Kappa free light chains: diagnostic and prognostic relevance in MS and CIS
Stefan Presslauer1, Dejan Milosavljevic2, Wolfgang Huebl2
1Department of Neurology, Wilhelminenspital, Vienna, Austria.
Background:
Quantification of kappa free light chains (KFLC) in cerebrospinal fluid shows high diagnostic sensitivity in multiple sclerosis and clinically isolated syndrome patients. However, a clearly defined threshold value is still missing and a possible prognostic value of the KFLC levels in these patients remains undefined.
Methods:
Results of KFLC quantification in 420 controls were used to set an upper limit of normal KFLC concentration in CSF under different blood-CSF-barrier conditions. Additionally, KFLC values of MS and CIS patients were assessed and results were evaluated with reference to the patients corresponding disease courses.
Results:
The calculated upper limit of normal KFLC-concentration covers 98% of these control patients. Using this cut-off, plasma cell activity in CSF can be detected in 97% of MS patients and in 97% of CIS patients. However, there is no evidence that the extent of KFLC elevation provides prognostic value in MS and CIS patients in this study.
Conclusion:
KFLC determination should become a first line screen in the diagnostic algorithms of MS and CIS. The extent of elevation of intrathecal KFLC has no prognostic value on the disease course in MS and CIS patients.
Insights
Kappa free light chains (KFLC) in cerebrospinal fluid are highly sensitive for diagnosing multiple sclerosis (MS) and clinically isolated syndrome (CIS). However, KFLC levels do not predict disease progression in MS and CIS patients.
Area of Science:
- Neurology
- Immunology
Background:
- Cerebrospinal fluid (CSF) kappa free light chains (KFLC) show high diagnostic sensitivity for multiple sclerosis (MS) and clinically isolated syndrome (CIS).
- A definitive KFLC threshold for diagnosis and its prognostic value in MS and CIS remain unclear.
Purpose of the Study:
- Establish a normal KFLC concentration threshold in CSF.
- Evaluate the diagnostic and prognostic utility of KFLC levels in MS and CIS patients.
Main Methods:
- KFLC levels in 420 controls were analyzed to define the upper limit of normal CSF KFLC concentration.
- KFLC values from MS and CIS patients were correlated with their disease progression.
Main Results:
- An upper limit of normal KFLC concentration was established, covering 98% of controls.
- CSF KFLC detected plasma cell activity in 97% of MS and 97% of CIS patients.
- No correlation was found between KFLC elevation extent and prognostic value in MS and CIS.
Conclusions:
- CSF KFLC determination is recommended as a first-line diagnostic tool for MS and CIS.
- Intrathecal KFLC elevation does not offer prognostic value for disease course in MS and CIS.
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