Serum free light chain response after 2 courses of induction chemotherapy predicts prognosis in myeloma patients

Pulsatilla saponin A Induces Apoptosis and Differentiation of Myeloma Cells

OBJECTIVES

To investigate the performance of Pulsatilla saponin A (PsA) in Multiple Myeloma (MM) cells.

METHODS

Proliferation, cell cycle analysis, apoptosis and TUNEL assays were conducted to detect the growth and apoptosis in MM cells. Western blotting was used to identify the change in the protein.

RESULTS

In cell assays, PsA significantly inhibited the growth and apoptosis in MM cells. Cyclin B1, caspase-3, cleaved-caspase-3, PARP, cleaved-PARP, p-ERK increased, while Bcl-2 decreased after PSA treatment. The CD49e positive rate of U266 cells was increased after 96h PsA treatment. At the same time, immunoglobulin and the Free Light Chain (FLC) ratio in the culture supernatant obviously increased. Also, the differentiation induced by PsA was confirmed in the primary myeloma cells.

CONCLUSION

Our findings reveal that PsA may exert its antitumor effect by causing G2 arrest and apoptosis in myeloma cells. And low-dose PsA can induce the differentiation of myeloma cell lines and primary myeloma cells, probably through the MEK/ERK signaling pathway in vitro.

Prognostic impact of rapid reduction of involved free light chains in multiple myeloma patients under first-line treatment with Bendamustine, Prednisone, and Bortezomib (BPV)

Introduction

Light chain involvement is observed in almost every patient (pt) with newly diagnosed multiple myeloma (MM). Owing to a relatively short half-life, rapid reduction in the involved free light chain (iFLC) is of potential prognostic value.

Methods

This retrospective analysis included 92 pts with newly diagnosed MM treated with bendamustine, prednisone, and bortezomib (BPV).

Results

After a median number of two (range 1–5) BPV cycles, the majority of pts (n = 86; 93%) responded with either sCR (n = 21), CR (n = 1), nCR (n = 25), VGPR (n = 20), or PR (n = 19). PFS and OS at 48 months were 39% and 67%, respectively. At baseline, 79 out of 92 pts (86%) had iFLC levels above the upper standard level and an abnormal ratio of involved to uninvolved free light chain ≥ 8. In a subgroup analysis of these pts, we evaluated the prognostic importance of an early reduction of the iFLC during the first two BPV cycles. A reduction ≥ 50% of the iFLC on day 8 of the first cycle was observed in 31 of 69 pts. These pts had a significantly better median PFS of 49 months as compared to 20 months in 38 pts with a lower iFLC reduction (p = 0.002). In contrast, OS did not differ significantly with a 48 months survival of 77% vs 69% (p > 0.05).

Conclusion

These results indicate that a rapid decrease in the iFLC on day 8 is an early prognostic marker for newly diagnosed MM pts undergoing BPV treatment.

Early Normalization of Free Light Chains Predicts Better Outcomes in Patients with Multiple Myeloma

Background: The half-life of free light chain is short and can be used as an early marker for tumor response in patients with multiple myeloma [MM]. This prospective study is aimed at evaluating whether early light chain response can predict response to treatment in patients with MM.

Materials and Methods: Thirty six patients with a diagnosis of MM and with an abnormal to normal light chain ratio of > 10 were included in this study.

Results: The median age at presentation was 56 years. Fourteen patients had lambda light chain disease, whereas 22 patients had kappa light chain disease. Twenty-four patients [66.6%] had reduction of abnormal to normal light chain ratio to < 10 after 2 cycles, of whom 15 [62.5%] achieved a CR or VGPR after 6 cycles. Among 12 patients who did not have reduction of abnormal to normal light chain ratio to < 10, only 1 patient achieved CR while 11 patients [91.6%] achieved a PR or less[Fishers exact p=0.004]. Median follow-up was 13 months. Median progression-free survival for the entire cohort was 15 months. One-year Progression-Free Survival was 77% vs 57.1%, [p= 0.008], respectively for patients with early normalization and those who did not show early normalization.

