Clinical Significance Of Serum Free Light Chain Monitoring In Multiple Myeloma

Objective:To analyze the clinical value of monitoring serum free light chain(sFLC)in the prognosis of patients with multiple myeloma and explore the clinical characteristics of a new recurrence pattern of light chain escape(LCE).Methods:From January 1,2015 to January 1,2019,59 newly diagnosed patients with multiple myeloma were included in the study.sFLC was monitored regularly and relevant clinical indicators were collected,including albumin(Alb),creatinine(Cr),?2-microglobulin(?2-MG),C-reactive protein(CRP),lactate dehy drogenase(LDH),hemoglobin(Hb),M protein,bone marrow the proportion of smear plasma cells,fish test results,ISS stage and chemotherapy plan,etc.According to the type of light chain,the patients were divided into two groups:sFLC-?group and sFLC-?group.The differences of clinical indexes and charac teristics between the two groups were compared,and the correlation between sFLC ratio,difference and various clinical indexes was studied.At the same time,sFLCR was divided into normal group and abnormal group according to the fourth and eighth course of induction treatment.Age,sex,albumin(Alb),creatinine(Cr),?2-microglobulin(?2-MG),C-reactive protein(CRP),lactate dehydro genase(LDH),hemoglobin(Hb),the proportion of plasma cells in bone marrow smear,sFLCR,s FLC difference(dsFLC),ISS stage,fish risk were carried out between the two groups Cox analysis and survival analysis of the two groups were used to study the correlation between PFS,sFLCR and dsFLC.Finally,the clinical characteristics and differences between LCE group and non-LCE group were analyzed.Results:1.Between sFLC-?and?groups,there was no difference in age,albumin(Alb),creatinine(Cr),?2-microglobulin(?2-MG),C-reactive protein(CRP),lactate dehydrogenase(LDH),hemoglobin(Hb),plasma cell ratio of bone marrow smear,ISS stage and FISH cytogenetics between the two groups(P>0.05).2.There was a positive correlation between s FLC and creatinine(Cr)in sFLC-?and?groups(P<0.05),but there was no correlation between albumin(Alb),?2-microglobulin(?2-MG),C-reactive protein(CRP),lactate dehydrogenase(LDH),hemoglobin(Hb)and the proportion of plasma cells in bone marrow smears(P>0.05),3.After four courses of sFLCR returned to normal group,PFS univariate analysis showed that there were significant differences in induction regimen with bortezomib and ISS stages(stage I and II,III),(P<0.05).Multivariate Cox regression analysis showed that there was no correlation between PFS and clinical indexes such as sex,age,bortezomib induction therapy,ISS stage,anemia and so on.After eight courses of induction therapy,sFLCR returned to normal group PFS univariate analysis found no difference between clinical indicators.The median PFS of the two groups was(18±1.72)months and(16±2.90)months respectively,and there was significant difference between the two groups(?~2=5.096,p=0.024).The PFS of the sFLCR group returned to normal after four courses of treatment was longer than that of the group with eight courses of treatment.4.There was a negative correlation between sFLCR(when sFLCR>1.65)and PFS(r=-0.494,P<0.05),while there was no correlation between dsFLC and PFS(r=-0.212,P>0.05).5.There was no significant difference in Alb,Cr,?2-MG,CRP,Hb,plasm a cell ratio of bone marrow smear and sFLC between LCE group and non-LCE group(P>0.05),but there was significant difference in LDH between the two groups(P<0.05).LDH was higher in LCE group.The median PFS of the two groups was(9±2.92)months and(29±2.74)months,respectively,and there was significant difference between the two groups(?~2=11.970,P=0.001).The PFS of the LCE group was shorter.Conclusion:1.The value of serum free light chain(sFLC)in patients with MM is positively correlated with serum creatinine value,and has nothing to do with the type of light chain.2.After four courses of chemotherapy,the PFS of sFLCR group returned to normal was related to stage I of ISS,and bortezomib was included in the treatment plan,while there were no related factors of PFS in the multivariate analysis of normal group of eight courses,and there was statistical difference in PFS between the two groups.After four courses of treatment,the PFS of sFLC group returned to normal was longer and the prognosis was better.3.There was a negative correlation between sFLCR(when sFLCR>1.65)and PFS,but there was no correlation between dsFLC and PFS.4.There was significant difference in LDH between LCE group and non-LCE group at first diagnosis.LDH was higher and PFS was shorter in LCE group,and the prognosis was poor.