ArticleFrontiers in immunology2026
Kappa free light chains in cerebrospinal fluid to detect inflammation - results from a multicentric prospective real-world study.
Article in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Kappa index: real-world study for assessing cut-off values that provide the best accuracy for multiple sclerosis diagnosis in patients with CIS.Frontiers in immunology · 2026Article
- Diagnostic value of the kappa free light chain index in multiple sclerosis under the 2024 CSF positivity criterion: a multicentre study in oligoclonal band-negative patients.Frontiers in immunology · 2026Article
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22 authors.
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Abstract
Background: Free light chain kappa (FLCκ) have emerged as a sensitive biomarker to detect intrathecal immunoglobulin synthesis. To evaluate the role of FLCκ in routine cerebrospinal fluid laboratory diagnostics we conducted a prospective nationwide real world diagnostic study for evaluating the integration of kappa free light chain into clinical routine (ORCAS - prospective multicenter validation of a new laboratory workflow integrating the free light Objectives: To determine whether testing for intrathecal synthesis of FLCκ in cerebrospinal fluid (CSF) can predict intrathecal immunoglobulin (Ig) synthesis of total IgG, IgA, IgM or CSF-specific oligoclonal bands (OCB) with high sensitivity. Materials & Methods: FLCκ were measured in 1052 paired CSF and serum samples according to local laboratory standards in six laboratories in Germany. Sensitivity and negative predictive value (NPV) of intrathecal FLCκ synthesis as first line detection of intrathecal Ig synthesis were assessed. Results: Of the 1052 samples, 624 fulfilled the inclusion criteria. The intrathecal fraction of FLCκ predicted intrathecal Ig synthesis with a sensitivity of 0.87 (CI 0.81-0.93) and a NPV of 0.97 (CI 0.95-0.98). The sensitivity for predicting CSF-specific OCB was 0.93 (CI 0.88-0.98). Conclusions: In the real world setting this study analyzing FLCk for detecting intrathecal Ig synthesis did not reach its prespecified primary endpoint of sensitivity >0.95. Therefore, FLCκ should not yet be introduced as a stand-alone preselection marker for intrathecal Ig synthesis, but may provide additional value when combined with established diagnostic parameters.
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