The cumulative amount of serum-free light chain is a strong prognosticator in chronic lymphocytic leukemia

摘要: Identification of patients at risk early disease progression is the mainstay tailored management in chronic lymphocytic leukemia (CLL). Although application established biomarkers limited by intrinsic detection/readout complexities, abnormality κ and λ serum-free light chain ratio [sFLC (κ/λ)] was proposed as a straightforward prognosticator CLL. By analyzing 449 therapy-naive patients, we show that an abnormal sFLC(κ/λ), along with CD38, ZAP-70, IGHV mutations, cytogenetics stage, independently predicts treatment-free survival (TFS) but becomes prognostically irrelevant if cumulative amount clonal nonclonal FLCs [sFLC(κ + λ)], variable associated cytogenetic risk, exceeds threshold 60.6 mg/mL. Patients sFLC(κ λ) above cut-off displayed poorer TFS outcome, irrespective sFLC(κ/λ). Only cytogenetics, remained multivariate model. assigning 1 point each for these variables, 3-year probability 94.8%, 84.5%, 61.6%, 21.1% scoring 0, 1, 2, 3 4, respectively (P < .0001). These data, demonstration monoclonal polyclonal B cells concur to FLC synthesis tumor tissues, suggest sFLC(κ/λ) mirror distinct biologic processes assessment represents sensitive cost-effective tool identifying CLL requiring treatment.