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Gastélum-Cano JM, Fragoso-Flores J, Noffal-Nuño VM, Deffis-Court M. An unusual pattern in serum protein electrophoresis to take in mind: A case report. Pract Lab Med 2021; 24:e00200. [PMID: 33490350 PMCID: PMC7810760 DOI: 10.1016/j.plabm.2020.e00200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 12/28/2020] [Indexed: 01/21/2023] Open
Abstract
Here we described a case of an asymptomatic 73 years-old female patient in geriatric routine consultation, whose laboratory testing showed hyperproteinemia with accompanying hyperglobulinemia. A diagnosis of BGUS was made only after a correlation among SPEP, densitometry tracing and IFE results was established, evidencing a second peak, that was less evident and not reported at first. These biclonal conditions are of very low incidence in the clinical laboratory, requiring the laboratory professional to have particular skills for their identification. As far as is known, clinical findings in BGUS are similar to those found in MGUS. However, they remain not well understood. Therefore, for an accurate diagnosis of BGUS, the clinical laboratory technician must be trained and sensitized to detect a second M - protein as a band or peak; taking in mind the possible different scenarios in heavy and light chain typing.
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Affiliation(s)
- José María Gastélum-Cano
- Laboratorios Ruiz, Mártires Del 2 de Octubre 808, Anzures, 72530, Puebla, Mexico
- Universidad Popular Autónoma Del Estado de Puebla, 21 Sur 1103, Barrio Santiago, 72410, Puebla, Mexico
| | - Jaime Fragoso-Flores
- Laboratorios Ruiz, Mártires Del 2 de Octubre 808, Anzures, 72530, Puebla, Mexico
- Universidad Popular Autónoma Del Estado de Puebla, 21 Sur 1103, Barrio Santiago, 72410, Puebla, Mexico
| | | | - Marcela Deffis-Court
- Hospital Médica Sur, Puente de Piedra 150, Toriello Guerra, 14050, Ciudad de México, Mexico
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Rodríguez-Lobato LG, Fernández de Larrea C, Cibeira MT, Tovar N, Isola I, Aróstegui JI, Rosiñol L, Díaz T, Lozano E, Yagüe J, Bladé J. Prognostic impact of immunoparesis at diagnosis and after treatment onset in patients with light-chain amyloidosis. Amyloid 2017; 24:245-252. [PMID: 29052436 DOI: 10.1080/13506129.2017.1390451] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Immunoparesis (IP) is a risk factor associated with an unfavourable outcome in several plasma cell disorders. It has been suggested that its presence in light-chain (AL) amyloidosis could be associated with worse prognosis. However, the relevance of IP after treatment has not been evaluated to date. The aim of this study was to determine the prognostic impact of IP at diagnosis and one year after treatment onset in patients with AL amyloidosis. METHODS The clinical records of 69 patients with AL amyloidosis treated at a single institution from January 2006 to January 2016 were included in the study. RESULTS IP was observed in 27.5% of patients at diagnosis. The presence of IP was associated with a lower probability to achieve very good partial response or better after first-line treatment (37.8% versus 62.2%; p = .04). However, only in the group of patients treated with autologous stem cell transplantation (ASCT), the presence of IP resulted in a shorter progression-free survival (PFS) (30.2 months versus not reached [NR]; p = .02) but not in overall survival (OS). Persistence of IP at one year after treatment onset was identified in only four (9.8%) of the 41 evaluable patients. In the ASCT group, the absence of IP at one year after treatment onset resulted in a longer median PFS and OS (NR versus 22.6 months; p = .006; and NR versus 35.2 months; p < .001; respectively). In the multivariate analysis, the absence of IP at one year after treatment onset was independently associated with longer survival. CONCLUSION IP at diagnosis has a negative impact on survival while its absence at one year after treatment is an independent marker for long-term survival.
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Affiliation(s)
- Luis Gerardo Rodríguez-Lobato
- a Department of Hematology , Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona , Barcelona , Spain
| | - Carlos Fernández de Larrea
- a Department of Hematology , Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona , Barcelona , Spain
| | - Maria Teresa Cibeira
- a Department of Hematology , Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona , Barcelona , Spain
| | - Natalia Tovar
- a Department of Hematology , Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona , Barcelona , Spain
| | - Ignacio Isola
- a Department of Hematology , Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona , Barcelona , Spain
| | - Juan I Aróstegui
- b Department of Immunology, Amyloidosis and Myeloma Unit , Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona , Barcelona , Spain
| | - Laura Rosiñol
- a Department of Hematology , Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona , Barcelona , Spain
| | - Tania Díaz
- a Department of Hematology , Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona , Barcelona , Spain
| | - Ester Lozano
- a Department of Hematology , Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona , Barcelona , Spain
| | - Jordi Yagüe
- b Department of Immunology, Amyloidosis and Myeloma Unit , Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona , Barcelona , Spain
| | - Joan Bladé
- a Department of Hematology , Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona , Barcelona , Spain
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