Serum free light chain analysis and urine immunofixation electrophoresis in patients with multiple myeloma.
OBJECTIVE
Retrospective studies have shown that immunoassays measuring free light chains (FLC) in serum are useful for diagnosis and monitoring of multiple myeloma. This study prospectively evaluates the use of FLC assays and, for the first time, investigates the relationship between serum FLC concentrations and the presence and detectability of Bence Jones (BJ) proteins in the urine.


METHODS
Three hundred seventy-eight paired samples of serum and urine were tested from 82 patients during the course of their disease. The sensitivities of serum FLC analysis and urine immunofixation electrophoresis (IFE) in detecting monoclonal FLC were compared. Serum FLC concentrations required for producing BJ proteins detected by IFE were determined.


RESULTS
Abnormal FLC were present in 54% of serum samples compared with 25% by urine tests. In abnormal serum samples for kappa or lambda, the sensitivity of IFE to detect the respective BJ proteins in urine were 51% and 35% and the median serum FLC concentrations required to produce detectable BJ proteins were 113 and 278 mg/L. Renal excretions of monoclonal FLC increased with serum concentrations, but excretions significantly decreased at high serum concentrations combined with renal dysfunction.


CONCLUSIONS
Serum FLC assays are significantly more sensitive for detecting monoclonal FLC than urine IFE analysis. They also have the advantage of FLC quantification and are more reliable for monitoring disease course and response to treatment.
Nowrousian
Mohammad R
MR
Department of Internal Medicine (Cancer Research), West German Cancer Center, University Hospital of Essen Medical School, Essen, Germany. nowrousian@uni-essen.de
Brandhorst
Dieter
D
Sammet
Christiane
C
Kellert
Michaela
M
Daniels
Rainer
R
Schuett
Philipp
P
Poser
Miriam
M
Mueller
Siemke
S
Ebeling
Peter
P
Welt
Anja
A
Bradwell
Arthur R
AR
Buttkereit
Ulrike
U
Opalka
Bertram
B
Flasshove
Michael
M
Moritz
Thomas
T
Seeber
Siegfried
S
D001536:Bence Jones Protein / Q000652:urine*; D006801:Humans; D007118:Immunoassay / Q000379:methods*; D007122:Immunoelectrophoresis / Q000379:methods*; D007147:Immunoglobulin Light Chains / Q000097:blood*; D009101:Multiple Myeloma / Q000175:diagnosis*; D012680:Sensitivity and Specificity
D007147:Immunoglobulin Light Chains; D001536:Bence Jones Protein