Useful For

Kappa and Lambda Serum Free Light Chains are a useful aid in the diagnosis and monitoring of a wide range of monoclonal gammopathies. These include multiple myeloma, lymphocytic neoplasms, Waldenström’s macroglobulinaemia, immunoglobulin light chain amyloidosis (AL amyloidosis), and  light chain deposition disease.

Traditionally, screening panels for multiple myeloma, AL, and other related monoclonal gammopathies have included a serum protein electrophoresis (SPEP) and serum and urine immunofixation (IFE).  However, with the introduction of serum free light chains, the sensitivity of laboratory testing has increased. This is especially seen with light chain disease, where the levels of monoclonal proteins may not be high enough to be detected on a SPEP.

“In the evaluation of multiple myeloma (MM), 12% of patients will not be detected by SPEP (Katzmann et al. Clin Chem (2009) 55:1517-1522). The addition of serum free light chains and IFE increases detection of MM to >99% and is consistent with the International Myeloma Working Group recommended guidelines (Dispenzieri et. Al Leukemia (2009) 23, 215-224).”

Recent diagnostic screening guidelines for most monoclonal gammopathies recommend serum free light chains in addition to a serum protein electrophoresis and serum immunofixation (IFE). When AL is suspected, the screen should also include a urine IFE.

References:

1.  Dispenzieri, A.; Kyle, R.; Merlini, G.; Miguiel, JS.; Ludwig, H.; Hajek, R.; Palumbo, A et al. Internaltional Myeloma Working Group guidelines for serum-free light chain analysis in multiple myeloma and related disorders. Leukemia. 2009, 23, 215-224.  
2. Katzmann, J.; Kyle, R.; Benson, J.; Larson, D.; Snyder, M.; Lust, J.; Rajkumar, V.; et al. Screening Panels for Detection of Monoclonal Gammopathies. Clin Chem. 2009, 55:8, 1517-1522.