Preface to 5th edition
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Preface to 5th edition |
The clinical mysteries of serum free light chain usage are becoming known and the rate of discovery is slowing. Considerable detail remains to be defined, but the broad sweep of the canvas is largely painted. It is a big story with a big impact.
Some successes have been dramatic. The management of AL amyloidosis and nonsecretory multiple myeloma have been revolutionised by the test. Treatments are properly tailored to patients’ needs and survival is increasing. Patients with light chain only multiple myeloma, the ‘Bence Jones myeloma’ of old, are better monitored by serum FLC tests, as are patients with renal impairment and free light chain breakthrough disease. Recent evidence shows that FLC concentrations, at diagnosis, are independent measures of survival with suggestions that their measurement should be included in the International Staging System for multiple myeloma. Also of importance, is the use of free light chain measurements in patients with monoclonal gammopathies of undetermined significance. In combination with M-spike concentrations and immunoglobulin class, risk stratification for progression is now possible. Many patients can be confidently reassured about the benign nature of their cancer marker. Others, at high risk, can be monitored more closely for the earliest signs of disease development.
There is great interest in using serum free light chain measurements alongside serum protein electrophoresis to screen symptomatic patients for monoclonal gammopathies. The strategy is more sensitive than testing for Bence Jones proteinuria also simpler and clinically more accurate. Many physicians are now using the test in this manner, leading to improvements in patient diagnosis and management.
Two emerging areas are of special note. Many patients with multiple myeloma develop acute and chronic renal failure because of free light chain damage. Identifying patients at risk allows early drug treatment and may prevent progression to renal failure. Furthermore, serum free light chains can be quickly removed by a novel protein leaking, ‘high cut-off’ dialyser. Early evidence indicates that patients with myeloma kidney can recover renal function and become independent of dialysis. This is likely to prove of great benefit to the 5,000 or so patients per year that develop this serious disease with its high morbidity and early mortality.
The purpose of this 5th edition is to ensure that all this new information is readily available, in a concise, single publication. Modernisation from the use of urine to serum
analysis is underway as free light chain tests gather momentum. The impact is considerable, but.........
AR Bradwell June 2008
