The Binding Site Group Ltd., 8 Calthorpe Road, Edgbaston, Birmingham B15 1QT, UK.
Clin Chim Acta. 2014 Jan 1;427:15-20. doi: 10.1016/j.cca.2013.08.018. Epub 2013 Aug 30.
Monoclonal free light chains (FLCs) are important disease biomarkers in patients with plasma cell-proliferative disorders. The increasing evidence for clonal diversity and evolution in multiple myeloma highlights the importance of laboratory algorithms that measure both intact immunoglobulins and monoclonal FLCs, at diagnosis and when monitoring response to treatment. A particular focus in the field has been on the utility of serum FLC (sFLC) assays to replace urine electrophoresis for monoclonal FLC measurement. Due to the limited sensitivity and practical constraints of urine analysis, a serum-based algorithm of SPE and sFLC has been adopted by many laboratories as a first line screen in patients with suspected monoclonal gammopathies. This review will discuss the data supporting the use of this simple serum-based algorithm at initial diagnosis, including its utility for the rapid identification of monoclonal FLC in the setting of unexplained acute kidney injury, and provide a comprehensive review of the diagnostic sensitivity of sFLC in patients with multiple myeloma, AL amyloidosis and light chain deposition disease.
单克隆游离轻链（FLC）是浆细胞增生性疾病患者的重要疾病生物标志物。越来越多的证据表明多发性骨髓瘤中的克隆多样性和进化很重要，这凸显了实验室算法的重要性，这些算法可在诊断时以及监测对治疗的反应时测量完整的免疫球蛋白和单克隆 FLC。该领域的一个特别关注点一直是血清 FLC（sFLC）测定在替代尿液电泳用于单克隆 FLC 测量方面的实用性。由于尿液分析的灵敏度有限且存在实际限制，因此许多实验室采用基于血清的 SPE 和 sFLC 算法作为疑似单克隆丙种球蛋白病患者的一线筛查。这篇综述将讨论支持在初始诊断中使用这种简单的基于血清的算法的数据，包括其在不明原因急性肾损伤情况下快速识别单克隆 FLC 的实用性，并全面回顾 sFLC 在多发性骨髓瘤、AL 淀粉样变性和轻链沉积病患者中的诊断灵敏度。
