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Test ID: FLCP Immunoglobulin Free Light Chains, Serum

Reporting Name

Immunoglobulin Free Light Chains, S

Useful For

Monitoring serum from patients with monoclonal light chain diseases without a M-spike on protein electrophoresis

Clinical Information

The monoclonal gammopathies are characterized by a clonal expansion of plasma cells that secrete a monoclonal immunoglobulin (Ig). The monoclonal Ig secreted by these cells serves as a marker of the clonal proliferation and the quantitation of monoclonal protein can be used to monitor the disease course.

 

The monoclonal gammopathies include multiple myeloma (MM), light chain multiple myeloma (LCMM), Waldenstrom macroglobulinemia (WM), nonsecretory myeloma (NSMM), smoldering multiple myeloma (SMM), monoclonal gammopathy of undetermined significance (MGUS), primary systemic amyloidosis (AL), and light chain deposition disease (LCDD).

 

Monoclonal proteins are typically detected by serum protein electrophoresis (SPEP) and immunofixation (IF). However, the monoclonal light chain diseases (LCMM, AL, LCDD) and NSMM often do not have serum monoclonal proteins in high enough concentration to be detected and quantitated by SPEP.

 

A sensitive nephelometric assay specific for kappa free light chain (FLC) and lambda free light chain (FLC) that doesn't recognize light chains bound to Ig heavy chains has recently been described. This automated, nephelometric assay is reported to be more sensitive than IF for detection of monoclonal FLC. In some patients with NSMM, AL, or LCDD, the FLC assay provides a positive identification of a monoclonal serum light chain when the serum IF is negative. In addition, the quantitation of FLC has been correlated with disease activity in patients with NSMM and AL.

 

The following algorithms are available in Special Instructions:

-Laboratory Approach to the Diagnosis of Amyloidosis

-Laboratory Screening Tests for Suspected Multiple Myeloma

Interpretation

The specificity of this assay for detection of monoclonal light chains relies on the ratio of free kappa and lambda (K/L) light chains. Once an abnormal free light chain (FLC) K/L ratio has been demonstrated and a diagnosis has been made, the quantitation of the monoclonal light chain is useful for monitoring disease activity.

 

Changes in FLC quantitation reflect changes in the size of the monoclonal plasma cell population. Our experience to date is limited, but changes of more than 25% or trending of multiple specimens are needed to conclude biological significance.

Profile Information

Test ID Reporting Name Available Separately Always Performed
KFLC Kappa Free Light Chain, S No Yes
LFLC Lambda Free Light Chain, S No Yes
KLR Kappa/Lambda FLC Ratio No Yes

Testing Algorithm

The following algorithms are available in Special Instructions:

-Laboratory Approach to the Diagnosis of Amyloidosis

-Laboratory Screening Tests for Suspected Multiple Myeloma

Analytic Time

Same day/1 day

Day(s) and Time(s) Performed

Monday through Saturday; Continuously until 3 p.m.

Clinical Reference

Drayson M, Tang LX, Drew R, et al: Serum free light chain measurements for identifying and monitoring patients with nonsecretory multiple myeloma. Blood 2001;97(9):2900-2902

Method Name

Nephelometry

Specimen Type

Serum


Specimen Required


Container/Tube:

Preferred: Serum gel

Acceptable: Red top

Specimen Volume: 1 mL


Specimen Minimum Volume

0.5 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 28 days
  Frozen  28 days
  Ambient  72 hours

Reference Values

KAPPA-FREE LIGHT CHAIN

0.33-1.94 mg/dL

 

LAMBDA-FREE LIGHT CHAIN

0.57-2.63 mg/dL

 

KAPPA/LAMBDA FLC RATIO

0.26-1.65

Test Classification

This test has been cleared or approved by the U.S. Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information

83883 x 2

LOINC Code Information

Test ID Test Order Name Order LOINC Value
FLCP Immunoglobulin Free Light Chains, S 81632-2

 

Result ID Test Result Name Result LOINC Value
KFLC Kappa Free Light Chain, S 80515-0
KLR Kappa/Lambda FLC Ratio 80517-6
LFLC Lambda Free Light Chain, S 80516-8

Forms

If not ordering electronically, complete, print, and send a General Request (T239) with the specimen.

Mayo Clinic Laboratories | Neurology Catalog Additional Information:

mml-Demyelinating-Diseases, mml-Neuroimmunology, mml-Neuromuscular, mml-Autonomic, mml-Pediatric, mml-Spinal-Cord