Monitoring Monoclonal Gammopathies

FLC κ/λ Ratio: Disease Sensitivity

November 2009

This composite slide has a few different groups of patients. The light gray area represents the kappa and lambda reference range determined from normals, plotted as blue circles. Older normals with reduced renal clearance, shown as red dots, as well as polyclonal hypergammaglobulinemia patients, shown as green squares, may fall outside these ranges.

When the data is viewed as the kappa:lambda ratio, however, all those samples fall within the reference range, but the kappa and lambda light chain myelomas are abnormal. The point I want to make with this slide is the yellow circles. These are nonsecretory myelomas that have no measurable M-spikes. Yet you can clearly see that many of these patients now have a “tumor marker” that can be used to monitor their disease.

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Jump to section:

• Introduction
• Slide Images
• International Myeloma Working Group: Disease Monitoring
• Serum Protein Electrophoresis and Immunofixation Electrophoresis
• Serum and Urine Protein Electrophoresis and Immunofixation Electrophoresis
• Methods for Monitoring Monoclonal Gammopathies: 2005 IMWG
• Methods for Monitoring Monoclonal Gammopathies
• Small IgG kappa M-spike
• Large IgG kappa M-spike
• Relationship of Serum Agarose Electrophoresis M-spike and Ig Quantitation¹
• Disease Monitoring
• Monoclonal Gammopathies: Primary Systemic Amyloidosis
• Free Light Chain: Antibody Specificity
• FLC κ/λ Ratio: Disease Sensitivity²
• Methods for Monitoring Monoclonal Gammopathies
• International Myeloma Working Group: 2009 Guidelines for Disease Monitoring³
• Response Criteria for FLC^4,5
• Receiver Operator Curve (ROC): % FLC Reduction vs. Overall Hematologic Response⁶
• International Myeloma Working Group: 2009 Guidelines for Disease Monitoring
• References
• Questions?