{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T11:16:26Z","timestamp":1787224586130,"version":"build-2736575974"},"reference-count":63,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Br J Haematol"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>Clinical decision\u2010making based on myeloma\u2010defining event criteria using thresholds for involved serum free light chain level of 10\u2009mg\/dL and ratio of involved to uninvolved light chain of &gt;100 is a poor indicator for the risk of progression to multiple myeloma. Poor performance of this criterion can be attributed to (a) methodological flaws in the publication on which the light chain level and ratio figures are based, (b) failure to apply light chain type\u2010specific criteria for kappa and lambda chain\u2010associated lesions, (c) \u2018drift\u2019 in the antibody reactivity for free kappa light chains resulting in higher values in more recent testing, (d) lack of high\u2010sensitivity imaging in earlier studies resulting in inclusion of patients with occult multiple myeloma, and (e) evidence from newer studies showing much lower risk of progression to myeloma than presented initially. The light chain level and ratio\u2010based criterion for myeloma\u2010defining event, in its current form, ought to be removed from the International Myeloma Working Group guidelines. The criterion should be revised by collection of prospective data from multiple institutions using standardized patient selection criteria with emphasis on high\u2010sensitivity imaging studies to exclude occult multiple myeloma patients, subgrouping patients by intact immunoglobulin smouldering multiple myeloma (SMM); light chain SMM; heavy chain and light chain type of lesion; and application of light chain type\u2010specific levels per gram of monoclonal immunoglobulin, measuring monoclonal light chains. Both static and dynamic measures should be collected, followed by rigorous statistical analysis to identify parameters predicting risk of progression to multiple myeloma in 2\u2009years.<\/jats:p>","DOI":"10.1111\/bjh.70427","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T06:52:26Z","timestamp":1774594346000},"page":"1555-1563","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Serum free light chain concentration and ratio\u2010based criterion for myeloma\u2010defining event, in its current version, is untenable"],"prefix":"10.1111","volume":"208","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0621-7254","authenticated-orcid":false,"given":"Gurmukh","family":"Singh","sequence":"first","affiliation":[{"name":"Department of Pathology Medical College of Georgia at Augusta University  Augusta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hoc.2014.06.005"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood\u20102014\u201009\u2010568899"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1011442"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f3863"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15051558"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2024.1394048"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/978\u20103\u2010540\u201085772\u20103_2"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.26590"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/jalm\/jfaa153"},{"key":"e_1_2_7_11_1","volume-title":"Electrophoresis and mass spectrometry. 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