The International Myeloma Working Group (IMWG) guidelines recommend using electrophoresis and immunofixation to define response and progressive disease (PD) in immunoglobulin (Ig) secretory multiple myeloma (Ig-MM), whereas the role of serum-free light chain (sFLC) is controversial. We retrospectively analyzed the value of adding sFLC assays in the definition of response and PD according to IMWG criteria in 339 Ig-MM patients treated with a first-line novel agent-based therapy (median follow-up 54 months). sFLC PD was defined according to conventional criteria plus increased sFLC levels, or sFLC escape (sFLCe); progression/sFLCe-free survival (ePFS) was the time from the start of treatment to the date of first PD or sFLCe, or death; overall survival after PD/sFLCe (OS after Pe) was the time from first PD or sFLCe to the date of death. 148 (44%) patients achieved a complete response and 198 (60%) a normal sFLC ratio (sFLCR). sFLCR normalization was an independent prognostic factor for extended PFS (HR = 0.46, p = 0.001) and OS (HR = 0.47, p = 0.006) by multivariable analysis. 175 (52%) patients experienced PD according to the IMWG criteria, whereas 180 (53%) experienced PD or sFLCe. Overall, a sFLCe was observed in 31 (9%) patients. Median PFS and ePFS were both equal to 36 (95% CI = 32–42, and 32–40, respectively) months. sFLC PD adversely affected the OS after Pe compared to PD with increasing monoclonal Ig only (HR = 0.52, p = 0.012). Our results support the inclusion of the sFLC assay for defining response and PD in Ig-MM.

Role of serum-free light chain assay for defining response and progression in immunoglobulin secretory multiple myeloma / Tacchetti P.; Rocchi S.; Zamagni E.; Barbato S.; Rizzello I.; De Cicco G.; Pantani L.; Mancuso K.; Fusco A.; Dozza L.; Ursi M.; Favero E.; Terragna C.; Testoni N.; Cavo M.. - In: AMERICAN JOURNAL OF HEMATOLOGY. - ISSN 0361-8609. - STAMPA. - 97:12(2022), pp. 1607-1615. [10.1002/ajh.26747]

Role of serum-free light chain assay for defining response and progression in immunoglobulin secretory multiple myeloma

Tacchetti P.;Rocchi S.;Zamagni E.;Barbato S.;Rizzello I.;De Cicco G.;Pantani L.;Mancuso K.;Fusco A.;Dozza L.;Ursi M.;Favero E.;Terragna C.;Testoni N.;Cavo M.
2022

Abstract

The International Myeloma Working Group (IMWG) guidelines recommend using electrophoresis and immunofixation to define response and progressive disease (PD) in immunoglobulin (Ig) secretory multiple myeloma (Ig-MM), whereas the role of serum-free light chain (sFLC) is controversial. We retrospectively analyzed the value of adding sFLC assays in the definition of response and PD according to IMWG criteria in 339 Ig-MM patients treated with a first-line novel agent-based therapy (median follow-up 54 months). sFLC PD was defined according to conventional criteria plus increased sFLC levels, or sFLC escape (sFLCe); progression/sFLCe-free survival (ePFS) was the time from the start of treatment to the date of first PD or sFLCe, or death; overall survival after PD/sFLCe (OS after Pe) was the time from first PD or sFLCe to the date of death. 148 (44%) patients achieved a complete response and 198 (60%) a normal sFLC ratio (sFLCR). sFLCR normalization was an independent prognostic factor for extended PFS (HR = 0.46, p = 0.001) and OS (HR = 0.47, p = 0.006) by multivariable analysis. 175 (52%) patients experienced PD according to the IMWG criteria, whereas 180 (53%) experienced PD or sFLCe. Overall, a sFLCe was observed in 31 (9%) patients. Median PFS and ePFS were both equal to 36 (95% CI = 32–42, and 32–40, respectively) months. sFLC PD adversely affected the OS after Pe compared to PD with increasing monoclonal Ig only (HR = 0.52, p = 0.012). Our results support the inclusion of the sFLC assay for defining response and PD in Ig-MM.
2022
Role of serum-free light chain assay for defining response and progression in immunoglobulin secretory multiple myeloma / Tacchetti P.; Rocchi S.; Zamagni E.; Barbato S.; Rizzello I.; De Cicco G.; Pantani L.; Mancuso K.; Fusco A.; Dozza L.; Ursi M.; Favero E.; Terragna C.; Testoni N.; Cavo M.. - In: AMERICAN JOURNAL OF HEMATOLOGY. - ISSN 0361-8609. - STAMPA. - 97:12(2022), pp. 1607-1615. [10.1002/ajh.26747]
Tacchetti P.; Rocchi S.; Zamagni E.; Barbato S.; Rizzello I.; De Cicco G.; Pantani L.; Mancuso K.; Fusco A.; Dozza L.; Ursi M.; Favero E.; Terragna C.; Testoni N.; Cavo M.
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Descrizione: Role of serum-free light chain assay for defining response and progression in immunoglobulin secretory multiple myeloma
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/904998
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