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Maria Stella Graziani

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ISSN print: 0393 – 0564
ISSN digital: 0392- 7091

BC: Articoli scritti da L. Paolini

Serum free light chain assays for monitoring response to treatment in a patient with pharmacoresistant light chain multiple myeloma
L. Paolini  |  G. Di Noto  |  D. Ricotta  | 
<p>We describe the case of a 78 year old man admitted to the Nephrology ward with strangury. Laboratory tests showed&#160;proteinuria with preserved renal function. Serum and urine immunofixation showed a faint monoclonal <span style="font-family: symbol;">l</span> band, while&#160;serum free light chain (FLC) assays (Freelite, The Binding Site) resulted in an abnormal <span style="font-family: symbol;">k</span>/<span style="font-family: symbol;">l</span> ratio, confirming the&#160;presence of a <span style="font-family: symbol;">l</span>FLC monoclonal component. After bone marrow examination, the diagnosis was stage IIA<span style="font-family: symbol;"> l</span> light chain&#160;multiple myeloma. The patient started bortezomib, melphalan and prednisone treatment. In the following days, <span style="font-family: symbol;">l</span> FLC&#160;concentrations still remained elevated indicating therapy failure. A week later, the patient became anuric and laboratory&#160;tests showed a pattern of acute renal failure and increased serum<span style="font-family: symbol;"> l</span> FLC concentrations. The patient started a new&#160;treatment with bicarbonate, mannitol and dexamethasone, but therapy was not effective again and&#160;<span><span style="font-family: symbol;">l</span></span><span>&#160;</span>FLC&#160;concentrations resulted persistently high and associated with anury. Clinicians decided to suspend pharmacological&#160;therapy and to dialyze the patient. FLC assay was performed every two hours to monitor FLC removal. After six&#160;sessions of hemodialysis, <span style="font-family: symbol;">l</span> FLC concentrations decreased, diuresis was restored and renal function improved.&#160;Myeloma treatment was re-initiated with steroids and, after kidney recovery, dialysis was suspended. In this case, FLC&#160;assays helped to confirm myeloma suspicion, to define the most effective therapy and to assess the response to&#160;treatment.</p>
Biochimica Clinica ; 38(5) 389-391
Casi clinici - Case report