TY - JOUR
T1 - High serum-free light chain levels and their rapid reduction in response to therapy define an aggressive multiple myeloma subtype with poor prognosis
AU - Van Rhee, Frits
AU - Bolejack, Vanessa
AU - Hollmig, Klaus
AU - Pineda-Roman, Mauricio
AU - Anaissie, Elias
AU - Epstein, Joshua
AU - Shaughnessy, John D.
AU - Zangari, Maurizio
AU - Tricot, Guido
AU - Mohiuddin, Abid
AU - Alsayed, Yazan
AU - Woods, Gail
AU - Crowley, John
AU - Barlogie, Bart
PY - 2007/8/1
Y1 - 2007/8/1
N2 - Serum-free light chain (SFLC) levels are useful for diagnosing nonsecretory myeloma and monitoring response in lightchain-only disease, especially in the presence of renal failure. As part of a tandem autotransplantation trial for newly diagnosed multiple myeloma, SFLC levels were measured at baseline, within 7 days of starting the first cycle, and before both the second induction cycle and the first transplantation. SFLC baseline levels higher than 75 mg/dL (top tertile) identified 33% of 301 patients with higher near-complete response rate (n-CR) to induction therapy (37% vs 20%, P = .002) yet inferior 24-month overall survival (OS: 76% vs 91%, P < .001) and event-free survival (EFS: 73% vs 90%, P < .001), retaining independent prognostic significance for both EFS (HR = 2.40, P = .008) and OS (HR = 2.43, P = .016). Baseline SFLC higher than 75 mg/dL was associated with light-chain-only secretion (P < .001), creatinine level 176.8 μM(2 mg/dL) or higher (P < .001), beta-2-microglobulin 297.5 nM/L (3.5 mg/L) or higher (P < .001), lactate dehydrogenase 190 U/L or higher (P < .001), and bone marrow plasmacytosis higher than 30% (P = .003). Additional independent adverse implications were conferred by toptertile SFLC reductions before cycle 2 (OS: HR = 2.97, P = .003; EFS: HR = 2.56, P = .003) and before transplantation (OS: HR = 3.31, P = .001; EFS: HR = 2.65, P = .003). Unlike baseline and follow-up analyses of serum and urine M-proteins, high SFLC levels at baseline - reflecting more aggressive disease - and steeper reductions after therapy identified patients with inferior survival.
AB - Serum-free light chain (SFLC) levels are useful for diagnosing nonsecretory myeloma and monitoring response in lightchain-only disease, especially in the presence of renal failure. As part of a tandem autotransplantation trial for newly diagnosed multiple myeloma, SFLC levels were measured at baseline, within 7 days of starting the first cycle, and before both the second induction cycle and the first transplantation. SFLC baseline levels higher than 75 mg/dL (top tertile) identified 33% of 301 patients with higher near-complete response rate (n-CR) to induction therapy (37% vs 20%, P = .002) yet inferior 24-month overall survival (OS: 76% vs 91%, P < .001) and event-free survival (EFS: 73% vs 90%, P < .001), retaining independent prognostic significance for both EFS (HR = 2.40, P = .008) and OS (HR = 2.43, P = .016). Baseline SFLC higher than 75 mg/dL was associated with light-chain-only secretion (P < .001), creatinine level 176.8 μM(2 mg/dL) or higher (P < .001), beta-2-microglobulin 297.5 nM/L (3.5 mg/L) or higher (P < .001), lactate dehydrogenase 190 U/L or higher (P < .001), and bone marrow plasmacytosis higher than 30% (P = .003). Additional independent adverse implications were conferred by toptertile SFLC reductions before cycle 2 (OS: HR = 2.97, P = .003; EFS: HR = 2.56, P = .003) and before transplantation (OS: HR = 3.31, P = .001; EFS: HR = 2.65, P = .003). Unlike baseline and follow-up analyses of serum and urine M-proteins, high SFLC levels at baseline - reflecting more aggressive disease - and steeper reductions after therapy identified patients with inferior survival.
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U2 - 10.1182/blood-2007-01-067728
DO - 10.1182/blood-2007-01-067728
M3 - Article
C2 - 17416735
AN - SCOPUS:34547962120
SN - 0006-4971
VL - 110
SP - 827
EP - 832
JO - Blood
JF - Blood
IS - 3
ER -