Abstract
Normalization of the serum free light chain ratio (FLCr) with the absence of bone marrow monoclonal plasma cells following achievement of a complete response (CR) to therapy denotes a stringent CR in multiple myeloma (MM), and is associated with improved overall survival (OS). However, its value in patients achieving <CR is not clear. We hypothesized that patients achieving a normalization of FLCr with initial therapy of MM will have an improved outcome, even in the absence of a CR. We retrospectively evaluated 449 patients with newly-diagnosed MM with measurable disease at baseline, who did not achieve a CR with initial therapy. One hundred fifty three patients (34%) had a normal FLCr while 296 (66%) had an abnormal ratio. Patients with a normal FLCr had a longer progression-free survival (PFS) (29 vs. 16 months, P <.001) and OS (91 vs. 58 months, P <.001). Normalization of FLCr retained its prognostic value in a multivariable model. Our results suggest an important role for sFLC measurement in disease monitoring even in patients who achieve only a partial response to therapy. Obtaining a normal FLCr confers a favorable prognosis independent from other factors, supporting the inclusion of sFLC in all levels of response criteria.
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