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Ferrante M, Furlan D, Zibellini S, Borriero M, Candido C, Sahnane N, Uccella S, Genuardi E, Alessandria B, Bianchi B, Mora B, Grimaldi D, Defrancesco I, Jiménez C, Cavallo F, Ferrero D, Dogliotti I, Merli M, Varettoni M, Ferrero S, Drandi D. MYD88 L265P Detection in IgM Monoclonal Gammopathies: Methodological Considerations for Routine Implementation. Diagnostics (Basel) 2021; 11:diagnostics11050779. [PMID: 33926007 PMCID: PMC8146978 DOI: 10.3390/diagnostics11050779] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/17/2021] [Accepted: 04/23/2021] [Indexed: 12/19/2022] Open
Abstract
In IgM monoclonal gammopathies MYD88L265P is a prognostic and predictive biomarker of therapy response. MYD88L265P detection is mainly performed by allele-specific quantitative PCR (ASqPCR), however recently, droplet digital PCR (ddPCR) has been proved to be suitable for MYD88L265P screening and minimal residual disease monitoring (MRD). This study compared ASqPCR and ddPCR to define the most sensitive method for MYD88L265P detection in bone marrow (BM), peripheral blood (PB) sorted or unsorted CD19+ cells, and in plasma cell-free DNA (cfDNA). Overall, the analysis showed a good concordance rate (74%) between the two methods, especially in BM samples, while discordances (26%) were mostly in favor of ddPCR (ddPCR+ vs. ASqPCR-) and were particularly evident in samples with low mutational burden, such as PB and cfDNA. This study highlights ddPCR as a feasible approach for MYD88L265P detection across different specimen types (including cfDNA). Interestingly, its high sensitivity makes CD19+ selection dispensable. On the other hand, our results showed that MYD88L265P detection on PB samples, especially with ASqPCR, is suboptimal for screening and MRD analysis. Finally, significantly different MYD88L265P mutational levels observed between Waldenström Macroglobulinemia and IgM monoclonal gammopathy of undetermined significance patients suggest the need for further studies in order to identify possible correlations between mutational levels and risk of progression to Waldenström.
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Affiliation(s)
- Martina Ferrante
- Department of Molecular Biotechnology and Health Sciences, Hematology Division, University of Torino, 10100 Torino, Italy; (M.F.); (M.B.); (E.G.); (B.A.); (D.G.); (F.C.); (D.F.); (D.D.)
| | - Daniela Furlan
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (D.F.); (S.U.)
| | - Silvia Zibellini
- Division of Hematology, IRCCS Foundation, Policlinico San Matteo, 27100 Pavia, Italy; (S.Z.); (C.C.); (I.D.); (M.V.)
| | - Michela Borriero
- Department of Molecular Biotechnology and Health Sciences, Hematology Division, University of Torino, 10100 Torino, Italy; (M.F.); (M.B.); (E.G.); (B.A.); (D.G.); (F.C.); (D.F.); (D.D.)
| | - Chiara Candido
- Division of Hematology, IRCCS Foundation, Policlinico San Matteo, 27100 Pavia, Italy; (S.Z.); (C.C.); (I.D.); (M.V.)
| | - Nora Sahnane
- University Hospital “Ospedale di Circolo e Fondazione Macchi”-ASST Sette Laghi, University of Insubria, 21100 Varese, Italy; (N.S.); (B.B.); (B.M.); (M.M.)
| | - Silvia Uccella
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (D.F.); (S.U.)
| | - Elisa Genuardi
- Department of Molecular Biotechnology and Health Sciences, Hematology Division, University of Torino, 10100 Torino, Italy; (M.F.); (M.B.); (E.G.); (B.A.); (D.G.); (F.C.); (D.F.); (D.D.)
| | - Beatrice Alessandria
- Department of Molecular Biotechnology and Health Sciences, Hematology Division, University of Torino, 10100 Torino, Italy; (M.F.); (M.B.); (E.G.); (B.A.); (D.G.); (F.C.); (D.F.); (D.D.)
