More than 80％ of patients with MM is present as intact monoclonal immunoglobulin (Ig).Usually,the patients with intact immunoglobulin MM (IIMM) show parallel fluctuations of their intact Ig and FLCs or BJP.In the era of novel agents,including thalidomide,lenalidomide and bortezomib,the natural disease development and classic relapse patterns have been changed,the relapse was characterized by an increase in sFLC or BJP without a corresponding increase in paraprotein level,a phenomenon termed "light chain escape",indicates a worse outcome in patients with MM.This review focuses on the mechanism,clinical significance and early diagnosis of light chain escape.%80％多发性骨髓瘤患者中M蛋白为完整免疫球蛋白分子.在病程中M蛋白与血清游离轻链(sFLC)或本周蛋白水平变化相一致,但随着沙利度胺、雷利度胺及硼替佐米等药物的广泛应用,越来越多的学者发现MM表现出不同于以往的生物学行为,某些MM缓解者复发时仅仅sFLC或本周蛋白显著升高,而没有相应升高的M蛋白,并可出现髓外复发.这种现象称之为轻链逃逸(light chain escape,LCE).发生轻链逃逸往往提示MM患者预后不良.本文重点就MM轻链逃逸的发生机制、临床意义及早期诊断的最新研究进展作一综述.
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