| Objective(s):To analyze the characteristics of serum total light chain levels in patients with newly diagnosed multiple myeloma,observing the changes of total light chain levels before and after chemotherapy,to determine the value of serum total light chain detection for diagnosis and monitoring effects of chemotherapy.Methods:From January 2016 to December 2018,a total of 47 patients with newly diagnosed multiple myeloma who were admitted to the Department of Hematology of the Second Affiliated Hospital of Kunming Medical University,analyzing the clinical materials retrospectively of them,the clinical materials include gender,age,immunophenotyping,Dufie-Salmin staging,immunoglobulin IgG、IgA、IgM quantification,kappa light chain assay,lambda light chain assay,serum protein electrophoresis,serum immunofixation electrophoresis,albumin,serum calcium,creatinine,uric acid,lactate dehydrogenase,hemoglobin,chemotherapy regimen,course of treatment,and post-chemotherapy efficacy evaluation.Depending on the type of light chain,47 patients were categorized into κ light chain group and X light chain group,to analyze the correlation between the total light chain level and albumin,serum calcium,creatinine,uric acid,lactate dehydrogenase,hemoglobin.Depending on κ/λ ratio,47 patients were categorized into high ratio group and low ratio group,to compare the percentage of hypoalbuminemia,hypercalcemia,renal insufficiency,hyperuricemia,high lactate dehydrogenase,and anemia between the high ratio group and low ratio group,to evaluate the value of total light chain level and κ/λ ratio as the indicators of target organ damage.At the same time,in patients with regular chemotherapy,analyzing the changes of total light chain levels before and after chemotherapy,to compare the absolute values of changes of κ light chain and λ light chain in different therapeutic groups before and after chemotherapy,to explore the efficacy evaluation value and disease surveillance value of absolute value of light chain changes.Results:1.47 patients with newly diagnosed multiple myeloma,including 24 males and 23 females,with a median age of 63(52,72)years old.The immunophenotype of monoclonal protein,17 cases(36.1%)are classfied as IgG-K type,15 cases(32%)are classfied as IgG-λ type,4 cases(8.5%)are classfied as IgA-K type,5 cases(10.6%)are classfied as IgA-λ type,1 case(2.1%)is classfied as IgD-λ type,1 case(2.1%)is classfied as free κ type,4 cases(8.6%)are classfied as free λ type.7 cases(14.9%)were in stage Ⅱ,and 40 cases(85.1%)were in Stage Ⅲ.2.Pearson correlation analysis between total light chain level and albumin,uric acid,creatinine,lactate dehydrogenase,serum calcium,and hemoglobin levels showed that there was no correlation between κ light chain levels and the above indicators in the κ group(r=-0.104,0.230,0.080,-0.058,0.335,-0.072,P>0.05);in the X group,X light chain level was not correlated with albumin,serum calcium,uric acid,hemoglobin levels(r=-0.217,0.208,0.558,-0.272,P>0.05),but positively correlated with creatinine and lactate dehydrogenase levels(r=0.899,0.585,P<0.05).3.Incidence rate of Alb<35g/L,UA>420μmol/L,Cr>177μmol/L,LDH>245 U/L,corrected serum calcium>2.75mmol/L,Hb≤85g/L in high ratio group are 69.2%,66.6%,53.8%,33.3%,17.9%,51.3%,the incidence rate of above indicators in the low ratio group are 50%,25%,12.5%,25%,12.5%,37.5%.The incidence rate of Cr>177μmol/L and UA>420μmol/L was significantly higher than that of the low ratio group(P<0.05).4.In the 47 patients,2 patients gave up treatment,the remaining 45 patients,the light chain type of 21 cases are κ type,the other 24 cases are λ type.In the κ group,there are 18 cases that the treatment regimen containes bortezomib.The specific regimen was:BDT 12 cases(66.7%),BD 2 cases(11.1%),PAD 4 cases(22.2%);There are 3 cases without bortezomib,the specific regimen was 2 cases(66.7%)of VAD and 1 case(33.3%)of DECP.In the X group,there are 16 cases that the treatment regimen containes bortezomib,the specific regimen was:14 cases of BDT(87.5%),1 case of BD(6.25%),1 case of PAD(6.25%);there are 8 cases without bortezomib.the specific regimen was 4 cases(50%)of VADT,1 case(12.5%)of DECP,1 case(12.5%)of MPT,2 cases(25%)of VAD,compare the chemotherapy regimen,there is no difference in the composition of bortezomib between the κ group and λ group.5.Among the 47 patients,2 patients gave up treatment,and the remaining 45 patients underwent chemotherapy.34 patients received four cycles of regular chemotherapy,11 patients have not finished four cycles.Among the 34 patients who received four cycles of chemotherapy,23 received bortezomib-containing regimen and 11 received bortezomib-free regimens.in the bortezomib-containing group,5 cases(21.7%)were completely relieved,12 cases(52.2%)were partial relieved,5 cases(21.7%)were in stable disease condition,and 5 cases(21.7%)progressed.In bortezomib-free regimens group,7 cases(63.6%)were partially relieved,3 cases(27.3%)were stable,and 1 case(9.1%)progressed.The overral response rate of the two groups was 73.9%of bortezomib group,bortezomib-free group was 63.6%,there was no significant difference in the overral response rate between the two groups(P<0.05).6.The study also reviewed the level of total light chain after four cycles of regular chemotherapy.In the κ group,the median level of κ light chain measurement decreased in patients with effective therapy.However,in patients with ineffective therapy,the median level of the kappa light chain has little change.In the X group,the median level of the lambda light chain assay decreased in patients with effective therapy,whereas the median level of the lambda light chain assay did not change much in patients with ineffective therapy.At the same time,comparing the absolute values of light chain changes among different therapy effects(complete remission,partial remission,disease stabilization,disease progression).In κ group,there was no significant difference in the absolute value of light chain changes between the above four therapy effects.In the X group,the absolute values of the light chain changes between the above four therapy effects were statistically different.Conclusion(s):1.The serum total light chain level is positively correlated with Cr and LDH levels in multiple myeloma patients that the light chain type is X type;2.There was no significant difference in the overral response rate between patients treated with bortezomib and those without bortezomib;3.The total light chain level can be used as an indicator of the efficacy monitoring of multiple myeloma. |
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