Identifying Clonal Lambda Light Chain Genes in Patients with MGUS or Smoldering Multiple Myeloma

Currently patients with systemic AL amyloidosis (AL) are not identified until they are sick due to end-organ damage, usually a result of elevated clonal Ig free light chains (FLC) produced by λ clones in 75% of cases. Delays in diagnosis put patients at risk of developing irreversible organ damage making AL much harder to treat. Only about 25% of newly diagnosed AL patients are eligible for melphalan (MEL) based stem cell transplant (SCT). To extend the overall survival and quality of life of AL patients, early diagnosis is critical. 

The SAVE trial may enable early appreciation of risk of AL λ-type based on the variable region germline gene used by the clonal plasma cells. Close follow up of patients at risk may reduce the likelihood of eventually being diagnosed with advanced organ involvement. Earlier diagnosis may permit prompt induction therapy if required and expanded application of MEL 200 SCT.

Authors:

Ping Zhou, MD, PhD, Adin Kugelmass, BSc, Denis Toskic, Melissa Warner, BS, Lisa X. Lee, MD, Teresa Fogaren, NP, Cindy Varga, MD, BSc and Raymond L Comenzo, MD