Multiple Myeloma Monitoring Guidelines for Relapse Detection
Introduction
Did you know?
- IMWG recommend serum free light chain (sFLC) testing to monitor myeloma patients when the monoclonal protein produced is not measurable by traditional techniques.
- Evidence suggests the inclusion of sFLC testing in monitoring all patients, even those with measurable disease. This enables earlier detection of disease relapse, allowing appropriate treatment plans to be initiated.
Speaker
Featured in this video
Dr. Aurore Lison
Medical Science Liaison, Binding Site, part of Thermo Fisher Scientific
Key Takeaways
44% of myeloma patients relapse with a different clone
Changes in monoclonal protein expression occur in almost half of the myeloma patients between diagnosis and relapse. Zamarin et al. studied the monoclonal protein type for 126 myeloma patients at both diagnosis and relapse using SPE and serum Freelite tests.
Overall, the study observed that the monoclonal protein type at relapse differed to the type at diagnosis in 44% of all patients, that 56% of the patients express FLCs at relapse and that 22% of the patients undergo FLC escape.
For the different myeloma types, Zamari et al. found that:
- Among patients that expressed both FLC and intact immunoglobulins at diagnosis, 22% relapsed with light chain only (FLC escape).
- Among patients that expressed only intact immunoglobulins at diagnosis, 17% patients started also to produce FLC at relapse.
sFLC testing allowed these light chain escapes and relapses to be detected. These may have been missed if testing was performed with SPE alone.
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50% of light chain escape patients develop renal impairment
Light chain escape is linked to significant morbidity and mortality, with 50% of patients developing renal impairment. Brioli et al. investigated patient survival according to their monoclonal protein relapse type. The study observed that patients relapsing with FLC involvement experienced poorer prognosis and overall survival compared to intact immunoglobulin only patients.
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References
- Zamarin D et al. Patterns of relapse and progression in multiple myeloma patients after auto-SCT: implications for patients' monitoring after transplantation. Bone Marrow Transplant. 2013 Mar;48(3):419-24.
- Brioli A et al. Serum free immunoglobulin light chain evaluation as a marker of impact from intraclonal heterogeneity on myeloma outcome. Blood. 2014 May 29;123(22):3414-9.
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