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. 2008 Oct;22(10):1933-7.
doi: 10.1038/leu.2008.171. Epub 2008 Jul 3.

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

C L H Snozek  1 , J A Katzmann, R A Kyle, A Dispenzieri, D R Larson, T M Therneau, L J Melton 3rd, S Kumar, P R Greipp, R J Clark, S V Rajkumar
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Prognostic value of the serum free light chain ratio in newly diagnosed myeloma: proposed incorporation into the international staging system

C L H Snozek et al. Leukemia. 2008 Oct.

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 kappa/lambda (reference range 0.26-1.65). On the basis of the distribution of values, a cutpoint kappa/lambda 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 beta(2)-microglobulin >or=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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Figures

Figure 1
Figure 1
(a) Kaplan-Meier estimate of overall survival. Overall survival was significantly inferior in patients with an FLC ratio of <0.03 or >32 (n =479 patients) compared with those with an FLC ratio that was between 0.03 and 32 (n =311 patients), median survival 30 versus 39 months, respectively, P<0.001. (b) Risk Stratification model. Abnormal FLC ratio (<0.03 or >32), high Sβ2M (≥3.5 g/l) or low serum albumin (<3.5 g/dl) were defined as adverse risk factors. Overall survival was significantly different among patients with 0, 1, 2 or 3 adverse risk factors, with median survival times of 51, 39, 30 and 22 months, respectively, P<0.001.
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