| | - Benedetta Bianchi
- University Hospital “Ospedale di Circolo e Fondazione Macchi”-ASST Sette Laghi, University of Insubria, 21100 Varese, Italy; (N.S.); (B.B.); (B.M.); (M.M.)
| | - Barbara Mora
- University Hospital “Ospedale di Circolo e Fondazione Macchi”-ASST Sette Laghi, University of Insubria, 21100 Varese, Italy; (N.S.); (B.B.); (B.M.); (M.M.)
| | - Daniele Grimaldi
- Department of Molecular Biotechnology and Health Sciences, Hematology Division, University of Torino, 10100 Torino, Italy; (M.F.); (M.B.); (E.G.); (B.A.); (D.G.); (F.C.); (D.F.); (D.D.)
| | - Irene Defrancesco
- Division of Hematology, IRCCS Foundation, Policlinico San Matteo, 27100 Pavia, Italy; (S.Z.); (C.C.); (I.D.); (M.V.)
| | - Cristina Jiménez
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), 37001 Salamanca, Spain;
| | - Federica Cavallo
- Department of Molecular Biotechnology and Health Sciences, Hematology Division, University of Torino, 10100 Torino, Italy; (M.F.); (M.B.); (E.G.); (B.A.); (D.G.); (F.C.); (D.F.); (D.D.)
- Hematology, A.O.U. Città della Salute e della Scienza, University of Torino, 10100 Torino, Italy
| | - Dario Ferrero
- Department of Molecular Biotechnology and Health Sciences, Hematology Division, University of Torino, 10100 Torino, Italy; (M.F.); (M.B.); (E.G.); (B.A.); (D.G.); (F.C.); (D.F.); (D.D.)
- Hematology, A.O.U. Città della Salute e della Scienza, University of Torino, 10100 Torino, Italy
| | - Irene Dogliotti
- Stem Cell Transplant Unit, University Hospital AOU Città della Salute e della Scienza, 10100 Torino, Italy;
| | - Michele Merli
- University Hospital “Ospedale di Circolo e Fondazione Macchi”-ASST Sette Laghi, University of Insubria, 21100 Varese, Italy; (N.S.); (B.B.); (B.M.); (M.M.)
| | - Marzia Varettoni
- Division of Hematology, IRCCS Foundation, Policlinico San Matteo, 27100 Pavia, Italy; (S.Z.); (C.C.); (I.D.); (M.V.)
| | - Simone Ferrero
- Department of Molecular Biotechnology and Health Sciences, Hematology Division, University of Torino, 10100 Torino, Italy; (M.F.); (M.B.); (E.G.); (B.A.); (D.G.); (F.C.); (D.F.); (D.D.)
- Hematology, A.O.U. Città della Salute e della Scienza, University of Torino, 10100 Torino, Italy
- Correspondence: ; Tel.: +39-388-064-3900
| | - Daniela Drandi
- Department of Molecular Biotechnology and Health Sciences, Hematology Division, University of Torino, 10100 Torino, Italy; (M.F.); (M.B.); (E.G.); (B.A.); (D.G.); (F.C.); (D.F.); (D.D.)
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Lee AYS, Lin MW. Polymeric IgA paraprotein on agarose gel electrophoresis immunofixation identifies a unique subset of IgA myeloma patients. Clin Chim Acta 2020; 512:112-116. [PMID: 33127346 DOI: 10.1016/j.cca.2020.10.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/13/2020] [Accepted: 10/22/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES On agarose gel electrophoresis, IgA paraprotein has a tendency to polymerise and form multiple bands on immunofixation. We decided to investigate if there are any differences in clinical parameters with monomeric vs. polymeric IgA paraprotein multiple myeloma (MM) patients. METHODS During an 18-month retrospective and prospective cross-sectional audit review period at one Australian laboratory, we identified 92 IgA MM patients that were divided up according to monomeric or polymeric IgA paraproteins based on their appearance on IFE. Medical and pathology records were reviewed for demographic details, and laboratory data to examine for end-organ manifestations of MM. RESULTS After correcting for age, polymeric IgA MM patients had a greater degree of proteinuria and hence, higher incidence of hypogammaglobulinaemia. The patients tended to have a higher quantity of paraprotein as well. No difference in mortality was seen. CONCLUSIONS Our study is the first to stratify IgA MM patients according to the laboratory appearance of their paraprotein and may hold important prognostic and predictive clues for these patients.
