International Myeloma Working Group guidelines for serum-free light chain analysis in multiple myeloma and related disorders

Research output: Contribution to journalReview article


The serum immunoglobulin-free light chain (FLC) assay measures levels of free kappa and lambda immunoglobulin light chains. There are three major indications for the FLC assay in the evaluation and management of multiple myeloma and related plasma cell disorders (PCD). In the context of screening, the serum FLC assay in combination with serum protein electrophoresis (PEL) and immunofixation yields high sensitivity, and negates the need for 24-h urine studies for diagnoses other than light chain amyloidosis (AL). Second, the baseline FLC measurement is of major prognostic value in virtually every PCD. Third, the FLC assay allows for quantitative monitoring of patients with oligosecretory PCD, including AL, oligosecretory myeloma and nearly two-thirds of patients who had previously been deemed to have non-secretory myeloma. In AL patients, serial FLC measurements outperform PEL and immunofixation. In oligosecretory myeloma patients, although not formally validated, serial FLC measurements reduce the need for frequent bone marrow biopsies. In contrast, there are no data to support using FLC assay in place of 24-h urine PEL for monitoring or for serial measurements in PCD with measurable disease by serum or urine PEL. This paper provides consensus guidelines for the use of this important assay, in the diagnosis and management of clonal PCD.


  • A. Dispenzieri
  • R. Kyle
  • G. Merlini
  • J. S. Miguel
  • H. Ludwig
  • R. Hajek
  • A. Palumbo
  • S. Jagannath
  • J. Blade
  • S. Lonial
  • M. Dimopoulos
  • R. Comenzo
  • H. Einsele
  • B. Barlogie
  • K. Anderson
  • M. Gertz
  • J. L. Harousseau
  • M. Attal
  • P. Tosi
  • P. Sonneveld
  • M. Boccadoro
  • G. Morgan
  • P. Richardson
  • O. Sezer
  • M. V. Mateos
  • M. Cavo
  • D. Joshua
  • W. Chen
  • K. Shimizu
  • R. Powles
  • S. V. Rajkumar
  • B. G. M. Durie
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cancer and Oncology


  • myeloma, amyloid, immunoglobulin-free light chain, prognosis
Original languageEnglish
Pages (from-to)215-224
Issue number2
Publication statusPublished - 2009
Publication categoryResearch

Bibliographic note

The information about affiliations in this record was updated in December 2015. The record was previously connected to the following departments: Emergency medicine/Medicine/Surgery (013240200)