Complementarily of urine analysis and serum free light chain assay for assessing response treatment response: Illustrated by three case examples

Clinica Chimica Acta

Volumn 412, Issue 23-24, 2011, Pages 2206-2210

  Levinson, Stanley S ^a,b  

^a VETERANS AFFAIRS MEDICAL CENTER   (United States)

^b University of Louisville School of Medicine   (United States)

Author keywords

Immunofixation electrophoresis; Monoclonal free light chains; Treatments

Indexed keywords

BORTEZOMIB; DEXAMETHASONE; MELPHALAN; PARAPROTEIN; PREDNISONE; THALIDOMIDE;

ADULT; AMYLOIDOSIS; ARTICLE; BLOOD ANALYSIS; CASE REPORT; CLINICAL FEATURE; DRUG SUBSTITUTION; DRUG TOLERANCE; DRUG WITHDRAWAL; HIGH RISK PATIENT; HUMAN; HUMAN TISSUE; IMMUNOELECTROPHORESIS; KIDNEY BIOPSY; LABORATORY DIAGNOSIS; LIGHT CHAIN; MACROGLOSSIA; MALE; MEDICAL RECORD REVIEW; MONOCLONAL IMMUNOGLOBULINEMIA; MULTIPLE MYELOMA; PATIENT SELECTION; PRIORITY JOURNAL; PROTEIN ANALYSIS; PROTEIN BLOOD LEVEL; PROTEIN URINE LEVEL; PROTEINURIA; REFERENCE VALUE; REMISSION; TREATMENT RESPONSE; URINALYSIS;

HUMANS; IMMUNOGLOBULIN LIGHT CHAINS; MALE; MIDDLE AGED; RETROSPECTIVE STUDIES; TREATMENT OUTCOME;

EID: 80053634607     PISSN: 00098981     EISSN: 18733492     Source Type: Journal    
DOI: 10.1016/j.cca.2011.08.012     Document Type: Article

References (35)

