Relationship between elevated immunoglobulin free light chain and the presence of IgH translocations in multiple myeloma

Elevated immunoglobulin free light chain (FLC) level and abnormal FLC ratio is commonly seen in multiple myeloma (MM) and have prognostic implications. We hypothesized that presence of IgH translocations leads to unbalanced production of light chains and more extreme abnormalities of FLC and may explain the prognostic value of FLC. We studied 314 patients with newly diagnosed MM enrolled on a phase-III trial, in whom results of FISH testing and serum FLC were available. Cytogenetic analyses and FLC estimates were performed on stored samples and results correlated with clinical data. The median ratio (FLC-ratio) and the absolute difference (FLC-diff) between the involved and uninvolved FLC was higher among those with IgH translocations, especially t(14;16). In multivariate analysis, the prognostic value of FLC estimates on progression free and overall survival were independent of high-risk IgH translocations t(4;14) and t(14;16). A combination of the risk factors; either abnormal FLC estimate and/or the presence of high-risk IgH translocation, achieved better prognostic stratification. In conclusion, patients with IgH translocations tend to have higher FLC levels and abnormal ratios, but the prognostic effect of FLC is only partially explained by translocation status. A system including both these risk factors allows better prediction of outcome