Serum free light chain level at diagnosis in myeloma cast nephropathy-a multicentre study.

Yadav, Punit and Sathick, Insara Jaffer and Leung, Nelson and Brown, Elizabeth E and Cook, Mark and Sanders, Paul W and Cockwell, Paul (2020) Serum free light chain level at diagnosis in myeloma cast nephropathy-a multicentre study. Blood cancer journal, 10 (3). p. 28. ISSN 2044-5385. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs

[img]
Preview
Text (PDF file format)
BCJ.pdf - Published Version
Available under License Creative Commons Attribution 4.0.

Download (517kB) | Preview
Official URL: https://www.nature.com/articles/s41408-020-0295-4

Abstract

Myeloma cast nephropathy (MCN) is a common cause of severe renal impairment in multiple myeloma (MM). The level of free light chain (FLC) that causes MCN varies substantially and there is uncertainty about the threshold level that should be used to inform clinical practice. In a multicentre cohort study of 103 patients with a diagnosis of MM and biopsy-confirmed MCN made between 2002-2014, we report prospectively measured levels of serum FLC at diagnosis obtained using a single nephelometric assay (Freelite®) and we explore the relationship between serum FLC level at diagnosis with renal outcome and patient survival. Using a landmark approach, overall survival (OS) was compared between patients who achieved independence from dialysis compared to those who remained dialysis dependent at 3-month, 6-month, 9-month, and 12-month time points. The median serum FLC level at diagnosis was 7531 mg/L (range 107-114600). Serum creatinine was 535 μmol/L (range 168-2993) and eGFR 7 ml/min/1.73 m (range 1-34). Six patients (5.8%) had an FLC level <1500 mg/L, which is the International Myeloma Working Group threshold for MCN and two patients were below the International Kidney and Monoclonal Gammopathy working group threshold of 500 mg/L; one was hypercalcaemic, and one had high-normal serum calcium level and had received a non-steroidal anti-inflammatory agent. Sixty-nine (67%) patients required haemodialysis treatment of whom 36 (52.1%) recovered independent renal function. Sixty-six (64%) patients died with a median OS of 2.5 years (95% CI 1.8-3.3). A landmark analysis revealed that independence from dialysis was associated with improved survival at 3-months (P = 0.003), 6-months (P = 0.035) and 9-months (P = 0.014); there was no survival benefit observed beyond 12 months (P = 0.146). Serum FLC level at diagnosis was neither associated with renal function recovery nor with OS. This is the largest reported cohort of patients with biopsy-confirmed MCN and prospectively measured serum FLC levels. These results indicate that a serum monoclonal FLC > 500 mg/L should be considered the threshold level associated with the development of MCN.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects: QZ Pathology. Oncology
WH Haemic and lymphatic systems. Haematology
WJ Urogenital system. Urology
Divisions: Emergency Services > Renal
Planned IP Care > Oncology and Clinical Haematology
Related URLs:
Depositing User: Mrs Yolande Brookes
Date Deposited: 06 Mar 2020 13:47
Last Modified: 06 Mar 2020 13:47
URI: http://www.repository.uhblibrary.co.uk/id/eprint/2908

Actions (login required)

View Item View Item