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Free Light Chains & Monoclonal Gammopathies

Impact on Diagnostic Panels



FLC Reference Range

Slide 11

August 2008

This next slide illustrates free light chain results from normals and patients. In the bottom corner are results from a series of normal donors. As we age, (illustrated by the red dots) renal clearance goes down, and if we have a polyclonal elevation of immunoglobulins (illustrated by the green dots) there may be an increase in kappa and lambda free light chains, but the ratio remains in the reference range illustrated by the rectangular box.

In patients with lambda light chain multiple myeloma or with kappa light chain multiple myeloma, we see that all the sera are outside the reference range but the median ratios are about 100 times normal. I’ve also included on this slide results from patients with non-secretory myeloma. These myeloma patients, remember, have normal PEL & IFE assays. But you can see that approximately two-thirds of them have abnormal serum free light chain results. So this assay seems exquisitely sensitive for monoclonal free light chain diseases. Now if we can identify these monoclonal light chain diseases with the serum free light chain assay, it raises the question of whether we still need urine in our screening panel.

FLC Reference Range

 


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