| Objective: Through monitoring of serum free light chain(sFLC)and monoclonal‐protein(MP)in patients with multiple myeloma.We explored the value of different sFLC and MP levels in clinical indicators,efficacy and prognosis of patients with multiple myeloma relapse,and the clinical value of light chain escape(LCE).Methods:Retrospective analysis of clinical data of 71 patients with relapsed MM treated.According to different levels of serum FLC and MP after relapse,they are divided into three groups: MO,MLC,LCE(light chain escape).Then we compared the clinical indicators,efficacy,survival after relapse(SAR)and overall survival(OS)of patients in each group.Results:1.Among 71 patients with MM relapse,34(47.9%)were MO group,25(35.2%)were MLC group and 12(16.9%)were LCE group.There were significant differences in the levels of Hb,PLT,ALB,β 2-mg,MP,SFLC and the proportion of myeloplasma cells afte rrelapse(P < 0.05).The levels of MP,Hb and PLT in LCE group were significantly lower than those in the initial diagnosis,but the levels of sFLC,LDH and Cr were significantly higher.The above is statistically significant(P<0.05)2.At the initial diagnosis,MP level of LCE group was lower than that of MO and MLC group(P = 0.368),sFLC level was significantly higher than that of other two groups,and sFLC level of Oo group was the lowest(P < 0.0001);MP level of Mo group was higher than that of other two groups,After relapse,MP level of LCE group was significantly lower than that of other two groups(P < 0.0001),meanwhile,sFLC of LCE group was significantly higher than that of other two groups,and sFLC of MO group was the lowest(P < 0.0001).3.Through the evaluation of the curative effect of all patients after 4 courses of treatment,We found 26 patients in the MO group(76.5%),13 patients in the MLCgroup(52.0%)and 5 patients in the LCE group(41.7%)who achieved VGPR and above VGPR.meanwhile MO group had the best effect(P = 0.045).Moreover,We found 8 patients in the MO group(23.5%),12 patients in the MLC group(48.0%)and7 patients in the LCE group(58.3%)who appeared PR or SD/PD.4.Univariate analysis for factors showed that MO group and LCE group were the risk factors of influencing SAR,ALB≥35(g/L),marrow plasma cell ratio≥30%,MO group and LCE group were the risk factors of influencing OS(P < 0.05);among the Multivariate analysis for factors,IgG type relapse and MO group were the independent risk factors of influencing SAR,IgG type relapse,ASCT,MO group and LCE group were the independent risk factors of influencing OS(P < 0.05)5.The survival analysis of MO group,MLC group and LCE group showed that the average SAR was 41 months,28.6 months and 23.5 months(P = 0.002),the average OS was 79.6 months,57.9 months and 41 months(P < 0.0001),the MO group had longer SAR and OS,and the LCE group was the shortest.In addition,the average SAR of the patients without free light chain and the patients with free light chain were 38.9 and 25.7 months(P = 0.006),and the average OS were 69.1 and 51.2months of them respectively(P < 0.001).The SAR and OS of the patients without free light chain were longer than those of the patients with free light chain.Conclusion:1.The changes of sFLC/MP level in MM patients before and after relapse can reflect the clonal heterogeneity of tumor,which is of great clinical significance for the evaluation of disease progress,treatment effect and prognosis.2.After relapse,patients with only MP elevation had longer SAR and OS,while patients with only sFLC elevation had shorter SAR and OS,suggesting that the change of sFLC/MP level can be used as a reliable index to predict the prognosis of MM patients.3.The appearance of light chain escape often indicates poor treatment effect,disease progress and early relapse.Dynamic monitoring of sFLC/MP level is helpful to detect light chain escape and early intervention in time. |
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