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Journal of Medical Biochemistry

The Journal of Society of Medical Biochemists of Serbia

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Free Light Chains of Immunoglobulin as a Prognostic Factor for Some Plasmaproliferative Diseases

Zoran Mijušković1 / Vesna Radović1 / Janko Pejović1 / Ljiljana Tukić1 / Slobodan Marjanović1 / Jelica Stojanović1

Institute of Medical Biochemistry, Military Medical Academy, Belgrade, Serbia1

Clinic of Hematology, Military Medical Academy, Belgrade, Serbia2

STADA Hemofarm A.D., Institute of Research and Development, Belgrade, Serbia3

Faculty of Natural Science and Mathematics, University of Kragujevac, Serbia4

This content is open access.

Citation Information: Journal of Medical Biochemistry. Volume 30, Issue 4, Pages 293–301, ISSN (Online) 1452-8266, ISSN (Print) 1452-8258, DOI: 10.2478/v10011-011-0017-3, August 2011

Publication History

Published Online:
2011-08-02

Free Light Chains of Immunoglobulin as a Prognostic Factor for Some Plasmaproliferative Diseases

Quantitation of monoclonal immunoglobulins and their fragments is used for monitoring the plasmaproliferative disease course and the effect of therapy. The aim of free light chains examination was to evaluate the significance of the FLC ratio as a prognostic factor for remission, progression and survival in different disease groups. The concentrations of immunoglobulins and free light chains were measured by an immunonephelometric method on a »SIEMENS« DADE BN II analyser with reagents (Freelite, The Binding Site, UK). In this examination 151 patients from 3 different disease groups: 1. Light chain disease or Bence Jones myeloma (37), 2. Biclonal gammopathy with FLC (23) and 3. Monoclonal gammopathy of undetermined significance (91), were investigated during a period of 7 years. The reference interval for FLC ratio is 0.26-1.65. According to the International Staging System for multiple myeloma, a serum FLC ratio of <0.03 or >32 was taken as abnormal. The patients with light chain disease and biclonal gammopathy with FLC with an abnormal FLC ratio and a combination of adverse risk factors (76.7%) had median survival times of 22-30 months, versus patients with a normal or slightly varied FLC ratio without adverse risk factors (23.3%) with median survival times of 39-51 months. About 38% of patients who had shown lowered free light chains values by more than 50% under therapy, achieved disease remission in the light chain disease and biclonal gammopathy with FLC groups. In the group of patients with monoclonal gammopathy of undetermined significance, 66.0% had a normal or slightly modified FLC ratio which corresponds to low and low-intermediate risk of disease progression, as opposed to 34.0% with an abnormal FLC ratio (<0.25 or >4) which corresponds to high and high-intermediate risk. An abnormal FLC ratio in the examined groups could be an independent risk factor for progression and poorer disease prognosis.

Slobodni Laki Lanci Imunoglobulina Kao Prognostički Faktor Kod Nekih Plazmaproliferativnih Bolesti

Kvantitativno određivanje monoklonskih imunoglobulina i njihovih fragmenata koristi se za praćenje toka i terapijskog odgovora kod plazmaproliferativnih bolesti. Cilj određivanja slobodnih lakih lanaca imunoglobulina u serumu bolesnika jeste provera značaja njihovog količnika (κ/λ indeks) kao prognostičkog faktora remisije, progresije i preživljavanja. Koncentracije imunoglobulina i slobodnih lakih lanaca određivane su imunonefelometrijskom metodom na analizatoru SIEMENS DADE Behring II sa reagensima (FREELITE, The Binding Site, UK). U ispitivanje je uključen 151 bolesnik tokom perioda od 7 godina, koji su razvrstani u 3 grupe: 1. bolest lakih lanaca ili Bence Jones mijelom (37); 2. biklonalna gamapatija sa slobodnim lakim lancima (23) i 3. monoklonska gamapatija neutvrđenog značaja (91). Referentnim intervalom za κ/λ indeks smatraju se vrednosti 0,26-1,65. Prema Internacionalnom prognoznom indeksu za multipli mijelom, kao patološki uzet je κ/λ indeks <0,03 ili >32. Bolesnici iz prve dve grupe sa patološkim k/λ indeksom i kombinacijom nepovoljnih faktora rizika (76,7%) imali su prosečno vreme preživljavanja 22-30 meseci, nasuprot bolesnicima sa fiziološkim ili neznatno izmenjenim κ/λ indeksom bez nepovoljnih faktora rizika (23,3%), sa prosečnim vremenom preživljavanja 39-51 mesec. Oko 38% bolesnika koji su pod terapijom imali sniženje κ/λ indeksa >50% su ostvarili remisiju bolesti. U grupi ispitanika sa MGNZ, 66,0% je imalo fiziološke ili neznatno izmenjene κ/λ indekse, što odgovara niskom i srednje niskom riziku progresije, nasuprot 34,0% sa patološkim κ/λ indeksom (<0,25 ili >4), što odgovara srednje visokom i visokom riziku progresije. Postojanje patološki značajnog κ/λ indeksa u ispitivanim grupama predstavlja nezavisan faktor rizika za progresiju bolesti i lošiju prognozu.

Keywords: free light chains; FLC ratio; plasmaproliferative disease; prognostic factor

Keywords: slobodni laki lanci; κ/λ indeks; plazmaproliferativne bolesti; prognostički faktor

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