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Received on March 5, 2008
Accepted on August 7, 2008
Cancer Diagnostics |
1 Department of Clinical Chemistry, Ulleval University Hospital, 0407 Oslo, Norway
2 Department of Hematology, Ulleval University Hospital, 0407 Oslo, Norway
* To whom correspondence should be addressed. E-mail: armin.piehler{at}medisin.uio.no.
BACKGROUND: Serum free light chain (SFLC) measurements have recently come into use as an aid for diagnosing monoclonal gammopathy. We evaluated SFLC measurements in combination with serum protein electrophoresis (SPE) and clinical information for diagnosing multiple myeloma (MM) in a hospital population.
METHODS: We measured SFLCs in 3818 sera received for SPE over a 1-year period when patient symptoms or biochemical findings suggested myeloma-related tissue damage (n = 1067). We reviewed SPE and SFLC results from 489 patients together with their final diagnoses obtained from the hospital information technology department.
RESULTS: SFLC measurement, combined with SPE and clinical information, allowed identification of 95% of patients (38 of 40) with previously undiagnosed MM, macroglobulinemia, or primary amyloidosis. Additionally, we identified 45 patients with monoclonal gammopathy of undetermined significance (MGUS) and 4 with plasmacytoma. Of patients followed at our hospital in whom SFLCs were not measured, only 1 patient was diagnosed with MM. This patient had anemia and was mistakenly not tested for SFLCs. An abnormal 
/
ratio was found in 26 of 29 patients with MM but also in 36 of 203 patients with renal impairment, polyclonal immunoresponse, or other nonhematological diagnoses. None of the 203 patients with nonhematological disease had a / ratio <0.05 or >10.
CONCLUSIONS: The combined use of SPE, SFLC measurements, and clinical criteria allows MM to be efficiently diagnosed or excluded based on serum measurements only.
The following articles in journals at HighWire Press have cited this article:
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  R. B Fulton and S. L Fernando Serum free light chain assay reduces the need for serum and urine immunofixation electrophoresis in the evaluation of monoclonal gammopathy Ann Clin Biochem, September 1, 2009; 46(5): 407 - 412. [Abstract] [Full Text] [PDF]
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 A. J. Bakker, A. Bierma-Ram, C. Elderman-van der Werf, M. L. Strijdhaftig, and J. J. van Zanden Quantitation of Serum Free Light Chains Clin. Chem., August 1, 2009; 55(8): 1585 - 1587. [Full Text] [PDF]
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J. A. Katzmann, R. A. Kyle, J. Benson, D. R. Larson, M. R. Snyder, J. A. Lust, S. V. Rajkumar, and A. Dispenzieri Screening Panels for Detection of Monoclonal Gammopathies Clin. Chem., August 1, 2009; 55(8): 1517 - 1522. [Abstract] [Full Text] [PDF]
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A. P. Piehler and P. Urdal In Reply Clin. Chem., August 1, 2009; 55(8): 1587 - 1588. [Full Text] [PDF]
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 E. J.D. Robson, J. Taylor, C. Beardsmore, S. Basu, G. Mead, and T. Lovatt Utility of Serum Free Light Chain Analysis When Screening for Lymphoproliferative Disorders: The Experience at a District General Hospital in the United Kingdom Lab Med, June 1, 2009; 40(6): 325 - 329. [Full Text] [PDF]
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D. Siegel, E. Bilotti, and K. H. van Hoeven Serum Free Light Chain Analysis for Diagnosis, Monitoring, and Prognosis of Monoclonal Gammopathies Lab Med, June 1, 2009; 40(6): 363 - 366. [Abstract] [Full Text] [PDF]
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G. Palladini, P. Russo, T. Bosoni, L. Verga, G. Sarais, F. Lavatelli, M. Nuvolone, L. Obici, S. Casarini, S. Donadei, et al. Identification of Amyloidogenic Light Chains Requires the Combination of Serum-Free Light Chain Assay with Immunofixation of Serum and Urine Clin. Chem., March 1, 2009; 55(3): 499 - 504. [Abstract] [Full Text] [PDF]
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J. A. Katzmann and A. Dispenzieri Screening Algorithms for Monoclonal Gammopathies Clin. Chem., November 1, 2008; 54(11): 1753 - 1755. [Full Text] [PDF]
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