abnormal and normal plasma cells in the bone marrow in patients with multiple myeloma and its precursor diseases. Leuk Res. 2014;38(3):371-376. doi: 10.1016/j.leukres.2013.12.007
- Lachmann HJ, Gallimore R, Gillmore JD, et al. Outcome in systemic AL amyloidosis in relation to changes in concentration of circulating free immunoglobulin light chains following chemotherapy. Br J Haematol. 2003;122(1):78-84. doi: 10.1046/j. 1365-2141.2003.04433.x
- Mead GP, Carr-Smith HD, Drayson MT, Morgan GJ, Child JA, Bradwell AR. Serum free light chains for monitoring multiple myeloma. Br J Haematol. 2004;126(3):348-354. doi: 10.1111/j.1365-2141.2004.05045.x
- van Rhee F, Bolejack V, Hollmig K, et al. High serum-free light chain levels and their rapid reduction in response to therapy define an aggressive multiple myeloma subtype with poor prognosis. Blood. 2007;110(3):827-832. doi: 10.1182/blood-2007-01-067728
- Zhan F, Huang Y, Colla S, et al. The molecular classification of multiple myeloma. Blood. 2006;108(6):2020-2028. doi: 10.1182/blood-2005-11-013458
- Zhu AY, Zhu FB, Wang FC, Zhang LJ, Ma Y, Hu JG. Analysis of relationship between serum total light chain kappa/lambda ratio and proportion of bone marrow plasma cells in patients with IgG type and IgA type multiple myeloma. Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2017;25(5):1454-1459. doi: 10.7534/j.issn.1009-2137.2017.05.030
Details
| Primary Language | English |
|---|---|
| Subjects | Haematology |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | March 8, 2024 |
| Submission Date | January 31, 2024 |
| Acceptance Date | February 17, 2024 |
| Published in Issue | Year 2024 Volume: 6 Issue: 2 |
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