Journal article
Diagnostic Utility of Immunofixation and Free Light Chain Assay in AL Amyloidosis: A Systematic Review and Meta-analysis
Blood advances
04/14/2026
DOI: 10.1182/bloodadvances.2025019530
PMID: 41979328
Abstract
In this systematic review, we aimed to assess the sensitivity of serum and urine immunofixation (IFE) and serum free light chain (sFLC) in detecting plasma cell dyscrasia (PCD) associated with light chain (AL) amyloidosis. We searched the literature using PubMed, Embase, and CENTRAL databases since inception through March 2024. We included studies reporting the diagnostic accuracy of IFE and/or sFLC in patients with AL amyloidosis. We used the GRADE approach to assess the certainty of evidence and QUADAS-2 to assess the risk of bias. After deduplication, 29,237 records were screened, and 44 studies (n = 18,071) were included. For the meta-analysis, 28 studies reported sensitivity for SIFE (n = 3,390), 24 studies for UIFE (n = 2,830), 19 studies for SIFE and UIFE (n = 2,819), 21 studies for sFLC ratio (n = 3,678), 6 studies for SIFE and sFLC ratio (n = 372), 3 studies for UIFE and sFLC ratio (n = 242), and 10 studies for all three tests (n = 1,430). Pooled sensitivities were: SIFE 0.68 (95% CI 0.62-0.73), UIFE 0.77 (0.72-0.81), SIFE and UIFE 0.89 (0.84-0.93), sFLC ratio 0.82 (0.78-0.86). When SIFE, UIFE, and sFLC ratio were combined, the sensitivity reached 0.99 (0.96-1.00). The high sensitivity of combining SIFE, UIFE, and sFLC ratio supports their use as a reliable initial testing strategy to raise suspicion for AL amyloidosis and guide decisions regarding future diagnostic modalities.
Details
- Title: Subtitle
- Diagnostic Utility of Immunofixation and Free Light Chain Assay in AL Amyloidosis: A Systematic Review and Meta-analysis
- Creators
- Muayad Azzam - University of Kansas Medical CenterQais Hamarsha - University of Kansas Medical CenterHassan Kawtharany - University of Kansas Medical CenterJamil Nazzal - University of Kansas Medical CenterAseel Alkhader - University of Kansas Medical CenterTala Khraise - Valparaiso UniversityMohammad M AlMasri - Sparrow Health SystemHadi K Abou Zeid - Wake Forest UniversityIktimal Alwan - AdventHealth TampaNour Jaber - University of Kansas Medical CenterMatthew D Seftel - Canadian Blood ServicesMaria Adela Aguirre - Hospital Italiano de Buenos AiresDeborah Boedicker - Universidade Presbiteriana MackenzieNaresh Bumma - The Ohio State UniversityAntonia S Carroll - St Vincent's Hospital SydneyRaymond Comenzo - Tufts Medical CenterJoselle Cook - Mayo ClinicNoel R Dasgupta - Indiana University School of MedicineAlfredo De La Torre - Greenfield Research (Canada)Angela Dispenzieri - Mayo ClinicFaizi Jamal - City Of Hope National Medical CenterJack Khouri - Cleveland ClinicMaria M Picken - Loyola University Medical CenterShahzad Raza - Cleveland Clinic Lerner College of MedicineNelson Leung - Mayo ClinicVaishali Sanchorawala - Boston Medical CenterNitasha Sarswat - University of ChicagoHira Shaikh - University of Iowa Holden Comprehensive Cancer CenterDaulath Singh - University of IowaVishal Kukreti - Princess Margaret Cancer CentreReem A Mustafa - University of Kansas Medical Center
- Resource Type
- Journal article
- Publication Details
- Blood advances
- DOI
- 10.1182/bloodadvances.2025019530
- PMID
- 41979328
- NLM abbreviation
- Blood Adv
- ISSN
- 2473-9529
- eISSN
- 2473-9537
- Publisher
- American Society of Hematology
- Language
- English
- Electronic publication date
- 04/14/2026
- Academic Unit
- Internal Medicine
- Record Identifier
- 9985153517102771
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