Freelite®
and Hevylite® Freelite & Hevylite at Diagnosis
The IMWG guidelines recommend Freelite for the diagnosis of monoclonal gammopathies.1
free light chains providing improved accuracy compared to traditional methods.
Initial laboratory investigation using a strategy of performing SPE and serum and Freelite analysis will allow identification of all significant monoclonal proteins and negate the requirement for urine Bence Jones Protein samples.22-24
A Hevylite result at diagnosis provides a baseline value that is useful in monitoring and prognosis.
Suggested Laboratory Diagnostic Pathway At Diagnosis SPE/CZE and Freelite ratio Positive Negative
An abnormal serum FLC ratio has been identified as an independent risk factor for progression of MGUS to MM or related disorders.3
The table below shows MGUS risk stratification based
on risk factors: • abnormal FLC ratio • serum monoclonal protein >15g/L • IgA or IgM monoclonal protein type
Type with IFE
Suspect AL amyloidosis, 24hr urine
MGUS risk Criteria Absolute Recommended follow-up group
Low
No risk present
Establish baseline with relevant/appropriate Hevylite pair
Establish Freelite baseline
Low- Any one risk
intermediate factor present High-
Any two risk
intermediate factors present High
All three risk Screening for new unexplained AKI
The majority of multiple myeloma patients produce an excess of serum FLC which can be nephrotoxic. Freelite enables a rapid initial investigation for myeloma kidney.
The International Kidney and Monoclonal Gammopathy Research Group state that if the concentration of monoclonal free light chain is >500 mg/L in a patient presenting with unexplained AKI, a diagnosis of tubular interstitial pathology, often Cast Nephropathy, is likely.6
They recommend Freelite plus SPE for
diagnosis of monoclonal gammopathies in unexplained AKI as if detected early, renal impairment due to Cast Nephropathy is reversible.
factors present * accounting for death as a competing risk.
Hevylite pair suppression is also an independent risk factor for MGUS progression.37
Smouldering multiple myeloma (SMM)
SMM patients with a serum involved/uninvolved free light chain ratio 8 (but <100) are considered higher risk with poor prognosis. These patients should be monitored closely and may be considered candidates for early treatment intervention.34
Prognostic value of Freelite for your AL amyloidosis patients Want to learn more?
Learn how to use Freelite & Hevylite together
Primary systemic or light chain amyloidosis (AL) is characterised by accumulation of monoclonal FLC or their fragments as insoluble amyloid fibrils, leading to functional and structural organ damage. The difference between the involved and the uninvolved FLC (dFLC) is an independent prognostic marker for overall survival in AL amyloidosis, alongside the cardiac biomarkers cTnT and NT- ProBNP.36
risk*(%) 2
6 months initially & if stable,
follow up every 2-3 years or when symptoms suggest a plasma cell malignancy
10 18 27
6 months initially, then annually
and upon any change in the patient’s clinical condition
The assay quantitatively measures Freelite & Hevylite for Prognosis
Freelite can help identify patients with a high risk of progression and poor prognosis as it is an independent prognostic indicator in multiple myeloma (MM) and AL amyloidosis patients.
The International Myeloma Working Group guidelines recognise Freelite as an important prognostic tool for Monoclonal Gammopathy of Undetermined Significance (MGUS), smouldering and active MM, solitary plasmacytoma and AL amyloidosis.1
In conjunction with this, several other
publications have highlighted Freelite as an independent marker of prognosis in plasma cell dyscrasias. 29-36
More information at:
www.bindingsite.com
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