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Affiliation(s)
- Adrian Y S Lee
- Department of Immunopathology, NSW Pathology and Institute of Clinical Pathology and Medical Research, Westmead Hospital, NSW, Australia; Sydney Medical School, The University of Sydney, NSW, Australia
| | - Ming-Wei Lin
- Department of Immunopathology, NSW Pathology and Institute of Clinical Pathology and Medical Research, Westmead Hospital, NSW, Australia; Sydney Medical School, The University of Sydney, NSW, Australia.
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Immunoglobulin M Paraproteinaemias. Cancers (Basel) 2020; 12:cancers12061688. [PMID: 32630470 PMCID: PMC7352433 DOI: 10.3390/cancers12061688] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/14/2020] [Accepted: 06/23/2020] [Indexed: 12/11/2022] Open
Abstract
Monoclonal paraproteinaemia is an increasingly common reason for referral to haematology services. Paraproteinaemias may be associated with life-threatening haematologic malignancies but can also be an incidental finding requiring only observation. Immunoglobulin M (IgM) paraproteinaemias comprise 15–20% of monoclonal proteins but pose unique clinical challenges. IgM paraproteins are more commonly associated with lymphoplasmacytic lymphoma than multiple myeloma and can occur in a variety of other mature B-cell neoplasms. The large molecular weight of the IgM multimer leads to a spectrum of clinical manifestations more commonly seen with IgM paraproteins than others. The differential diagnosis of B-cell and plasma cell dyscrasias associated with IgM gammopathies can be challenging. Although the discovery of MYD88 L265P and other mutations has shed light on the molecular biology of IgM paraproteinaemias, clinical and histopathologic findings still play a vital role in the diagnostic process. IgM secreting clones are also associated with a number of “monoclonal gammopathy of clinical significance” entities. These disorders pose a novel challenge from both a diagnostic and therapeutic perspective. In this review we provide a clinical overview of IgM paraproteinaemias while discussing the key advances which may affect how we manage these patients in the future.
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Lin P, Molina TJ, Cook JR, Swerdlow SH. Lymphoplasmacytic lymphoma and other non-marginal zone lymphomas with plasmacytic differentiation. Am J Clin Pathol 2011; 136:195-210. [PMID: 21757593 DOI: 10.1309/ajcp8foivtb6lber] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Small B-cell lymphomas with plasmacytic differentiation frequently present diagnostic challenges. Session 3 of the 2009 Society for Hematopathology/European Association for Haematopathology Workshop focused on lymphoplasmacytic lymphoma (LPL). The submitted cases illustrated classic examples of bone marrow-based and nodal LPL and cases with atypical features, including unusual phenotypes or involvement of extranodal sites. Several cases showed varying degrees of overlap with marginal zone lymphoma, and, as acknowledged in the 2008 World Health Organization classification, a definitive distinction between these 2 possibilities cannot always be established. Session 6 of the workshop focused on other non-marginal zone lymphomas that may display plasmacytic differentiation. This session highlights the wide variety of neoplasms that enter into the differential diagnosis of small B-cell lymphomas with plasmacytic differentiation and demonstrates the use of clinical features and ancillary studies in establishing an appropriate diagnosis by 2008 World Health Organization criteria.
