Clinical significance of FLC tests in patients without other evidence of hematologic disorder.

IF 3.2 4区 医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL
Dor Shpitzer, Yael C Cohen, Chava Perry, Guy Melamed, Hillel Alapi, Anat Reiner-Benaim, Irit Avivi
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引用次数: 0

Abstract

The clinical significance of an abnormal free light chain (FLC) test, performed due to unspecific complains in the absence of a known plasma cell dyscrasia (PCD) or lymphoproliferative disease (LPD), is not fully elucidated. We investigated the importance of an abnormal FLC ratio (FLC-R) in this setting. Patients registered in the Maccabi Healthcare Services database, tested for FLC during 2007-2023 without previously documented PCD/LPD or increased total protein (TP) level, were reviewed. Demographics, co-morbidities, and laboratory tests were recorded. FLC-R was defined as normal (0.26-1.65) or slightly (slAb 0.1-0.26/1.65-4), moderately (mAbn 0.1-0.05/4-8) and significantly abnormal (sigAb- < 0.05 or > 8). Factors associated with PCD/LPD and overall survival were identified. In total, 8,661 patients, 2,215 (25.6%) with abnormal FLC-R [2,090 (24.1%)-slAb, 65 (0.75%)-mAbn and 60 (0.7%)-sigAb], were analyzed. Almost none had anemia nor acute renal failure. 14% had concomitant increased immunoglobulins. Within a median follow-up of 52 months, 943 were diagnosed with PCD (816-MGUS, 127-MM/Amyloidosis/plasmacytoma) and 48 with LPD. Median time to PCD and LPD were 19 and 28 months. Multivariate analysis found slAb (HR = 1.8, CI95%:1.53-2.12, p < 0.001), mAbn (HR = 6.3, CI95%:4.16-9.53, p < 0.001), and sigAb FLC (HR = 10.4, CI95%:7.0-15.35, p < 0.001), to be associated with PCD/LPD diagnosis. Decreased IgG, increased IgA, and concomitant comorbidities predicted PCD, whereas increased IgM predicted LPD. Older age, male gender, anemia, decreased albumin, increased IgG and concomitant comorbidities, predicted shorter survival. Our large study emphasizes the independent clinical significance of abnormal FLC-R as a predictor of PCD/LPD diagnosis even in patients with normal TP level, promoting early detection of PCD/LPD.

对无其他血液病证据的患者进行 FLC 检测的临床意义。
游离轻链(FLC)检测异常的临床意义尚未完全阐明,这种异常是在没有已知浆细胞异常(PCD)或淋巴细胞增生性疾病(LPD)的情况下,由于非特异性主诉而出现的。我们研究了 FLC 比值(FLC-R)异常在这种情况下的重要性。我们对在马卡比医疗保健服务数据库中登记的、在 2007-2023 年间接受过 FLC 检测且之前没有 PCD/LPD 或总蛋白 (TP) 水平升高记录的患者进行了回顾性研究。记录了人口统计学特征、合并疾病和实验室检测结果。FLC-R 被定义为正常(0.26-1.65)或轻度(slAb 0.1-0.26/1.65-4)、中度(mAbn 0.1-0.05/4-8)和明显异常(sigAb- 8)。确定了与 PCD/LPD 和总生存率相关的因素。共对 8,661 例患者进行了分析,其中 2,215 例(25.6%)FLC-R 异常[2,090 例(24.1%)-slAb、65 例(0.75%)-mAbn 和 60 例(0.7%)-sigAb]。几乎没有人出现贫血或急性肾功能衰竭。14%的患者同时伴有免疫球蛋白升高。在中位随访 52 个月期间,943 人被诊断为 PCD(816 人-MGUS,127 人-MM/淀粉样变性/浆细胞瘤),48 人被诊断为 LPD。PCD和LPD的中位时间分别为19个月和28个月。多变量分析发现 slAb(HR = 1.8,CI95%:1.53-2.12,p
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来源期刊
Clinical and Experimental Medicine
Clinical and Experimental Medicine 医学-医学:研究与实验
CiteScore
4.80
自引率
2.20%
发文量
159
审稿时长
2.5 months
期刊介绍: Clinical and Experimental Medicine (CEM) is a multidisciplinary journal that aims to be a forum of scientific excellence and information exchange in relation to the basic and clinical features of the following fields: hematology, onco-hematology, oncology, virology, immunology, and rheumatology. The journal publishes reviews and editorials, experimental and preclinical studies, translational research, prospectively designed clinical trials, and epidemiological studies. Papers containing new clinical or experimental data that are likely to contribute to changes in clinical practice or the way in which a disease is thought about will be given priority due to their immediate importance. Case reports will be accepted on an exceptional basis only, and their submission is discouraged. The major criteria for publication are clarity, scientific soundness, and advances in knowledge. In compliance with the overwhelmingly prevailing request by the international scientific community, and with respect for eco-compatibility issues, CEM is now published exclusively online.
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