Recommendations for Use of Free Light Chain Assay in Monoclonal Gammopathies

Recommendations for Use of Free Light Chain Assay in Monoclonal Gammopathies The serum immunoglobulin free light chain assay measures levels of free κ and λ immunoglobulin light chains. There are three major indications for the free light chain assay in the evaluation and management of multiple myeloma and related plasma cell disorders. In the context of screening, the serum free light chain assay in combination with serum protein electrophoresis and immunofixation yields high sensitivity, and negates the need for 24-hour urine studies for diagnoses other than light chain amyloidosis. Second, the baseline free light chains measurement is of major prognostic value in virtually every plasma cell disorder. Third, the free light chain assay allows for quantitative monitoring of patients with oligosecretory plasma cell disorders, including AL, oligosecretory myeloma, and nearly twothirds of patients who had previously been deemed to have non-secretory myeloma. In AL patients, serial free light chains measurements outperform protein electrophoresis and immunofixation. In oligosecretory myeloma patients, although not formally validated, serial free light chains measurements reduce the need for frequent bone marrow biopsies. In contrast, there are no data to support using free light chain assay in place of 24-hour urine electrophoresis for monitoring or for serial measurements in plasma cell disorders with measurable disease by serum or urine electrophoresis. Preporuke za Primenu Testa Slobodnih Lakih Lanaca Kod Monoklonskih Gamapatija Serumski test slobodnih lakih lanaca meri nivoe imunoglobulinskih slobodnih κ i λ lakih lanaca. Tri su glavne indikacije za primenu serumskog testa slobodnih lakih lanaca u proceni i lečenju multiplog mijeloma i srodnih plazma ćelijskih poremećaja. U kontekstu skrininga, test slobodnih lakih lanaca u kombinaciji sa elektroforezom proteina seruma i imunofiksacijom doprinosi visokoj osetljivosti, čime se izbegava upotreba 24-časovnih urinarnih testova za otkrivanje amiloidoznih lakih lanaca. Referentna merenja slobodnih lakih lanaca imaju veliku prognostičku vrednost za gotovo sve plazma ćelijske poremećaje. Test slobodnih lakih lanaca omogućava kvantitativno praćenje bolesnika sa oligosekretornim plazma ćelijskim poremećajima, uključujući primarnu, sistemsku AL amiloidozu, oligosekretorni mijelom, i oko 2/3 bolesnika sa nesekretornim multiplim mijelomom. Kod bolesnika sa primarnom, sistemskom AL amiloidozom, serijska merenja slobodnih lakih lanaca prevazilaze testove elektroforeze proteina i imunofiksacije. Kod bolesnika sa oligosekretornim mijelomom, iako neformalno validirana, serijska merenja slobodnih lakih lanaca umanjuju potrebu za čestim biopsijama koštane srži. Nasuprot tome, ne postoji podrška za primenu testa slobodnih lakih lanaca umesto 24-časovne urinarne elektroforeze za praćenje ili serijska merenja plazma ćelijskih poremećaja, koja se mogu izmeriti serumskom ili urinarnom elektroforezom.

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