Serial measurement of free light chain detects poor response to therapy early in three patients with multiple myeloma wh
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CASE REPORT
Serial measurement of free light chain detects poor response to therapy early in three patients with multiple myeloma who have measurable M-proteins Shin-ichi Fuchida • Akira Okano • Mayumi Hatsuse Satoshi Murakami • Harue Haruyama • Saori Itoh • Chihiro Shimazaki
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Received: 13 March 2012 / Revised: 13 August 2012 / Accepted: 13 August 2012 / Published online: 2 September 2012 Ó The Japanese Society of Hematology 2012
Abstract Free light chain (FLC) assays are important in the diagnosis and monitoring of patients with multiple myeloma (MM). Serum FLC concentrations also correlate with disease course in the majority of MM patients and have been incorporated into the new response criteria. Although baseline values of FLC are prognostic in newly diagnosed MM, serial measurement of serum FLC does not appear to be of greater value in patients who have measurable M-proteins by electrophoresis. We examined the kinetics of serum FLC in six patients with newly diagnosed MM during treatment with high-dose dexamethasone (HDDEX) and bortezomib and dexamethasone. In some cases, the involved serum FLC increased in the latter part of each chemotherapy cycle before the start of the next cycle, especially in HD-DEX, suggesting that the response to these agents may be insufficient for induction therapy for MM. Earlier disease assessment by serum FLC assays may be of value in detecting poorly responding patients who require alternative forms of therapy. Keywords Multiple myeloma Free light chain Chemotherapy
S. Fuchida (&) A. Okano M. Hatsuse S. Murakami H. Haruyama C. Shimazaki Department of Hematology, Social Insurance Kyoto Hospital, 27 Koyamashimofusa-cho, Kita-ku, Kyoto, Kyoto 603-8151, Japan e-mail: [email protected] S. Itoh Medical & Biological Laboratories Co., Ltd., 4-5-3 Sakae, Naka-Ku, Nagoya, Aichi 460-0008, Japan
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Introduction Multiple myeloma (MM) is monoclonal B-cell malignancy with terminally differentiated plasma cell phenotype and monoclonal immunoglobulin secretion in the majority of cases [1]. Approximately, 95 % of patients with MM produce intact immunoglobulin and/or light chain monoclonal proteins, and serial assessments of monoclonal protein levels in serum or daily urinary excretion have been used to monitor disease progression and response therapy. In cases of light chain only secreting MM with renal dysfunction and in non-secretory disease, such assays have not been helpful. Monoclonal immunoglobulin free light chains (FLCs) present in the serum and urine of many patients with MM. The new FLC assay is important in the diagnosis and monitoring of light chain only secreting MM (Bence Jones myeloma) and it has enabled the detection of monoclonal protein in some patients with non-secretory myeloma that were previously undetectable [2]. Intact immunoglobulin MM patients are monitored by following changes in their total immunoglobulin measured by nephelometry or their monoclonal immunoglobulin measured by protein electrophoresis. Both methods are inaccurate at low level
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