Light Chain-Predominant Multiple Myeloma Subgroup: Impaired Renal Function Correlates with Decreased Survival

Lab Med. 2022 Mar 7;53(2):145-148. doi: 10.1093/labmed/lmab054.


Objective: Patients with light chain-predominant multiple myeloma have been shown to exhibit shorter survival. Retrospective comparison of clinical and laboratory data was undertaken to ascertain the likely cause(s) of this observation.

Methods: Records of patients with multiple myeloma seen at 1 institution revealed 316 patients with conventional and 71 patients with light chain-predominant multiple myelomas with secretion of intact immunoglobulins. Laboratory and clinical findings in the 2 groups were compared.

Results: Patients with light chain-predominant multiple myeloma had a significantly higher death rate, a higher rate of chronic dialysis, a lower estimated glomerular filtration rate and serum albumin, a significantly higher urine protein concentration, and a significantly higher prevalence of hypertension and blood transfusion requirements. Other clinical and laboratory parameters surveyed were not significantly different between the 2 groups.

Conclusion: The shorter survival of patients with light chain-predominant multiple myeloma is clearly associated with renal damage caused by excess free immunoglobulin light chains. Renal damage may be ameliorated by early aggressive treatment with chemotherapy, plasmapheresis, and dialysis; a multi-institutional prospective controlled trial would be needed to test this hypothesis.

Keywords: cast nephropathy; eGFR; light chain–predominant multiple myeloma; multiple myeloma; serum free light chains; survival.

MeSH terms

  • Humans
  • Immunoglobulin Light Chains
  • Kidney / physiopathology
  • Multiple Myeloma* / complications
  • Multiple Myeloma* / mortality
  • Multiple Myeloma* / therapy
  • Prospective Studies
  • Renal Insufficiency* / complications
  • Retrospective Studies
  • Survival Rate


  • Immunoglobulin Light Chains