用血清游离轻链检测预测多发性骨髓瘤的反应和进展：对血清游离轻链反应定义的验证。

Prediction of response and progression in multiple myeloma with serum free light chains assay: corroboration of the serum free light chain response definitions.

机构信息

University of Michigan Hematology and Oncology Fellowship Program, Ann Arbor, MI, USA.

出版信息

Clin Lymphoma Myeloma Leuk. 2010 Feb;10(1):E10-3. doi: 10.3816/CLML.2010.n.010.

DOI:10.3816/CLML.2010.n.010

PMID:20223721

Abstract

BACKGROUND

The International Myeloma Working Group (IMWG) proposed response and progression criteria using serum free light chain (sFLC) testing for patients with nonsecretory multiple myeloma (MM). We attempt to validate these criteria by comparing paraprotein responses with sFLC responses in patients with secretory myeloma.

PATIENTS AND METHODS

Prospectively entered data for 89 patients with MM enrolled on various clinical trials at the Cleveland Clinic between April 2004 and December 2006 were reviewed.

RESULTS

By standard paraprotein criteria, 4 patients had complete remission (CR), 22 had partial remission (PR), 34 had stable disease (SD), 26 had progressive disease (PD), and 3 were inevaluable. Only 43 patients (48%) had an involved sFLC > or = 10 mg/dL (which is considered evaluable by the IMWG), of which 14 had PR, 8 had SD, 18 had PD, and 3 were inevaluable. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for sFLC in predicting response were 81%, 83%, 64%, and 92% respectively. The sensitivity, specificity, PPV, and NPV for sFLC in predicting progression were 93%, 80%, 72%, and 95% respectively.

CONCLUSION

sFLC reliably predicts response and progression in MM. However, half of the patients had inevaluable disease by sFLC, thus limiting the utility of sFLC testing in patients with nonmeasurable disease by electrophoretic methods.

摘要

背景

国际骨髓瘤工作组（IMWG）提出了使用血清游离轻链（sFLC）检测非分泌性多发性骨髓瘤（MM）患者的反应和进展标准。我们试图通过比较分泌性骨髓瘤患者的免疫固定电泳反应和 sFLC 反应来验证这些标准。

患者和方法

回顾了 2004 年 4 月至 2006 年 12 月期间在克利夫兰诊所参加各种临床试验的 89 例 MM 患者的前瞻性入组数据。

结果

根据标准的免疫固定电泳反应标准，4 例患者达到完全缓解（CR），22 例患者达到部分缓解（PR），34 例患者病情稳定（SD），26 例患者疾病进展（PD），3 例患者无法评估。仅有 43 例（48%）患者的 sFLC 受累>或=10mg/dL（这被 IMWG 认为是可评估的），其中 14 例患者达到 PR，8 例患者达到 SD，18 例患者达到 PD，3 例患者无法评估。sFLC 预测反应的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为 81%、83%、64%和 92%。sFLC 预测进展的敏感性、特异性、PPV 和 NPV 分别为 93%、80%、72%和 95%。