Contributions
Abstract: EP1480
Type: Poster Sessions
Abstract Category: Pathology and pathogenesis of MS - Immunology
Background: Previous studies suggested that the detection of elevated kappa free light chain (KFLC) levels in the CSF might have diagnostic value in Multiple Sclerosis (MS). We hypothesize that CSF KFLC concentration might also have prognostic impact.
We aimed to study whether CSF KFLC concentration in Clinically Isolated Syndrome (CIS) predicts conversion to clinically definite MS (CDMS) and disability progression.
Methods: We retrospectively selected adult patients with a typical CIS submitted to diagnostic lumbar puncture during the first 3 months after clinical presentation at a University Hospital, between January 2008 and December 2017. Additional selection factors were baseline MRI and oligoclonal band status availability and minimum 1 year of follow-up.
Consecutive patients paired CSF/serum samples, stored according to international consensus guidelines, were evaluated for KFLC concentration, using immunonephelometry (BN ProSpec, Siemens) and immunoturbidimetry (Optilite, Binding Site). KFLC values were expressed as KFLC quotient (CSF/serum KFLC) and KFLC index (CSF KFLC/serum KFLC)/(CSF albumin/serum albumin). A value of KFLC index >100 was considered significant for high KFLC intrathecal concentration.
We estimated risk of conversion CIS-CDMS and risk of disability progression after conversion, as measured by Expanded Disability Status Scale (EDSS) confirmed progression at 3 months, using a Cox univariate and multivariate regression (accounting for other established prognostic factors).
Results: Of the 31 patients analysed, 27 were women (87.1%), with a mean age of 30.5 years (± 8.4). Medular CIS was the most common type, accounting for 12 patients (38.7%). 12 patients (38.7%) had 0-3 T2 lesions on baseline MRI, with 67.7% showing absent baseline Gad+ lesions. A majority of patients (87.1%) had positive oligoclonal bands in the CSF. Median KFLC quotients were 0.47 (IQR 0.72) (BN ProSpec) and 0.41 (IQR 0.64) (Optilite), with 48.1% of patients showing KFLC index>100.
26 patients (83.9%) converted to CDMS in a median follow-up time of 64 months (IQR 69.0). Higher KFLC index (>100) was not associated with CIS to CDMS conversion (HR 0,931, 95% CI 0.400-2.167; p=0.868), or EDSS progression (HR 1.191, 95% CI 0.397-3.574; p=0.775)
Conclusion: In our cohort, KFLC index does not seem to independently influence risk to conversion or risk of disability progression. Further studies with larger samples are necessary to accurately define prognostic value.
Disclosure: - Manuel Salavisa: received consultant fees from Novartis and Merck Serono and support for scientific meetings from Biogen Idec, Merck Serono, Novartis and Sanofi Genzyme.
- Ana Sofia Correia received an educational sponsorship from Merck Serono, consultant fees from Biogen Idec, Merck Serono, Novartis and Roche, as well as research support from Biogen Idec.
- Filipa Ladeira received consultant fees from Novartis and support for scientific meetings from Biogen Idec, Novartis, Sanofi Genzyme and Teva.
- Pedro Paixão: nothing to disclose
- Alexandra Mendes: nothing to disclose
- João Faro Viana: nothing to disclose
- Miguel Viana Baptista: nothing to disclose
Abstract: EP1480
Type: Poster Sessions
Abstract Category: Pathology and pathogenesis of MS - Immunology
Background: Previous studies suggested that the detection of elevated kappa free light chain (KFLC) levels in the CSF might have diagnostic value in Multiple Sclerosis (MS). We hypothesize that CSF KFLC concentration might also have prognostic impact.
We aimed to study whether CSF KFLC concentration in Clinically Isolated Syndrome (CIS) predicts conversion to clinically definite MS (CDMS) and disability progression.
Methods: We retrospectively selected adult patients with a typical CIS submitted to diagnostic lumbar puncture during the first 3 months after clinical presentation at a University Hospital, between January 2008 and December 2017. Additional selection factors were baseline MRI and oligoclonal band status availability and minimum 1 year of follow-up.
Consecutive patients paired CSF/serum samples, stored according to international consensus guidelines, were evaluated for KFLC concentration, using immunonephelometry (BN ProSpec, Siemens) and immunoturbidimetry (Optilite, Binding Site). KFLC values were expressed as KFLC quotient (CSF/serum KFLC) and KFLC index (CSF KFLC/serum KFLC)/(CSF albumin/serum albumin). A value of KFLC index >100 was considered significant for high KFLC intrathecal concentration.
We estimated risk of conversion CIS-CDMS and risk of disability progression after conversion, as measured by Expanded Disability Status Scale (EDSS) confirmed progression at 3 months, using a Cox univariate and multivariate regression (accounting for other established prognostic factors).
Results: Of the 31 patients analysed, 27 were women (87.1%), with a mean age of 30.5 years (± 8.4). Medular CIS was the most common type, accounting for 12 patients (38.7%). 12 patients (38.7%) had 0-3 T2 lesions on baseline MRI, with 67.7% showing absent baseline Gad+ lesions. A majority of patients (87.1%) had positive oligoclonal bands in the CSF. Median KFLC quotients were 0.47 (IQR 0.72) (BN ProSpec) and 0.41 (IQR 0.64) (Optilite), with 48.1% of patients showing KFLC index>100.
26 patients (83.9%) converted to CDMS in a median follow-up time of 64 months (IQR 69.0). Higher KFLC index (>100) was not associated with CIS to CDMS conversion (HR 0,931, 95% CI 0.400-2.167; p=0.868), or EDSS progression (HR 1.191, 95% CI 0.397-3.574; p=0.775)
Conclusion: In our cohort, KFLC index does not seem to independently influence risk to conversion or risk of disability progression. Further studies with larger samples are necessary to accurately define prognostic value.
Disclosure: - Manuel Salavisa: received consultant fees from Novartis and Merck Serono and support for scientific meetings from Biogen Idec, Merck Serono, Novartis and Sanofi Genzyme.
- Ana Sofia Correia received an educational sponsorship from Merck Serono, consultant fees from Biogen Idec, Merck Serono, Novartis and Roche, as well as research support from Biogen Idec.
- Filipa Ladeira received consultant fees from Novartis and support for scientific meetings from Biogen Idec, Novartis, Sanofi Genzyme and Teva.
- Pedro Paixão: nothing to disclose
- Alexandra Mendes: nothing to disclose
- João Faro Viana: nothing to disclose
- Miguel Viana Baptista: nothing to disclose