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Larsson A, Hansson LO. Comparison between a second generation automated multicapillary electrophoresis system with an automated agarose gel electrophoresis system for the detection of M-components. Ups J Med Sci 2008; 113:65-72. [PMID: 18521800 DOI: 10.3109/2000-1967-219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
During the last decade, capillary electrophoresis (CE) has emerged as an interesting alternative to traditional analysis of serum, plasma and urine proteins by agarose gel electrophoresis. Initially there was a considerable difference in resolution between the two methods but the quality of CE has improved significantly. We thus wanted to evaluate a second generation of automated multicapillary instruments (Capillarys, Sebia, Paris, France) and the high resolution (HR) buffer for serum or plasma protein analysis with an automated agarose gel electrophoresis system for the detection of M-components. The comparison between the two systems was performed with patients samples with and without M-components. The comparison included 76 serum samples with M-components > 1 g/L. There was a total agreement between the two methods for detection of these M-components. When studying samples containing oligoclonal bands/small M-components, there were differences between the two systems. The capillary electrophoresis system detected a slightly higher number of samples with oligoclonal bands but the two systems found oligoclonal bands in different samples. When looking at resolution, the agarose gel electrophoresis system yielded a slightly better resolution in the alpha and beta regions, but it required an experienced interpreter to be able to benefit from the increased resolution. The capillary electrophoresis has shorter turn-around times and bar-code reader that allows positive sample identification. The Capillarys in combination with HR buffer gives better resolution of the alpha and beta regions than the same instrument with the beta1-beta2+ buffer or the Paragon CZE2000 (Beckman) which was the first generation of capillary electrophoresis systems.
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Affiliation(s)
- Anders Larsson
- Department of Medical Sciences, Clinical Chemistry, University Hospital, Uppsala, Sweden.
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Gnerre P, Ottonello L, Montecucco F, Boero M, Dallegri F. Nephrotic syndrome in a patient with IgM myeloma with associated neutrophilia. Eur J Haematol 2007; 79:76-80. [PMID: 17598840 DOI: 10.1111/j.1600-0609.2007.00869.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
An unusual case having IgM monoclonal gammopathy with clinical and pathologic features of multiple myeloma (MM) in association with neutrophilia and nephrotic syndrome is reported. The patient showed lytic bone lesions, decreased IgG and IgA levels, Bence-Jones proteinuria, nephrotic proteinuria with edema, and histological plasma cell infiltration typical of MM. Moreover, mature neutrophilic leukocytosis, hepatomegaly, high leukocyte alkaline phosphatase score (LAP), absence of Philadelphia (Ph) chromosome and bcr gene rearrangement were also evidenced, all these features representing findings typical of the recently described plasma cell dyscrasia-associated neutrophilia. After the diagnosis, the patient was treated with melphalan and prednisone, with an excellent response to the treatment. Different from the 30 cases so far reported, this is the first case of plasma-cell dyscrasia with associated neutrophilia due to IgM-producing monoclonal gammopathy. At the same time, this is the first reported case of nephrotic syndrome secondary to IgM myeloma.
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Affiliation(s)
- Paola Gnerre
- First Clinic of Internal Medicine, Department of Internal Medicine and Medical Specialties, University of Genoa Medical School, Genoa, Italy
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Mullen EC, Wang M. Recognizing hyperviscosity syndrome in patients with Waldenstrom macroglobulinemia. Clin J Oncol Nurs 2007; 11:87-95. [PMID: 17441400 DOI: 10.1188/07.cjon.87-95] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hyperviscosity syndrome can develop in patients with plasma cell dyscrasias, particularly Waldenstrom macroglobulinemia (WM). Occurring in 10%-30% of patients with hyperviscosity syndrome, WM is an uncommon B-cell proliferative disorder characterized by bone marrow infiltration and production of monoclonal immunoglobulin M. The elevated blood viscosity in WM is the result of increased circulating serum immunoglobulin M. Because hyperviscosity syndrome can be lethal, it must be recognized and managed early. Hyperviscosity syndrome has a triad presentation: vision changes, neurologic abnormalities, and bleeding. Treatment includes hydration with diuresis, plasmapheresis, and control of the underlying disease. The current treatment for WM is chemotherapy (i.e., alkylating agents and nucleoside analogs) and the monoclonal antibody rituximab. Although hyperviscosity syndrome is not one of the most common conditions, when it does occur, oncology nurses play a critical role in patients' assessment and care.
