Cerebrospinal Fluid Immunoglobulin Light Chain Ratios Predict Disease Progression in MS

Cerebrospinal fluid immunoglobulin kappa to lambda ratio may be useful prognostic markers for early therapeutic stratification.

For patients with multiple sclerosis (MS), cerebrospinal fluid immunoglobulin light chain ratios predict disease progression, according to results published in the Journal of Neurology, Neurosurgery, and Psychiatry.

These ratios, which are determined at the time of diagnostic lumbar puncture, may be useful prognostic markers for determining appropriate therapy.

The study included participants undergoing elective diagnostic lumbar puncture who had clinically isolated syndrome (n=43), relapsing remitting MS (n=50), primary progressive MS (n=20), and other neurologic disease controls, both inflammatory (n=23) and non-inflammatory (n=114). The researchers assayed cerebrospinal fluid samples for free and immunoglobulin-associated light chains.

All MS groups had an increased median ratio of cerebrospinal fluid kappa to lambda free light chain (clinically isolated syndrome: 18.2; 95% CI, 6.8-30.3; relapsing remitting MS: 4.4; 95% CI, 2.7-11.4; primary progressive MS: 12.0; 95% CI, 3.6-37.1) compared with controls (other neurologic disease: 1.61; 95% CI, 1.4-1.9; neurologic inflammatory diseases: 1.7; 95% CI, 1.3-2.2; P <0.001).

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This ratio predicted Expanded Disability Status Score progression at 5 years, with a lower median Expanded Disability Status Score in the group with high (>10) kappa to lambda ratios (0.0; 95% CI, 0-2.5 vs 2.5; 95% CI, 0-4, high vs low; P =.049).


Rathbone E, Durant L, Kinsella J, et al. Cerebrospinal fluid immunoglobulin light chain ratios predict disease progression in multiple sclerosis [published online May 9, 2018]. J Neurol Neurosurg Psychiatry. doi:10.1136/jnnp-2018-317947