Abstract
Despite tremendous progress being made in recent years, multiple myeloma (MM) remains a challenging disease. The laboratory plays a critical role in the overall management of patients. The diagnosis, prognosis, clinical monitoring and evaluation of the response are key moments in the clinical care process. Conventional laboratory methods have been and continue to be the basis of laboratory testing in monoclonal gammopathies, along with the serum free light chain test. However, more accurate methods are needed to achieve new and more stringent clinical goals. The heavy/light chain assay is a relatively new test which can overcome some of the limitations of the conventional methods for the evaluation of intact immunoglobulin MM patients. Here, we report an update of the evidence accumulated in recent years on this method regarding its use in MM.
Highlights
Multiple myeloma (MM) is a complex and heterogeneous hematological malignancy characterized by the proliferation of clonal plasma cells (PCs) in the bone marrow (BM).The substitution of normal PCs with MM cells and the overproduction of a monoclonal protein (MP) eventually lead to the development of organ damage, summarized in the acronym CRAB, and to an immunosuppressed state.Monoclonal intact immunoglobulins (Igs) and free light chains (FLCs) secreted by malignant PCs are widely considered as biomarkers of tumor burden
Regarding the introduction of the heavy/light chain (HLC) assay in the last published guidelines in 2016, the IMWG stated that more data should be collected to draw conclusions about the role of this assay for intact Igs MM patients [16]
We have carried out an updated review of the most relevant studies evaluating the role of the HLC assay in the diagnosis, prognosis and follow-up of monoclonal gammopathy of undetermined significance (MGUS), smoldering MM (SMM) and MM in an attempt to define when this assay may provide additional information of interest for the clinical management of these patients
Summary
Multiple myeloma (MM) is a complex and heterogeneous hematological malignancy characterized by the proliferation of clonal plasma cells (PCs) in the bone marrow (BM). In SMM, the MP isotype and its concentration in serum are included in the majority of the widest spread models to identify patients with a higher risk of progression to active MM. For MGUS patients, Diagnostics 2021, 11, 2020 the Mayo Clinic stratification model contemplates the MP concentration, the MP isotype and the serum FLC ratio as risk factors for progression [11]. We perform a comprehensive review of the additional information provided by different parameters of the HLC assay (see Table 2) in the diagnosis, prognosis, and monitoring of patients with MGs secreting monoclonal intact Igs. Considering the reported evidence, we will try to define when this assay could complement conventional techniques and help in daily clinical practice.
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