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Elevated, combined serum free light chain levels and increased mortality: a 5-year follow-up, UK study
  1. Seetharam Anandram1,
  2. Lakhvir Kaur Assi2,
  3. Tracy Lovatt1,
  4. Jayne Parkes1,
  5. Joanne Taylor1,
  6. Alan Macwhannell1,
  7. Abraham Jacob1,
  8. Sunil Handa1,
  9. Stephen Harding2,
  10. Supratik Basu1
  1. 1The Department of Haematology. The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
  2. 2Department of Clinical R&D, The Binding Site Group Ltd, Edgbaston, Birmingham, UK
  1. Correspondence to Dr Supratik Basu, Department of Haematology, The Royal Wolverhampton Hospitals, Wednesfield Road, NHS Trust, Wolverhampton, WV10 0QP UK; supratik.basu{at}nhs.net

Abstract

Aims Abnormal serum free light chain (FLC) ratios are diagnostically important in almost all plasma cell disorders. However, absolute increases in polyclonal FLC levels are often discarded as inconsequential. Here we report an association between increased combined polyclonal FLC (cFLC: FLCκ plus FLCλ) concentrations and mortality.

Methods 723 patients sent for 30 routine haematological assessments were enrolled. Patients with a confirmed monoclonal gammopathy were removed. The remaining 527 patients were followed up for up to 4.5 years. Statistical analysis was performed using SPSS (V.19).

Results During follow-up, there were 99 deaths (18.8%). Kaplan-Meier survival analysis revealed 29% of these deaths occurred within the first 100 days (N=29). Multivariate analysis identified only cFLC >65 mg/l, albumin <33 g/l and  estimated glomerular filtration rate <30 ml/min/1.73 m2 to be independently associated with mortality within 100 days and 4.5 years with, cFLC having the highest HR of 7.1. A simple risk stratification model based only on albumin and cFLC identified 86% mortality within 100 days and 62% over 4.5 years.

Conclusions Elevated cFLC is significantly associated with increased mortality and with albumin can be used to identify patients at risk of mortality at 4.5 years with high-risk patients detected within 100 days.

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