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Significance of Serum Free Light Chains in Prognosis and Monitoring of Multiple Myeloma: A Review

Naveed Shahzad M and Huang C

Patients suffering from multiple myeloma show considerably variable outcomes in terms of prognosis. Survival may be as short as few months in refractory disease, while those with mild disease may live beyond a decade. Abnormally higher levels of serum free light chains and abnormal kappa to lambda ratios are found in the majority of cases. The severity of disease correlates with the elevation and abnormal ratio of these free light chains. These values and ratios are widely used to determine the prognosis and to monitor the disease activity and response to chemotherapy. They provide important clues to clinicians which might help them tailor the treatment protocols and make future therapeutic plans. The objective of this article is to review the importance of serum free light chains in the prediction of prognosis, monitoring of disease activity and evaluation of therapeutic response in multiple myeloma patients. We undertook a comprehensive systematic search of medical literature available on electronic databases. It is found that there is a linear relationship between disease activity and SFLC values as well as degree of abnormality of its ratios. Extremely high serum free light chains values indicate refractory disease while minimal elevation at baseline and normalization after chemotherapy is considered as a favorable sign. Similarly, highly abnormal ratios indicate poor outcomes while the effectiveness of chemotherapy was reflected by normalization of these ratios.