Abstract
Background Serum free light chains (FLC) assay measures the concentration of free kappa and lambda immunoglobulin light chains. Clinical uses FLC assay is clinically indicated for screening and prognosis of multiple myeloma and related plasma cell disorders including oligosecretory disease, AL amyloidosis and monoclonal gammopathy of undetermined significance. There are no data to support its use in myeloma with measurable disease by other methods. In assessment of disease response to treatment, FLC measurement is recommended in documenting stringent complete response in multiple myeloma, and in oligosecretory diseases but is unvalidated in light chain myeloma and intact immunoglobulin disease. Analytical issues Use of polyclonal FLC antibodies raises the question of adequate specificity and binding affinity to measure monoclonal FLC. Problematic samples can give FLC under- or over-estimation due to sample dilution anomalies, giving rise to difficulties in result interpretation, particularly when monitoring patients with clonal plasma cell diseases. Laboratory staff and clinicians should be aware of the potential for non-reactivity of individual monoclonal FLC, the effect that dilution has on FLC measurement, and the impact of assay imprecision on result interpretation. These issues, if not adequately appreciated, have the potential to mislead clinical diagnosis and assessment of response to therapy.
Published Version
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