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Kappa free light chain index as a diagnostic and prognostic biomarker in multiple sclerosis

Luis Moreno-Navarro1,2, Sergio Mora-Diaz3, Lourdes Ruiz-Escribano-Menchen4,5

  • 1Neurology Department, Dr. Balmis General University Hospital, C/Pintor Baeza 12, 03010, Alicante, Spain. moreno_luinav@gva.es.

Journal of Neurology
|September 23, 2025
PubMed
Abstract

Insights

The kappa free light chain (KFLC) index shows diagnostic performance comparable to oligoclonal bands (OCB) for multiple sclerosis (MS). An elevated KFLC index may indicate a higher risk of new lesions in the brainstem or spinal cord in people with MS.

Area of Science:

  • Neurology
  • Biomarker Discovery
  • Diagnostic Criteria

Background:

  • The 2024 McDonald criteria propose incorporating the kappa free light chain (KFLC) index for multiple sclerosis (MS) diagnosis.
  • Emerging research suggests a high KFLC index may correlate with poorer outcomes in people with MS (pwMS).
  • This study investigates the diagnostic and prognostic roles of the KFLC index in MS.

Purpose of the Study:

  • To assess the diagnostic accuracy of the KFLC index compared to the 2017 and proposed 2024 McDonald criteria.
  • To explore the prognostic value of the KFLC index in pwMS.
  • To evaluate the KFLC index's utility alongside oligoclonal bands (OCB) in MS diagnosis.

Main Methods:

  • Retrospective cohort study of 150 adults with a first episode suggestive of MS (2019-2024).
  • Simultaneous determination of KFLC index and OCB via lumbar puncture.
  • Comparison of diagnostic performance against established and proposed McDonald criteria.

Main Results:

  • KFLC index diagnostic performance (sensitivity 87.5%, specificity 79.2% at cut-off 12.0) was comparable to OCB.
  • An elevated KFLC index (≥100) was associated with younger age, female sex, relapses, and new infratentorial or spinal cord lesions.
  • In multivariable analysis, KFLC index ≥100 remained significantly associated with new infratentorial or spinal cord lesions (aOR 8.07, p=0.019).

Conclusions:

  • The KFLC index demonstrates diagnostic utility comparable to OCB, serving as an adjunctive biomarker for MS.
  • It should complement, not replace, clinical and MRI findings in MS diagnosis.
  • Elevated KFLC index is linked to short-term accrual of infratentorial or spinal cord lesions, warranting further validation.
Keywords:
DiagnosisKappa free light chainMultiple sclerosisOligoclonal bandsPrognosis

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