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Abstract
Current criteria for differential diagnosis of multiple myeloma (MM), Monoclonal gammopathy of undetermined significance (MGUS), and smoldering multiple myeloma (SMM) are included in the 2003 guidelines by the International Myeloma Working Group (IMWG). An updated version was then published in 2014, highlighting the importance of serum free light chain (sFLC) detection, as well as the κ/λ ratio as excellent indicators of clonality. At present, two commercial assays for sFLC quantification are available: the Freelite™ assay and the N-Latex assay. The first was developed by The Binding Site based on a mixture of polyclonal antibodies directed against a variety of FLC epitopes. It may be run on a wide range of nephelometers, as well as on turbidimeters. The second method was developed by Siemens and runs exclusively on Siemens instruments. It employs a probe mixture of mouse monoclonal antibodies. The aim of our study was to evaluate sFLC measurement and calculated κ/λ ratio in 85 patients with monoclonal gammopathies (MGs) in order to compare methods. We demonstrated that there is only a moderate concordance between the two FLC assays. In particular, in one case, we observed no qualitative alterations of the serum protein pattern, and in the absence of a Freelite™ assay, sFLC measurement would not have been possible to highlight the increase of λ FLC.
Highlights
Monoclonal gammopathy (MG) or plasma cells dyscrasias are disorders characterized by the proliferation and accumulation of plasma cell clone synthesizing immunoglobulin with identical isotopic and idiotipic features, detectable by serum or urine electrophoresis commonly referred to as a monoclonal protein (M-protein)
monoclonal gammopathy of undetermined significance (MGUS) accounts for over 50% of detected M-protein, whereas 35% of M-protein are due to multiple myeloma (MM), 10% to amyloidosis (AL), and the remaining 5% are associated with rare conditions such as cryoglobulinemia [5,6]
serum protein electrophoresis (SPE), sIFE, and uIFE for the detection of urinary Bence Jones protein (PBJ) as well as the quantification of serum free light chain (sFLC) and their ratio are all necessary tools for patient management
Summary
Monoclonal gammopathy (MG) or plasma cells dyscrasias are disorders characterized by the proliferation and accumulation of plasma cell clone synthesizing immunoglobulin with identical isotopic and idiotipic features, detectable by serum or urine electrophoresis commonly referred to as a monoclonal protein (M-protein). In 2014, they have been updated again through the International Myeloma Working Group (IMWG) guidelines [17] that included sFLC evaluation and a calculated κ/λ ratio as biomarkers of malignancy. The evaluation of these parameters are recommended for patient management, including screening, prognosis, therapy, and patient monitoring, as well as for the diagnosis and monitoring of all conditions where M-protein is barely detectable and hardly quantifiable [10,18,19,20]. Reverse phenomenon may occur during a favorable response to drug treatment In such cases, FLC levels may decrease compared to previous immunoglobulin patterns. Differences in the results obtained from both methods were observed in three patients with plasma cell dyscrasias
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