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Affiliation(s)
- Ellen C Mullen
- University of Texas M.D. Anderson Cancer Center, Houston, USA.
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Larsson A, Lindqvist A, Hillered L. Pseudoparaproteinemia Detected by CE due to Omnipaque™ Infusion: A Case Report. Chromatographia 2007. [DOI: 10.1365/s10337-007-0242-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Larsson A, Schneider K, Hansson LO, Knutsson F. Capillary electrophoresis for monitoring the effects of plasmapheresis: a feasibility study. Transfus Apher Sci 2005; 33:19-23. [PMID: 15953765 DOI: 10.1016/j.transci.2005.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2004] [Accepted: 04/01/2005] [Indexed: 11/28/2022]
Abstract
Plasmapheresis is an established method to treat patients with large monoclonal gammopathies (M-components) that increases the blood viscosity. During plasmapheresis the patient plasma is substituted with a mixture of saline, albumin and normal plasma. The treatment results in a reduction of the M-component in the circulation. Plasmapheresis causes changes in several proteins, which makes monitoring by nephelometric or turbidimetric analysis of specific proteins less suitable. Quantification of paraproteins by nephelometric assays are also known to be associated with technical problems. An alternative could be agarose gel electrophoresis but this method is too slow to permit monitoring during the plasmapheresis. Capillary electrophoresis of plasma proteins can be performed in less than 10 min. We have used the CAPILLARYS capillary electrophoresis system (Sebia, Paris, France) to monitor the effect of plasmapheresis treatment on 22 occasions. The mean reduction in M-component size was 51%, range 33-61%. Capillary electrophoresis is a rapid and inexpensive method that could be used to monitor the effect of plasmapheresis during the actual treatment.
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Affiliation(s)
- Anders Larsson
- Department of Medical Sciences, Clinical Chemistry, University Hospital, S-751 85 Uppsala, Sweden.
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Larsson A, Hansson LO. Analysis of inflammatory response in human plasma samples by an automated multicapillary electrophoresis system. Clin Chem Lab Med 2005; 42:1396-400. [PMID: 15576302 DOI: 10.1515/cclm.2004.260] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A new automated multicapillary zone electrophoresis instrument with a new high-resolution (HR) buffer (Capillarys with HR buffer) for analysis of human plasma proteins was evaluated. Albumin, alpha(1)-antitrypsin, alpha(1)-acid glycoprotein, haptoglobin, fibrinogen, immunoglobulin (Ig)A, IgG and IgM were determined nephelometrically in 200 patient plasma samples. The same samples were then analyzed on the Capillarys system (Sebia, Paris, France). The albumin concentration from the nephelometric determination was used for quantification of the individual peaks in the capillary electrophoresis (CE) electropherogram. There was strong linear correlation between the nephelometric and electrophoretic determination of alpha(1)-antitrypsin (R(2) = 0.906), alpha(1)-acid glycoprotein (R(2) =0.894) and haptoglobin (R(2) = 0.913). There was also good correlation between the two determinations of gamma-globulins (R(2) = 0.883), while the correlation was weaker for fibrinogen (R(2) = 0.377). The Capillarys instrument is a reliable system for plasma protein analysis, combining the advantages of full automation, good analytical performance and high throughput. The HR buffer in combination with albumin quantification allows the simultaneous quantification of inflammatory markers in plasma samples without the need for nephelometric determination of these proteins.
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Affiliation(s)
- Anders Larsson
- Department of Medical Sciences, Clinical Chemistry, University Hospital, 751 85 Uppsala, Sweden.
