title: Serum free light chain analysis and urine immunofixation electrophoresis in patients with multiple myeloma.
abstract: 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.
authors.affiliation: Department of Internal Medicine (Cancer Research), West German Cancer Center, University Hospital of Essen Medical School, Essen, Germany. nowrousian@uni-essen.de
authors.forename: Mohammad R
authors.initials: MR
authors.lastname: Nowrousian
authors.forename: Dieter
authors.initials: D
authors.lastname: Brandhorst
authors.forename: Christiane
authors.initials: C
authors.lastname: Sammet
authors.forename: Michaela
authors.initials: M
authors.lastname: Kellert
authors.forename: Rainer
authors.initials: R
authors.lastname: Daniels
authors.forename: Philipp
authors.initials: P
authors.lastname: Schuett
authors.forename: Miriam
authors.initials: M
authors.lastname: Poser
authors.forename: Siemke
authors.initials: S
authors.lastname: Mueller
authors.forename: Peter
authors.initials: P
authors.lastname: Ebeling
authors.forename: Anja
authors.initials: A
authors.lastname: Welt
authors.forename: Arthur R
authors.initials: AR
authors.lastname: Bradwell
authors.forename: Ulrike
authors.initials: U
authors.lastname: Buttkereit
authors.forename: Bertram
authors.initials: B
authors.lastname: Opalka
authors.forename: Michael
authors.initials: M
authors.lastname: Flasshove
authors.forename: Thomas
authors.initials: T
authors.lastname: Moritz
authors.forename: Siegfried
authors.initials: S
authors.lastname: Seeber
mesh_terms: 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
chemical_list: D007147:Immunoglobulin Light Chains; D001536:Bence Jones Protein