If you are having trouble viewing this email please use this link to view a web version 2010 Issue 10 Dear , Welcome to the 10th issue of InSite. In this edition we share with you the latest information for Hevylite and Freelite and start our series of clinical case studies. I hope to meet you at one or more of the congresses over the next few months so please visit us and let us know what you would like to see in future editions of InSite. Kind Regards Barbara Maniglia International Marketing Manager – Freelite & Hevylite 6th International Symposium on Clinical Applications of Serum Free Light Chain Analysis (Plus Hevylite) On line registration is now open for this exciting meeting in the Bath Assembly Rooms, UK, 23rd-24th September 2010. The symposium includes measurements in monoclonal gammopathies, myeloma kidney and inflammatory diseases; data from the Multi-centre, Phase III, Randomised control trial on extended haemodialysis with the Gambro protein-leaking HCO 1100 dialyser; and presentations on Hevylite (intact immunoglobulin kappa/lambda ratios) in a variety of clinical situations. The programme will focus on results from a number of recent studies. We are pleased to inform you that Robert Kyle, Brian Durie, Hervé Avet-Loiseau, Angela Dispenzieri, Ola Landgren, Philip Hawkins and Heinz Ludwig will be amongst the speakers. For more information and to register, follow the link www.bath2010.com   Hevylite Hevylite Assay panels are now available for analysis of immunoglobulin heavy chain/light chain pairs. A recent abstract published at the XII International Symposium on Amyloidosis in Rome demonstrates the utility of Hevylite in AL amyloidosis patients. A.D. Wechalekar, et al. Serum immunoglobulin heavy/light chain ratios (HevyLite) in patients with systemic AL Amyloidosis. Amyloid Apr 2010; 17 s1 T186 P188a Measurement of heavy/light chains and their ratios identifies and quantifies low-level roteins in patients with AL amyloidosis with a high degree of concordance with the standard measurements, and identified an M-protein in 19% of patients in whom no clonal abnormality could be detected by other means. Look out for abstracts relating to Hevylite at future scientific meetings.   Case Study In the first of a series of case studies we invite you to view an interesting case of Intact Immunoglobulin Multiple Myeloma (IIMM) and see the contribution made by Freelite to the management of the patient. IIMM clinical case: A 62 year old male presented to the clinician, he felt generally unwell with pain in the back and the ribs. In this case he had been referred to the Haematologist by a general practitioner after a paraprotein had been found. Further laboratory tests showed the paraprotein to be an IgG kappa with 15.2 g/L. BMPCs were 84% and a skeletal survey revealed generally osteopenic bones. His haemoglobulin measured at 10.6 g/dL, with a urea level of 12.5 mmol/L and creatinine 188 µmol/L. When his serum free light chain (sFLC) ratio was measured, it was 3,377, with a kappa of 39,850 and lambda of 11.8. A diagnosis was made of Intact Immunoglobulin Multiple Myeloma. Table 1: Comparison between IgG paraprotein levels and the sFLC ratio Treatment of chemotherapy and a stem cell transplant commenced. In this patient very high levels of free light chains were seen, however the patient had modest paraprotein levels. These high levels of serum free light chains indicated a more aggressive disease. Graph 1: sFLC ratio over a period of two years In this patient the serum free light chain levels gave an earlier indication of response to treatment than the paraprotein level. High serum free light chain levels and their rapid reduction in response to therapy may define an aggressive subtype of myeloma with poor prognosis. Courtesy of Dr Martin Auger, Norfolk and Norwich University Hospital, UK If you would like to share any clinical case studies with InSite, please forward to barbara.maniglia@bindingsite.co.uk Publication review – keep up to date with recent publications In recent months there have been three publications of note. These papers demonstrate the utility of serum free light chain analysis in expanding clinical areas. We are delighted to say that Benjamin Terrier, JE Gottenberg and Ola Landgren will be speaking at the 6th International symposium in Bath. In InSite 8 we informed you of the largest study to date to investigate the different screening for the detection of monoclonal gammopathies. In this study of 1877 patients the authors demonstrated that SPE and FLC provide a simple and efficient diagnostic screen, enabling urine studies and serum Immunofixation to be ordered more selectively. Jerry Katzman will also be speaking at Bath on “The role of serum FLC in the laboratory” Click here to order MKG535 - Jerry A.Katzman et al. Screening panels for detection of monoclonal gammopathies. Clin Chem 2009; 55:1517-1522. Hepatitis C virus related Lymphoproliferative disorders Terrier et al. Serum-free light chain assessment in hepatitis C virus–related lymphoproliferative disorders. Ann Rheum Dis 2009; 68:89-93 In this prospective study a total of 59 patients infected with HCV were followed. The authors evaluated the relevance of serum free light chain (FLC) assessment in hepatitis C virus-related lymphoproliferative disorders, including mixed cryoglobulinaemia and B cell non-Hodgkin Lymphoma. This paper concludes that an abnormal FLC ratio is associated with the presence of MC Vasculitis and/or B-NHL. And after anti-viral therapy, the Freelite ratio could be used as a surrogate marker of the control of the hepatitis C virus–related lymphoproliferation. Click here to order your copy- MKG555 Rheumatoid Arthritis and Sjogrens syndrome J.E. Gottenberg et al.  