Early Normalization of Free Light Chains Predicts Better Outcomes in Patients with Multiple Myeloma
in patients with multiple myeloma [MM]. This prospective study is aimed at evaluating whether early light chain response can predict response to treatment in patients with MM.
Materials and Methods: Thirty six patients with a diagnosis of MM and with an abnormal to normal light chain ratio of > 10 were included in this study.
Results: The median age at presentation was 56 years. Fourteen patients had lambda light chain disease, whereas 22 patients had kappa light chain disease. Twenty-four patients [66.6%] had reduction of abnormal to normal light chain ratio to < 10 after 2 cycles, of whom 15 [62.5%] achieved a CR or VGPR after 6 cycles. Among 12 patients who did not have reduction of abnormal to normal light chain ratio to < 10, only 1 patient achieved CR while 11 patients [91.6%] achieved a PR or less[Fishers exact p=0.004]. Median follow-up was 13 months. Median progression-free survival for the entire cohort was 15 months. One-year Progression-Free Survival was 77% vs 57.1%, [p= 0.008], respectively for patients with early normalization and those who did not show early normalization.
Conclusion: Early light chain response after 2 cycles of chemotherapy is a good predictor for treatment response in patients with MM treated with bortezomib based chemotherapy. Treatment intensification based on early light chain response merits further evaluation in a prospective trial
2. Yağcı M, Karakaya F, Suyanı E, et al. Serum free light chain response after 2 courses of induction chemotherapy predicts prognosis in myeloma patients. Clin Lymphoma Myeloma Leuk. 2015; 15(2):98–102.
3. Iwama K-I, Chihara D, Tsuda K, et al. Normalization of free light chain kappa/lambda ratio is a robust prognostic indicator of favorable outcome in patients with multiple myeloma. Eur J Haematol. 2013; 90(2):134–141.
4. Castillo JJ, Jurczyszyn A, Brozova L, et al. IgM myeloma: A multicenter retrospective study of 134 patients. Am J Hematol. 2017; 92(8):746-751.
5. Wang L, Jin FY, Li Y, et al. IgA Type Multiple Myeloma, Clinical Features, and Prognosis. Chin Med J (Engl). 2018; 131(10):1249-1250.
6. Kamesaki H, Amano H, Toyoda S, et al. Long-term, disease-free survival in a patient with IgA multiple myeloma. Am J Med. 1990; 88(2):196-197.
7. Zhang JJ, Sun WJ, Huang ZX, et al. Light chain multiple myeloma, clinic features, responses to therapy and survival in a long-term study. World J Surg Oncol. 2014; 12:234.
8. Shustik C, Bergsagel DE, Pruzanski W. Kappa and lambda light chain disease: survival rates and clinical manifestations. Blood. 1976; 48(1):41-51.
9. Rafae A, Malik MN, Abu Zar M, et al. An Overview of Light Chain Multiple Myeloma: Clinical Characteristics and Rarities, Management Strategies, and Disease Monitoring. Cureus. 2018;10(8):e3148.
10. Mercedes Gironella, Alicia Senín, Karla Vallejo, et al. Early Normalization of Serum Free Light Chain (FLC) Assays Correlates with Profound and Prolonged Responses in Newly Diagnosed Multiple Myeloma (MM). Blood. 2018; 132 (Supplement 1): 1897.
11. Reeder CB, Reece DE, Kukreti V, et al. Cyclophosphamide, bortezomib and dexamethasone induction for newly diagnosed multiple myeloma: high response rates in a phase II clinical trial. Leukemia. 2009; 23(7):1337-1341.
12. Richardson PG, Weller E, Lonial S, et al. Lenalidomide, bortezomib, and dexamethasone combination therapy in patients with newly diagnosed multiple myeloma. Blood. 2010; 116(5):679-686.
|Issue||Vol 14, No 4 (2020)|
|Light chain response; Multiple myeloma; Prognostic marker|
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