title: Free light chain: a novel predictor of adverse outcome in chronic lymphocytic leukemia.
abstract: OBJECTIVE
  Chronic lymphocytic leukemia (CLL) is characterized by a highly variable clinical course. This retrospective study is planned to assess the prognostic value of serum free light chain (sFLC) levels and FLC ratio (FLCR) in CLL.
  
  
  METHODS
  Quantitative levels of sFLC were measured nephelometrically in sera collected at diagnosis. The expressions of ZAP70 and CD38 were quantified by flow cytometry. Chromosomal abnormalities were determined by interphase fluorescence in situ hybridization (FISH).
  
  
  RESULTS
  In a cohort of 101 patients with a median follow-up of 29 (1-234) months, sFLC levels were found to be high in 55 patients (54.5%). An abnormal FLCR was found in 30 patients (29.7%). FISH-based genetic risk groups did not differ significantly with respect to sFLC and FLCR (P > 0.05). Median time to first treatment was shorter in patients with high sFLC levels (P = 0.02). Median overall survival (OS) was shorter in patients with high sFLC levels (P = 0.01) and abnormal FLCR (P = 0.05). In patients with early stage disease, median OS was shorter in high sFLC (P = 0.03) and abnormal FLCR groups (P = 0.048). A relationship was observed between abnormal sFLC levels and CD38 positivity on logistic regression analysis (P = 0.003; OR: 4.44; 95% CI: 1.66-11.8).
  
  
  CONCLUSIONS
  This study highlighted the adverse prognostic impact of high sFLC levels and abnormal FLCR with regard to survival in CLL, even in early stage patients. Prospective studies are warranted to validate the adverse impact of sFLC and FLCR on clinical outcome.
authors.affiliation: Gazi University Faculty of Medicine, Department of Hematology, Ankara, Turkey. zyegin@gazi.edu.tr
authors.forename: Zeynep A
authors.initials: ZA
authors.lastname: Yegin
authors.forename: Zübeyde N
authors.initials: ZN
authors.lastname: Ozkurt
authors.forename: Münci
authors.initials: M
authors.lastname: Yağci
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007147:Immunoglobulin Light Chains / Q000097:blood*; D017404:In Situ Hybridization, Fluorescence; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000097:blood / Q000276:immunology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015996:Survival Rate
chemical_list: D007147:Immunoglobulin Light Chains