Serum immunoglobulin free light chain assessment in rheumatoid arthritis and primary Sjögren’s syndrome.  Ann Rheum Dis 2007; 66:23-27 The authors concluded that serum free light chain levels are both increased and correlate with disease activity in patients with rheumatoid arthritis and in those with primary Sjögren’s syndrome, two diseases in which increased risk of lymphoma could result from persistent B cell activation and disease activity. The authors recommend further studies to determine whether the use of Freelite could represent a relevant biomarker for response to treatment and for the risk of lymphoma in autoimmune diseases. Click here to order your copy - MKG554 HIV Ola Landgren et al.  Circulating Serum Free Light Chains As Predictive Markers of AIDS-Related Lymphoma.  J. Clin Oncol 2010; 28 In this retrospective study serum immunoglobulin proteins are evaluated as predictors of non-Hodgkin’s lymphoma in HIV-infected individuals. Patients were assessed retrospectively for IgG, IgM and IgA levels, monoclonal immunoglobulins and serum free light chain levels. The results showed that both kappa and lambda serum free light chains were both significantly higher in patients and strongly predicted non-Hodgkin’s lymphoma in a dose-response manner up to two to five years before diagnosis of the lymphoma. The study concludes that elevated serum fee light chain levels may represent sensitive markers of polyclonal B-cell activation and dysfunction and could be used for identifying HIV-infected patients who have an increased non-Hodgkin’s lymphoma risk. Click here to order your copy - MKG553 CLL Zeynep A et al.  A novel predictor of adverse outcome in chronic lymphocytic leukemia.  Published Online: Jan 5 2010 11:41AM. DOI: 10.1111/j.1600-0609.2010.01412 This retrospective study of 101 CLL patients highlights the adverse prognostic impact of high sFLC levels and abnormal FLC ratio with regard to survival in CLL even in early stage patients.   Exhibitions and meetings – catching up and planning ahead The XII International symposium on amyloidosis - “From molecular mechanisms Toward the Cure of Systemic Amyloidoses” - www.amyloidosis2010.com This symposium took place on April 18-21, 2010 in Rome, Italy. A report will be included in InSite 11. European Haematology Association Congress, June 10-13 2010, Barcelona, Spain. Once again the EHA has created a program that promotes excellence in all fields of hematology. It’s plenary sessions are designed to be of interest to all specialties with key note speakers providing interesting presentations. The highly valued education sessions and Hematology-in-Focus offer a wide range of topics discussed on many levels. Workshops this year include the well-established ‘Molecular Hemopoiesis’ workshop and the brand new ‘Laboratory Hematology’ workshop. This new workshop will bring an extended focus on diagnostics into the program. The extensive program also offers Meet-the-Experts, lunch debate and the EHA scientific working group meetings. For more information visit the exhibition website Come and visit Binding Site at stand number 621 during the exhibition hours. We look forward to meeting you and answering your questions on Freelite and Hevylite. There will also be a chance to win a SONY reader PRS 600 (e-book reader) over the three days. Exhibition Opening Hours : Friday 11th June 2010 09:30 - 18:00 Saturday 12th June 2010 09:30 - 18:00 Sunday 13th June 2010 09:30 - 14:00 XLVII ERA-EDTA Congress, June 25-28 2010, Munich, Germany This year the ERA-EDTA and the German Society of Nephrology will join forces to produce a meeting of outstanding scientific quality combined with an extremely rich cultural experience. There will be a wide choice of lectures and symposia covering the various aspects of basic and clinical nephrology as well as the most recent research in the field. Special attention will be given to young researchers and nephrologists and to late breaking clinical trials.  For more information visit www.eraedta2010.org AACC annual meeting July 25-29, Ananheim, California In 2010, AACC will host its annual meeting in Anaheim, CA. The conference format includes 5 plenary sessions, symposia, interactive workshops, short courses, ‘brown bag’ sessions, meet the experts, chairs invited sessions, posters, and oral abstract presentations. For more information visit www.aacc.org   What’s in the next Issue: Review of Publication and Conferences The latest information on both Freelite and Hevylite More clinical case studies Webinars Don’t forget to visit our webinars page www.Freelite.co.uk/webinarmenu.asp regularly to view webinars held in the USA by The Binding Site Inc. Learn more about Serum Free Light chains by visiting our website www.Freelite.co.uk Refer a friend / colleague If you have a friend or colleague who you feel would benefit from receiving this newsletter then please use this link and ask them to complete the form - we will then be able to include them next time. Opt out If you no longer wish to receive this newsletter please use this unsubscribe link or reply to this email with unsubscribe in the subject line Previous editions Previous editions of InSite can also be read online using this link The Binding Site Group Ltd PO Box 11712, Birmingham, B14 4ZB, U.K. Registered in England Number 05508774