Immunoglobulin / free light chain ratio 1 1 2 Kiyotaka FUJITA Katsunori TAKAHASHI Ikunosuke SAKURABAYASHI FLC IgG, IgA, IgM, IgD, IgE 5 1 1 H 1 L H,,,, L 2 monoclonal immunoglobulinemia : M L L H 40 H L L free light chain : FLC FLC FLC L FLC Binding Site 1 M L 2011 400 FLC FLC 44,000 dimer 22,000 monomer tetramer FLC monoclonal polyclonal IFE IEP FLC 56 60 100 FLC Bence Jones BJP M M FLC FLC FLC FLC FLC FLC 1 0370-0006 1-7-1 2 0329-0498 3311-1 1 Faculty of Health Science, Gunma Paz College (1-7-1 Tonyamachi, Takasaki-shi, Gunma) 2 Jichi Medical School (3311-1 Yakushiji, Shimotsuke-shi, Tochigi)
FLC FLC FLC -FLC FLC Binding Site FLC FREELITE TM L hidden surface polyclonal L hidden surface FLC hidden surface FLC 2 BJP 3 BJP FLC FLC FLC 3.3 19.4mg L FLC 5.7 26.3mg L 0.26 1.65 4 M SPE 500 2000mg L FREELITE TM FLC 5mg L IFE 150 500mg L M MGUS monoclonal gammopathy of undetermined significance 5 178 M 150-184 M 88.0 96.1 IEP 100 SPE IEP 99 SPE IFE IEP FLC FLC FLC Nowrousian 6 BJP BJP intact immunoglibulin L FLC
FLC FLC FLC 7 FLC FLC 1.65 FLC 0.26 FLC H L 1 1 FLC X SPE IEP IFE 3 10 IFE M Drayson 8 2 3 FLC 13 BJP 9 BJP FLC 7
BJP SPE BJP BJP IEP Abraham 10 FLC M FLC BJP FLC 10 30g day FLC FLC 11 AL FLC M 10 1 FLC IFE Bradwell 12 IFE M 86 AL FLC FLC AL MGUS M 56 10 M 3g dl Kyle 13 50 3.270 5.3 MGUS MGUS 1 14 MGUS MGUS FLC 15 0.5 1.9 M IgG 21 IgA 6 IgD 3 FLC FLC 2 4 FLC 3 6 16 Junghans 17 IgG- MM IgG FLC FLC IgG Mösbauer 18 FLC IFE M 128 IFE M 98 FLC M FLC FLC 75mg dl 2 3.5mg L 302mg dl LDH 190U L 19 FLC FLC 19 Dispenzrei 20 AL FLC 152mg L FLC 152mg L FLC Dingli 21 47 5 10
FLC 18 IgG- IFE M FLC BJP- IFE M FLC P FLC 20 AL FLC 152mg L FLC 152mg L 15 Rajkumar 15 MGUS MGUS 33 10 20 5.312.6 16.735 FLC FLC FLC IFE IEP FLC M H H FLC IFE IEP M FLC 1 Dispenzieri A, Kyle RA, MerliniG, et al. International Myeloma Working Group guidelines for serum-free light chain analysis in multiple myeloma and related disordersinternational Myeloma Working Group guidelines.
Leukemia. 2 : 215-224, 2009. 2 Bradwell AR, Carr-Smith HD, Mead GP, et al. Highlysensitive, automatedimmunoassay for immunoglobulin free light chains in serum and urine. Clin Chem. 4 : 673-680, 2001. 3 Murata K, Clark RJ, Lockington KS,et al. Sharply increased serum free light-chain concentrations after treatment for multiple myeloma. Clin Chem. 1 : 16-18, 2010. 4 Katzmann JA, Clark RJ, Abraham RS, et al. Serum reference intervals and diagnostic ranges for free kappa and free lambda immunoglobulin light chains : relative sensitivity for detection of monoclonal light chains. Clin Chem. 9 : 1437-1444, 2002. 5,,... : 245-252, 2010. 6 Nowrousian MR, Brandhorst D, Sammet C, et al. Serum free light chain analysis and urine immunofixation electrophoresis in patients with multiple myeloma. Clin Cancer Res. 24 : 8706-8714, 2005. 7 Bradwell AR, Carr-Smith HD, Mead GP, et al. Serum test for assessment of patients with Bence Jones myeloma. Lancet. 9356 : 489-491, 2003. 8 Drayson M, Tang LX, Drew R, et al. Serum free lightchain measurements for identifying and monitoring patients with nonsecretory multiple myeloma. Blood. 9 : 2900-2902, 2001. 9 Shimizu K, Nagura E, Takatsuki K ; Japan Myeloma Study Group. Management of patients with multiple myeloma in Japan: data of 1,383 patients from 16 hospitals and 1 treatment group. Leuk Lymphoma. 12 : 2465-2469, 2004. 10 Abraham RS, Clark RJ, Bryant SC, et al. Correlation of serum immunoglobulin free light chain quantification with urinary Bence Jones protein in light chain myeloma. Clin Chem. 4 : 655-657, 2002. 11 Pratt G. The evolving use of serum free light chain assays in haematology. Br J Haematol. 4 : 413-422, 2008. 12 Bradwell AR. Free Light Chain Normal Ranges and Reference Intervals. In : Bradwell AR, deitor. Serum Free Light Chain Analysis. 4th edition. The Binding Site Ltd. 39-46, 2006. 13 Kyle RA, Therneau TM, Rajkumar SV, et al. Prevalence of monoclonal gammopathy of undetermined significance. N Engl J Med. 13 : 1362-1369, 2006. 14 Kyle RA, Rajkumar SV. Monoclonal gammopathy of undetermined significance. Br J Haematol. 6 : 573-589, 2006. 15 Rajkumar SV, Kyle RA, Therneau TM, et al. Serum free light chain ratio is an independent risk factor for progression in monoclonal gammopathy of undetermined significance. Blood. 3 : 812-817, 2005. 16 Wochner RD, Strober W, Waldmann TA. The role of the kidney in the catabolism of Bence Jones proteins and immunoglobulin fragments. J Exp Med. 2 : 207-221, 1967. 17 Junghans RP, Anderson CL. The protection receptor for IgG catabolism is the beta2-microglobulin-containing neonatal intestinal transport receptor. Proc Natl Acad Sci U S A. 11 : 5512-5516, 1996. 18 Mösbauer U, Ayuk F, Schieder H, et al. Monitoring serum free light chains in patients with multiple myeloma who achieved negative immunofixation after allogeneic stem cell transplantation. Haematologica. 2 : 275-276, 2007. 19 van Rhee F, Bolejack V, Hollmig K, et al. High serum-free light chain levels and their rapid reduction in response to therapy define an aggressive multiple myeloma subtype with poor prognosis. Blood. 3 : 827-832, 2007. 20 Dispenzieri A, Lacy MQ, Katzmann JA, et al. Absolutevalues of immunoglobulin free light chains are prognostic in patients with primary systemic amyloidosis undergoing peripheral blood stem cell transplantation. Blood. 8 : 3378-3383, 2006. 21 Dingli D, Kyle RA, Rajkumar SV, et al. Immunoglobulin free light chains and solitary plasmacytoma of bone. Blood. 6 : 1979-1983, 2006.