| Objective: Multiple myeloma is a plasma cell neoplasm that patients have a rapid proliferation of monoclonal B lymphocytes which produce a number of monoclonal Ig and more monoclonal light chains secreted than heavy chains lead to the appearance of numbers of s FLC that may exceed normal value.The increase in multiple myeloma often associated with monoclonal immunoglobulin, cause osteolytic lesions, anemia, hemorrhage, recurrent infections, blood hyperviscosity, hypercalcemia, renal insufficiency, amyloidosis, and a series of clinical manifestation. Because of its insidious onset, clinical manifestations, easy to cause the clinical misdiagnosis and missed diagnosis. The age-adjusted annual incidence is about 2.5~7.2 per 100,000. In our country the annual incidence is about 1 per 100,000. Ig is composed of two light chains and two heavy chains. Normal Immunoglobulin is synthesized and assembled in B cells according to special ratio. Light chain is synthesized a bit faster than heavy chain which results in the existence of some free light chains in serum(s FLC). Normally, the number of s FLC was kept in a suitable scope. MM patients have a rapid proliferation of monoclonal B lymphocytes which produce a number of monoclonal Ig and more monoclonal light chains secreted than heavy chains lead to the appearance of numbers of s FLC which may exceed normal value. If s FLC secretion overruns the absorption capability of kidney unit, it will be excreted in urine known as Bence Jones Protein.The diagnosis of MM always depends on the clinical manifestation, monoclonal immunoglobulins in serum or urine, FLC in the urine and the presence of excess monoclonal plasma cells in the bone marrow, but all the methods can not detect all the MM patients, especially for the light chain multiple myeloma(LCMM) and nonsecretory multiple myeloma(NSMM). The evaluation of the efficiency often depends on the IFE, SPE, the urine FLC and the bone marrow biopsy, but most of them are qualitative detection, they can not detect quantitatively, therefore, they can not reflect the efficiency of chemotherapy timely, accurately and quantitatively. But the half time of the FLC in the serum(2-6 hours) is shorter than the immunoglobulins(2-21 days) significantly, so the detection of the s FLC can see the response to the treatment in real time. When the immunoglobulin become normal in the serum, the s FLC may be abnormal all the same, indicates that the s FLC can detect the residual disease more sensitively. So it is important to test s FLC or u FLC content for MM diagnosis and therapy response. In the new international uniform response critrria for MM 2006, the s FLC assay is included to allow evaluation of multiple myeloma patients especially for oligo-secretory and non-secretory multiple myeloma. Now a highly sensitive technology using immuno-nephelometric assay to test s FLC content is being widely used around the world. But it is no reported about s FLC detecting and study in our country.So we detect s FLC by using immuno-nephelometric assay to explore the clinical significance of s FLC in multiple myeloma diagnosis and therapy response. To explore the clinical significance of detecting s FLC in multiple myeloma patients.Methods: Using immuno-nephelometric assays determinates the s FLC leve of 43 patients with previously untreated multiple myeloma and calculates the kappa/lambda ratio. Newly diagnosed multiple myeloma patients with s FLC anomaly detection rate, to explore the significance of s FLC detection in the diagnosis of multiple myeloma. At the same time, of which 35 cases of multiple myeloma patients treated according to the course of monitoring the s FLC level after fourth courses of treatment, evaluation of s FLC levels in the patients with multiple myeloma early diagnosis, clinical significance in condition monitoring.Results: In 43 cases of multiple myeloma patients, 41 cases were detected the abnormal free light chain by used serum free light chains, the detection rate was 95%, 33 cases of abnormal light chain is detected by serum total light chain method, the detection rate was 77%, the detection rate of the two groups significantly statistical difference(P < 0.05); urinary light chain assay in 34 cases of abnormal light chain is detected, the detection rate was 79%; the u FLC and s FLC group positive rate significantly statistical difference(P < 0.05). In the 9 patients of light chain multiple myeloma, 8 cases were detected abnormal free light chain by used serum free light chains, the detection rate was 89%, 6 cases of abnormal light chain was detected by used serum total light chain, the detection rate was 67%, the detection rate of the two groups had no statistical difference(P < 0.05); urinary light chain assay in 7 cases of abnormal light chain is detected, the detection rate was 78%; the detection rate and the serum levels of FLC group were statistically significant(P < 0.05). In 35 multiple myeloma patients after 4 courses of treatment, treatment of disease at diagnosis level and serum FLC value after effects are related, the correlation coefficient r=0.60628, P < 0.01 indicates the first visit free light chain value is high, the more effect of disease after treatment difference.Conclusion: s FLC detection method compared with total serum light chain detection method and detection method for urinary light chain multiple myeloma with high detection rate, the immune fixation electrophoresis detection combination, can clear diagnosis of multiple myeloma. And the serum FLC detection is convenient, strong operability, and is worth spreading in clinic. Determination of s FLC has important clinical significance on the detection of light chain multiple myeloma. With the level of disease in the treatment of multiple myeloma patients with s FLC values after the effect is related to initial free light chain, the higher the value, the more effect of disease after treatment difference. s FLC detection has an important significance for monitoring patients inmultiple myeloma. |
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