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Myeloma

Prognostic value of the serum free light chain ratio in newly diagnosed myeloma: proposed incorporation into the international staging system

Leukemia volume 22, pages 1933–1937 (2008)Cite this article

Abstract

To determine if the serum free light chain (FLC) ratio has prognostic value in patients with symptomatic multiple myeloma (MM), baseline serum samples from a well-characterized cohort of 790 newly diagnosed MM patients were tested with the FLC assay. FLC ratio was calculated as κ/λ (reference range 0.26–1.65). On the basis of the distribution of values, a cutpoint κ/λ FLC ratio of <0.03 or >32 was chosen for further analysis. Overall survival was significantly inferior in patients with an abnormal FLC ratio of <0.03 or >32 (n=479) compared with those with an FLC ratio between 0.03 and 32 (n=311), with median survival of 30 versus 39 months, respectively. We incorporated abnormal FLC ratio with the International Staging System (ISS) risk factors (that is, albumin <3.5 g/dl and serum β2-microglobulin ⩾3.5 g/l), to create a risk stratification model with improved prognostic capabilities. Patients with 0, 1, 2 or 3 adverse risk factors had significantly different overall survival, with median survival times of 51, 39, 30 and 22 months, respectively (P<0.001). These findings suggest that the serum FLC ratio at initial diagnosis is an important predictor of prognosis in myeloma, and can be incorporated into the ISS for improved risk stratification.

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Acknowledgements

This work was supported in part by research grants CA 107476 and CA 62242 from the National Cancer Institute. We thank AR Bradwell (Binding Site) for the free light chain reagents and Carol Shipman for her maintenance of the Dysproteinemia database.

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Authors and Affiliations

  1. Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, Rochester, MN, USA

    C L H Snozek, J A Katzmann & R J Clark

  2. Division of Hematology, College of Medicine, Mayo Clinic, Rochester, MN, USA

    R A Kyle, A Dispenzieri, S Kumar, P R Greipp & S V Rajkumar

  3. Division of Biostatistics, College of Medicine, Mayo Clinic, Rochester, MN, USA

    D R Larson & T M Therneau

  4. Division of Epidemiology, College of Medicine, Mayo Clinic, Rochester, MN, USA

    L J Melton III

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  1. C L H Snozek
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  2. J A Katzmann
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  3. R A Kyle
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  4. A Dispenzieri
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  5. D R Larson
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  6. T M Therneau
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  9. P R Greipp
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  10. R J Clark
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  11. S V Rajkumar
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Correspondence to S V Rajkumar.

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Snozek, C., Katzmann, J., Kyle, R. et al. Prognostic value of the serum free light chain ratio in newly diagnosed myeloma: proposed incorporation into the international staging system. Leukemia 22, 1933–1937 (2008). https://doi.org/10.1038/leu.2008.171

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  • DOI: https://doi.org/10.1038/leu.2008.171

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