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Assessment of free light chains in the cerebrospinal fluid of patients with lymphomatous meningitis - a pilot study.

Hildebrandt B, Müller C, Pezzutto A, Daniel P, Dörken B, Scholz C - BMC Cancer (2007)

Bottom Line: FLC levels in CSF were lower than serum FLC levels in samples for the same patient obtained at the same time (p < 0.01).Significantly more patients with cytopathologically and immunohistochemically proven LM displayed abnormal kappa/lambda FLC ratios in CSF compared to individuals with no LM (p < 0.01).This is the first report demonstrating that a significant proportion of LM patients display an abnormal kappa/lambda FLC ratio in the CSF.

View Article: PubMed Central - HTML - PubMed

Affiliation: Charité-Centrum für Tumormedizin, Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Campus Virchow-Klinikum, Charité- Universitätsmedizin Berlin, Augustenburger Platz 1, D-13344 Berlin, Germany. bert.hildebrandt@charite.de

ABSTRACT

Background: Lymphomatous meningitis (LM) represents a severe complication of malignant lymphomas. While clinical suspicion is raised by symptoms ranging from mild disturbances of sensation to severe pain or impaired consciousness, the definite diagnosis of LM is often difficult to obtain. Since B-cell lymphomas are clonally restricted to express either kappa or lambda immunoglobulin light chain, we hypothesised that analysis of free light chain (FLC) ratios might facilitate the diagnosis of LM.

Methods: Kappa and lambda FLC were measured using a novel nephelometric assay in cerebrospinal fluid (CSF) and serum from 17 patients. 5/17 suffered from LM as demonstrated by cytology, immunocytology, and/or imaging procedures.

Results: Measurement of FLC concentrations in CSF was achieved for all 17 patients. FLC levels in CSF were lower than serum FLC levels in samples for the same patient obtained at the same time (p < 0.01). CSF and serum FLC concentrations correlated weakly in all patients irrespective of LM status. Significantly more patients with cytopathologically and immunohistochemically proven LM displayed abnormal kappa/lambda FLC ratios in CSF compared to individuals with no LM (p < 0.01).

Conclusion: This is the first report demonstrating that a significant proportion of LM patients display an abnormal kappa/lambda FLC ratio in the CSF.

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Related in: MedlinePlus

Comparison of kappa FLC, lambda FLC, and kappa/lambda FLC ratios in patients with and without lymphomatous meningitis.
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Figure 1: Comparison of kappa FLC, lambda FLC, and kappa/lambda FLC ratios in patients with and without lymphomatous meningitis.

Mentions: We analysed CSF FLC concentrations in patients with and without proven LM. Two patients with LM presented kappa FLC levels in CSF greater than the upper limit of the normal serum reference range. By contrast, patients without LM displayed kappa FLC levels in CSF lower than the upper limit of the normal serum reference range. Further, the mean kappa FLC levels in CSF were approximately threefold higher in patients with LM compared to those without LM (15.5 mg/l vs, 5.0 mg/l; p = 0.06). Also see figure 1.


Assessment of free light chains in the cerebrospinal fluid of patients with lymphomatous meningitis - a pilot study.

Hildebrandt B, Müller C, Pezzutto A, Daniel P, Dörken B, Scholz C - BMC Cancer (2007)

Comparison of kappa FLC, lambda FLC, and kappa/lambda FLC ratios in patients with and without lymphomatous meningitis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2194780&req=5

Figure 1: Comparison of kappa FLC, lambda FLC, and kappa/lambda FLC ratios in patients with and without lymphomatous meningitis.
Mentions: We analysed CSF FLC concentrations in patients with and without proven LM. Two patients with LM presented kappa FLC levels in CSF greater than the upper limit of the normal serum reference range. By contrast, patients without LM displayed kappa FLC levels in CSF lower than the upper limit of the normal serum reference range. Further, the mean kappa FLC levels in CSF were approximately threefold higher in patients with LM compared to those without LM (15.5 mg/l vs, 5.0 mg/l; p = 0.06). Also see figure 1.

Bottom Line: FLC levels in CSF were lower than serum FLC levels in samples for the same patient obtained at the same time (p < 0.01).Significantly more patients with cytopathologically and immunohistochemically proven LM displayed abnormal kappa/lambda FLC ratios in CSF compared to individuals with no LM (p < 0.01).This is the first report demonstrating that a significant proportion of LM patients display an abnormal kappa/lambda FLC ratio in the CSF.

View Article: PubMed Central - HTML - PubMed

Affiliation: Charité-Centrum für Tumormedizin, Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Campus Virchow-Klinikum, Charité- Universitätsmedizin Berlin, Augustenburger Platz 1, D-13344 Berlin, Germany. bert.hildebrandt@charite.de

ABSTRACT

Background: Lymphomatous meningitis (LM) represents a severe complication of malignant lymphomas. While clinical suspicion is raised by symptoms ranging from mild disturbances of sensation to severe pain or impaired consciousness, the definite diagnosis of LM is often difficult to obtain. Since B-cell lymphomas are clonally restricted to express either kappa or lambda immunoglobulin light chain, we hypothesised that analysis of free light chain (FLC) ratios might facilitate the diagnosis of LM.

Methods: Kappa and lambda FLC were measured using a novel nephelometric assay in cerebrospinal fluid (CSF) and serum from 17 patients. 5/17 suffered from LM as demonstrated by cytology, immunocytology, and/or imaging procedures.

Results: Measurement of FLC concentrations in CSF was achieved for all 17 patients. FLC levels in CSF were lower than serum FLC levels in samples for the same patient obtained at the same time (p < 0.01). CSF and serum FLC concentrations correlated weakly in all patients irrespective of LM status. Significantly more patients with cytopathologically and immunohistochemically proven LM displayed abnormal kappa/lambda FLC ratios in CSF compared to individuals with no LM (p < 0.01).

Conclusion: This is the first report demonstrating that a significant proportion of LM patients display an abnormal kappa/lambda FLC ratio in the CSF.

Show MeSH
Related in: MedlinePlus