1. Mollee P. Current trends in the diagnosis, therapy and monitoring of the monoclonal gammopathies. Clin Biochem Rev 2009, 30:93-103.
2. Guidelines on the diagnsosis and management of AL amyloidosis. Br J Haematol 2004, 125:681-700.
3. Rajkumar S.V., Dispenzieri A., Kyle R.A. Monoclonal gammopathy of undetermined significance, Waldenstrom macroglobulinemia, AL amyloidosis, and related plasma cell disorders: diagnosis and treatment. Mayo Clin Proc 2006, 81:693-703.
4. Matsuda M., Yamada T., Gono T., et al. Serum levels of free light chain before and after chemotherapy in primary systemic AL amyloidosis. Intern Med 2005, 44:428-433.
5. Sanchorawala V., Seldin D.C., Magnani B., Skinner M., Wright D.G. Serum free light-chain responses after high-dose intravenous melphalan and autologous stem cell transplantation for AL (primary) amyloidosis. Bone Marrow Transplant 2005, 36:597-600.
6. Drayson M., Tang L.X., Drew R., Mead G.P., Carr-Smith H., Bradwell A.R. Serum free light-chain measurements for identifying and monitoring patients with nonsecretory multiple myeloma. Blood 2001, 97:2900-2902.
7. Dispenzieri A., Kyle R., Merlini G., et al. International Myeloma Working Group guidelines for serum-free light chain analysis in multiple myeloma and related disorders. Leukemia 2009, 23:215-224.
8. Hill P.G., Forsyth J.M., Rai B., Mayne S. Serum free light chains: an alternative to the urine Bence Jones proteins screening test for monoclonal gammopathies. Clin Chem 2006, 52:1743-1748.
9. Katzmann J.A. Screening panels for monoclonal gammopathies: time to change. Clin Biochem Rev 2009, 30:105-111.
10. Katzmann J.A., Dispenzieri A., Kyle R.A., 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, 81:1575-1578.
11. Piehler A.P., Gulbrandsen N., Kierulf P., Urdal P. Quantitation of serum free light chains in combination with protein electrophoresis and clinical information for diagnosing multiple myeloma in a general hospital population. Clin Chem 2008, 54:1823-1830.
12. Levinson S.S. Hook effect with lambda free light chain in serum free light chain assay. Clin Chim Acta 2010, 411:1834-1836.
13. Shaheen S.P., Levinson S.S. Serum free light chain analysis may miss monoclonal light chains that urine immunofixation electrophoreses would detect. Clin Chim Acta 2009, 406:162-166.
14. Beetham R., Wassell J., Wallage M.J., Whiteway A.J., James J.A. Can serum free light chains replace urine electrophoresis in the detection of monoclonal gammopathies?. Ann Clin Biochem 2007, 44:516-522.
15. Palladini G., Russo P., Bosoni T., et al. Identification of amyloidogenic light chains requires the combination of serum-free light chain assay with immunofixation of serum and urine. Clin Chem 2009, 55:499-504.
16. Tate J.R., Gill D., Cobcroft R., Hickman P.E. Practical considerations for the measurement of free light chains in serum. Clin Chem 2003, 49:1252-1257.
17. Singhal S., Vickrey E., Krishnamurthy J., Singh V., Allen S., Mehta J. The relationship between the serum free light chain assay and serum immunofixation electrophoresis, and the definition of concordant and discordant free light chain ratios. Blood 2009, 114:38-39.
18. Uljon S.N., Richardson P.G., Schur P.H., Anderson K.C., Tanasijevic M.J., Lindeman N.I. Serial serum free light chain measurements do not detect changes in disease status earlier than electrophoretic M-spike measurements in patients with intact immunoglobulin myeloma. Clin Chim Acta 2011, 412:562-568.
19. Mead G.P., Drayson M.T. Sensitivity of serum free light chain measurement of residual disease in multiple myeloma patients. Blood 2009, 114:1717.
20. Briand P.Y., Decaux O., Caillon H., Grosbois B., Le Treut A., Guenet L. Analytical performance of the serum free light chain assay. Clin Chem Lab Med 2010, 48:73-79.
21. Tate J.R., Mollee P., Dimeski G., Carter A.C., Gill D. Analytical performance of serum free light-chain assay during monitoring of patients with monoclonal light-chain diseases. Clin Chim Acta 2007, 376:30-36.
22. de Kat Angelino C.M., Raymakers R., Teunesen M.A., Jacobs J.F., Klasen I.S. Overestimation of serum kappa free light chain concentration by immunonephelometry. Clin Chem 2010, 56:1188-1190.
23. Levinson S.S. Regarding the overestimation of k free light chains. Clin Chem 2011, 57:775-776.
24. Levinson S.S. Polyclonal free light chain of Ig may interfere with interpretation of monoclonal free light chain kappa/lambda ratio. Ann Clin Lab Sci 2010, 40:348-353.
25. Katzmann J.A., Clark R.J., Abraham R.S., 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, 48:1437-1444.
26. Marshall G., Tate J., Mollee P. Borderline high serum free light chain kappa/lambda ratios are seen not only in dialysis patients but also in non-dialysis-dependent renal impairment and inflammatory states. Am J Clin Pathol 2009, 132:309.
27. Hutchison C.A., Harding S., Hewins P., et al. Quantitative assessment of serum and urinary polyclonal free light chains in patients with chronic kidney disease. Clin J Am Soc Nephrol 2008, 3:1684-1690.
28. Shaheen S.P., Talwalkar S.S., Medeiros L.J. Multiple myeloma and immunosecretory disorders: an update. Adv Anat Pathol 2008, 15:196-210.
29. Keren D.F., Alexanian R., Goeken J.A., Gorevic P.D., Kyle R.A., Tomar R.H. Guidelines for clinical and laboratory evaluation of patients with monoclonal gammopathies. Arch Pathol Lab Med 1999, 123:106-107.
30. Harrison H.H. The "ladder light chain" or "pseudo-oligoclonal" pattern in urinary immunofixation electrophoresis (IFE) studies: a distinctive IFE pattern and an explanatory hypothesis relating it to free polyclonal light chains. Clin Chem 1991, 37:1559-1564.
31. Levinson S.S., Keren D.F. Free light chains of immunoglobulins: clinical laboratory analysis. Clin Chem 1994, 40:1869-1878.
32. MacNamara E.M., Aguzzi F., Petrini C., et al. Restricted electrophoretic heterogeneity of immunoglobulin light chains in urine: a cause for confusion with Bence Jones protein. Clin Chem 1991, 37:1570-1574.
33. Falk R.H., Comenzo R.L., Skinner M. The systemic amyloidoses. N Engl J Med 1997, 337:898-909.
34. Durie B.G., Harousseau J.L., Miguel J.S., et al. International uniform response criteria for multiple myeloma. Leukemia 2006, 20:1467-1473.
35. Gertz M.A., Comenzo R., Falk R.H., et al. Definition of organ involvement and treatment response in immunoglobulin light chain amyloidosis (AL): a consensus opinion from the 10th International Symposium on Amyloid and Amyloidosis, Tours, France, 18-22 April 2004. Am J Hematol 2005, 79:319-328.