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Berth M, Delanghe J. Protein precipitation as a possible important pitfall in the clinical chemistry analysis of blood samples containing monoclonal immunoglobulins: 2 case reports and a review of the literature. Acta Clin Belg 2004; 59:263-73. [PMID: 15641396 DOI: 10.1179/acb.2004.039] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Two case reports are presented, both illustrating an analytical interference caused by monoclonal immunoglobulins. Falsely low results were obtained in the routine analysis of glucose, CRP and HDL-cholesterol. When analysing samples containing paraproteins, various problems can be encountered in the clinical laboratory: next to the antibody effect, pseudohyponatraemia, hyperviscosity, cryoglobulinaemia and gel formation have to be taken into account. In our two cases the interference was caused by paraprotein precipitation, causing an increased turbidity and an apparent increase of light absorbance at every wavelength due to light scattering, including the wavelengths used in the clinical chemistry assays. We review the literature on this sometimes overlooked interference in photometric/turbidimetric assays. This reaction is based on the insolubility of these proteins in specific physico-chemical circumstances in which many variables are involved, among others: pH and ionic strength, presence of preservatives and surfactants in the assays, pI and other specific properties of the monoclonal immunoglobulins. The complexity of the problem makes predicting or preventing this probably infrequent interference usually impossible. This artifact can cause both false positive and false negative results in multiple parameters (e.g. bilirubin, creatinine, iron, urea, uric acid), the most frequently reported analyte being phosphate. The Sia water test (Sia euglobulin precipitation test) can provide a first clue to a paraprotein aggregation; confirmation can be obtained by observing the time/ absorbance curves of the analysis, performing the test manually or setting up a serial dilution of the sample. The problem can be solved by avoiding the presence of the proteins in the assay, performing the analysis using an alternative method or diluting out the interference. Both laboratorians and clinicians should be aware of interferences in the clinical laboratory since the clinical consequences could be important.
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Affiliation(s)
- M Berth
- Universitair Ziekenhuis Gent, Laboratorium Klinische Biologie, De Pintelaan 185, 9000 Gent, Belgium.
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Lin P, Bueso-Ramos C, Wilson CS, Mansoor A, Medeiros LJ. Waldenstrom macroglobulinemia involving extramedullary sites: morphologic and immunophenotypic findings in 44 patients. Am J Surg Pathol 2003; 27:1104-13. [PMID: 12883242 DOI: 10.1097/00000478-200308000-00007] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Waldenstrom macroglobulinemia (WM) is a clinicopathologic syndrome in which a B-cell neoplasm involving the bone marrow, usually lymphoplasmacytic lymphoma (LPL), is associated with immunoglobulin M paraprotein in the serum. Extramedullary involvement occurs in a subset of patients and is infrequently examined histologically. The files of M.D. Anderson Cancer Center were searched for patients with WM who underwent biopsy of one or more extramedullary sites during the course of disease. Each biopsy specimen was classified using the criteria of the World Health Organization classification. The study group consisted of 44 patients (26 men and 18 women), with a total of 51 specimens obtained from lymph nodes (n = 36), soft tissue (n = 4), spleen (n = 3), skin (n = 2), lung (n = 2), tonsils (n = 1), colon (n = 1), liver (n = 1), and gallbladder (n = 1). Lymphoplasmacytic lymphoma was the most common histologic type, in 40 (78%) samples. This category was morphologically heterogeneous and was further subclassified as lymphoplasmacytic (n = 21), lymphoplasmacytoid (n = 18), and polymorphous (n = 1). Four of these LPL cases morphologically resembled marginal zone B-cell lymphoma. Four additional samples were involved by diffuse large B-cell lymphoma, probably transformed from LPL. Three more samples were involved by LPL with unusual features: two were CD5-positive and one was a composite tumor with classical Hodgkin's disease. Other categories of lymphoma in this group of patients with WM included small lymphocytic lymphoma/chronic lymphocytic leukemia (n = 2), mantle cell lymphoma (n = 1), and follicular lymphoma (n = 1). Waldenstrom macroglobulinemia is most commonly associated with LPL but can rarely occur with other types of B-cell lymphoma. Lymphoplasmacytic lymphoma in patients with WM is morphologically heterogeneous and can be indistinguishable from marginal zone B-cell lymphoma. CD5+ B-cell lymphomas with features otherwise typical of LPL are rare, and we think these tumors are part of the spectrum of LPL.
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Affiliation(s)
- Pei Lin
- Department of Hematopathology, University of Texas, MD Anderson Cancer Center, Houston, Texas 77030, USA.
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