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Clinical Chemistry 49: 1252-1257, 2003; 10.1373/49.8.1252
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(Clinical Chemistry. 2003;49:1252-1257.)
© 2003 American Association for Clinical Chemistry, Inc.

Minireview

Practical Considerations for the Measurement of Free Light Chains in Serum

Jillian R. Tate1,a, Devinder Gill2, Ralph Cobcroft2 and Peter E. Hickman1

1 Chemical Pathology and
2 Haematology Departments, Queensland Health Pathology Service, Princess Alexandra Hospital, Woolloongabba, Queensland 4102, Australia.

aAddress correspondence to this author at: Chemical Pathology Department, Queensland Health Pathology Service, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Queensland 4102, Australia. Fax 61-7-3240-7070; e-mail jill_tate{at}health.qld.gov.au.


Abstract

Background: A new immunoassay for free light chain measurements has been reported to be useful for the diagnosis and monitoring of monoclonal light chain diseases and nonsecretory myeloma. We describe experience with and some potential pitfalls of the assay.

Methods: The assay was assessed for precision, sample type and stability, recovery, and harmonization of results between two analyzers on which the reagents are used. Free-light-chain concentrations were measured in healthy individuals (to determine biological variation), patients with monoclonal gammopathy of undetermined significance, myeloma patients after autologous stem cell transplants, and patients with renal disease.

Results: Analytical imprecision (CV) was 6–11% for {kappa} and {lambda} free-light-chain measurement and 16% for the calculated {kappa}/{lambda} ratio. Biological variation was generally insignificant compared with analytical variation. Despite the same reagent source, values were not completely harmonized between assay systems and may produce discordant free-light-chain ratios. In some patients with clinically stable myeloma, or post transplantation, or with monoclonal gammopathy of undetermined significance, free-light-chain concentration and ratio were within the population reference interval despite the presence of monoclonal intact immunoglobulin in serum. In other patients with monoclonal gammopathy of undetermined significance, values were abnormal although there was no clinical evidence of progression to multiple myeloma.

Conclusions: The use of free-light-chain measurements alone cannot differentiate some groups of patients with monoclonal gammopathy from healthy individuals. As with the introduction of any new test, it is essential that more scientific data about use of this assay in different subject groups are available so that results can be interpreted with clinical certainty.




The following articles in journals at HighWire Press have cited this article:


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 Annals of Clinical & Laboratory ScienceHome page
I. Ramasamy
Serum Free Light Chain Analysis in B-cell Dyscrasias
Ann. Clin. Lab. Sci., January 1, 2007; 37(3): 291 - 294.
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T. D. Jaskowski, C. M. Litwin, and H. R. Hill
Detection of {kappa} and {lambda} Light Chain Monoclonal Proteins in Human Serum: Automated Immunoassay versus Immunofixation Electrophoresis
Clin. Vaccine Immunol., February 1, 2006; 13(2): 277 - 280.
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I. Herzum, H. Renz, and H. G. Wahl
Immunochemical Quantification of Free Light Chains in Urine
Clin. Chem., June 1, 2005; 51(6): 1033 - 1035.
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E. J. Thompson
Quality versus Quantity: Which Is Better for Cerebrospinal Fluid IgG?
Clin. Chem., October 1, 2004; 50(10): 1721 - 1722.
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G. P. Mead, M. T. Drayson, H. D. Carr-Smith, and A. R. Bradwell
Measurement of Immunoglobulin Free Light Chains in Serum
Clin. Chem., November 1, 2003; 49(11): 1957 - 1958.
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