Multiple Myeloma Clinical Trial
Official title:
Correlation Between the Urinary Protein/Creatinine Ratio in a Single Urine Sample Versus 24-hour Proteinuria in Patients With Multiple Myeloma.
The measurement of 24-hour proteinuria allows an assessment of treatment response in patients
with multiple myeloma. But it is difficult and restrictive to make.
This study was therefore designed to investigate the correlation between the ratio of
proteinuria / creatinine on samples, easier to obtain, and the 24-hour proteinuria in
assessing response to this treatment .
The measure of 24-hour proteinuria is an important biomarker for multiple myeloma.
Multiple myeloma is often accompanied by proteinuria overhead of secretion by plasma cells of
large quantities of immunoglobulin free light chains (FLC) kappa or lambda. This proteinuria
is composed of monoclonal FLC. The measure of the urinary concentration of FLC is an
important biomarker for both diagnosis and evaluation of response to treatment of light chain
multiple myeloma but also in intact immunoglobulins multiple myeloma.
The 24-hour proteinuria coupled with urine protein electrophoresis is the standard method for
measuring the concentration of urinary FLC. However, it is difficult to obtain a reliable
collection of the urine of 24 hours which can make it difficult to assess response to therapy
in some patients. It would be interesting to assess proteinuria in a single urine sample
collected at any time of day.
Contribution of urinary protein/creatinine ratio for assessment of proteinuria of glomerular
origine.
For reasons of convenience, the extent of 24-hour proteinuria was increasingly abandoned by
nephrologists in favor of urinary protein/creatinine ratio (UPCR). The use of UPCR measured
on a sample of urine overcomes the inaccuracies related to the collection of 24 or variations
in urine concentration. This report has been validated against the 24-hour proteinuria for
screening or monitoring of renal glomerular diseases by the French Society of Nephrology. In
theory, the UPCR is measured on a urine sample, taken preferably in the morning. In practice,
the precision of a measurement at any time of day is quite acceptable.
Using the urinary protein/creatinine ratio for assessment of response in multiple myeloma?
The use of UPCR has been validated in patients with renal glomerular disease and especially
in diabetic nephropathy. However, the UPCR has not been validated for the assessment of
proteinuria overload such as those seen in myeloma. Two recent papers have studied the UPCR
in multiple myeloma. The results of these articles suggest:
- That the UPCR is well correlated with the 24-hour proteinuria
- The UPCR varies over time depending on the response to treatment and could therefore be
used to monitor patients on treatment
However, given their limits, these two articles do not alow to recommend the widespread use
of UPCR instead of the classic 24-hour proteinuria in clinical practice yet. Prospective
studies are needed to analyze the correlation between UPCR and proteinuria of 24 hours to
assess response to therapy.
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