Conclusion: Early light chain response after 2 cycles of chemotherapy is a good predictor for treatment response in patients with MM treated with bortezomib based chemotherapy. Treatment intensification based on early light chain response merits further evaluation in a prospective trial

Serum Free Light Chain Assay and κ/λ Ratio Performance in Patients Without Monoclonal Gammopathies: High False-Positive Rate

OBJECTIVES

Serum free light chain assay is a recommended screening test for monoclonal gammopathies. Anecdotal observations indicated a high rate of false-positive abnormal κ/λ ratios. This study was undertaken to ascertain the magnitude of the false-positive rate and factors contributing to the error rate.

METHODS

Results of serum protein electrophoresis, serum free light chains, and related tests, usually done for investigation of suspected monoclonal gammopathy, were reviewed retrospectively for 270 patients and 297 observations.

RESULTS

Using the conventional κ/λ ratio, 36.4% of the ratios were abnormal, in the absence of monoclonal gammopathy. When the renal κ/λ ratio was used, the rate of abnormal κ/λ ratios was 30.1%. In patients with a γ-globulin concentration of 1.6 g/dL or more, the usual κ/λ ratio was abnormal in 54.8% of the patients. Urine protein electrophoresis was used in 53 (19.6%) instances, whereas bone marrow examination was done in 65 (24.1%) cases.

CONCLUSIONS

Usual κ/λ ratio was abnormal in 36.4% of the observations in patients without evidence of monoclonal gammopathy, and an abnormal κ/λ ratio should not be used as the sole indicator for diagnosis of neoplastic proliferation of the lympho-plasmacytic system. Hypergammaglobulinemia is associated with a higher rate of false-positive abnormal κ/λ ratios. Examination of urine for monoclonal immunoglobulins may be underused, and recommendations by some to use serum free light chain assay in place of, rather than as an adjunct to, urine electrophoresis are not warranted.

[The roles of serum free light chain ratio in the diagnosis and prognosis of newly diagnosed multiple myeloma]

OBJECTIVE

The roles of serum free light chain ratio (sFLCR) in the diagnosis and prognosis of newly diagnosed multiple myeloma (NDMM) patients were analyzed.

METHODS

The clinical data was retrospectively analyzed for 82 newly diagnosed multiple myeloma (NDMM) patients in the first affiliated hospital of Soochow University from September 28, 2012 to July 18, 2105. The serum free light chain levels were measured and κ/λ ratios were calculated, so we could analyze the roles of sFLCR in the diagnosis and prognosis of newly diagnosed multiple myeloma (NDMM) patients.

RESULTS

It was 85.5% (70/82) positive of M protein by serum protein electrophoresis (SFE) and 93.9%(77/82) by serum immunofixation electrophoresis (IFE). Both sFLC and sFLCR abnormalities were 96.3% (79/82). The estimated 40-months overall survival was 87% for the high free light chain ratio group (sFLCR ≥100 or≤0.01) and 61% for the low free light chain ratio group (0.01

CONCLUSION

sFLC assay is much more sensitive than the common methods used, such as SPE and IFE for the diagnosis of MM. The patients with significantly abnormal sFLCR have more tumor burden, higher aggressive progression, and adverse prognosis. Compared with the patients who have normal renal function, the patients with renal insufficiency acquire the same effect after receiving reasonable treatment actively.

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Key Words

• 血清游离轻链比率
• 多发性骨髓瘤
• 诊断
• 预后
• free light chain ratio
• muliple myeloma
• diagnosis
• prognosis

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MESH Headings

• Bone Marrow Cells
• Humans
• Immunoglobulin Light Chains/blood
• In Situ Hybridization, Fluorescence
• Multiple Myeloma/blood
• Multiple Myeloma/diagnosis
• Myeloma Proteins/chemistry
• Prognosis
• Renal Insufficiency/complications
• Retrospective Studies

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Affiliation(s)

P F Wang First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Key Laboratory of thrombosis and hemostasis of Ministry of health , Hematology Collaborative Innovation Center , Suzhou 215006, China
Y Xu
S Yan
Y Yao
H F Zheng
L Ma
S Jin
Y Xu
F R Gong
J Z Zhou
H R Chang
C C Fu

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