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Xu A, Guo T, Zhang S, Luo H, Shen M, Ye Y, Ji L. Prevalence of monoclonal gammopathy of undetermined significance in Shenzhen, China. Hematology 2024; 29:2352686. [PMID: 38819332 DOI: 10.1080/16078454.2024.2352686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/03/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Data on the prevalence of monoclonal gammopathy of undetermined significance (MGUS) in China are very limited. Our aim was to determine the prevalence and clinical characteristics of MGUS in a large Chinese population. METHODS This study included 49,220 healthy people who received serum immunofixation electrophoresis (sIFE) and serum protein electrophoresis (SPE) tests. Serum free light chain ratio, immunoglobulin quantification, and other clinically correlates of MGUS were performed for all patients with M-protein. RESULTS A total of 576 MGUS patients were identified by sIFE, with a median age of 58 years and an overall prevalence of 1.17% (95% CI, 1.08-1.27). Among those aged 50 years and older, the prevalence of MGUS was 2.26% (95% CI, 2.04-2.50). The prevalence of MGUS was significantly higher in males than in females (P < 0.05). The median concentration of M-protein was 3.1 g/L, ranging from 0.5 g/L to 25.1 g/L. The M-protein type was IgG in 55.4% of MGUS patients, followed by IgA (31.1%), IgM (9.5%), IgD (0.5%), biclonal (2.3%), and light chain (1.2%). Abnormalities in SPE, FLC ratios, and immunoglobulin levels were observed in 78.3%, 31.1%, and 38.4% of MGUS patients, respectively. CONCLUSIONS The prevalence of MGUS is substantially lower in southern China than in whites and blacks.
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Affiliation(s)
- Anping Xu
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, People's Republic of China
| | - Tong Guo
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, People's Republic of China
| | - Shuping Zhang
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, People's Republic of China
| | - Houlong Luo
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, People's Republic of China
| | - Mengxue Shen
- Department of Laboratory Medicine, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Yinghui Ye
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, People's Republic of China
| | - Ling Ji
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, People's Republic of China
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2
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Salinas M, Flores E, Blasco A, Lopez-Garrigós M, Torreblanca R, Leiva-Salinas M, Gutierrez I, Leiva-Salinas C. Laboratory reflex testing strategy for the early identification of primary care patients with multiple myeloma. Clin Biochem 2024; 126:110730. [PMID: 38387751 DOI: 10.1016/j.clinbiochem.2024.110730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVES Our objective was to shorten the screen for multiple myeloma (MM), through reflex testing. DESIGN AND METHODS The clinical laboratory in the public University Hospital of San Juan (Alicante, Spain), serves 234,551 inhabitants. Through an intervention agreed with general practitioners, the Laboratory Information System (LIS) automatically registered serum immunoglobulins (Ig) when serum total proteins (STP) > 80 g/L for the first time in primary care patients. When concomitantly one Ig presented a value above and one below its reference interval, the LIS automatically registered a serum protein electrophoresis (SPEP). When a monoclonal peak in SPEP, immunofixation electrophoresis (IFE) for the typification of monoclonal bands (MB) was performed. If MB were present, a comment in the report explained the intervention. The number of additionally registered Ig, SPEP, IFE, and new diagnosis of MM were counted. The number of days elapsed from the report of elevated STP result to the final MM diagnosis was also counted as median and interquartile range (IQR), and compared to a pre intervention period. RESULTS 2071 cases of hyperproteinemia were identified, and had 91 a monoclonal peak, confirmed by IFE. In 35 patients it was a new finding, and 9 were diagnosed with MM, 3 Waldestrom macroglobulinemia, 2 lymphoplasmacytic lymphoma and 21 monoclonal gammopathy of undetermined significance. The number of days elapsed from hyperproteinemia to diagnosis was lower in the intervention period (21.5 vs 119.4) (P < 0.01). As our results show, in addition to shortening the time to diagnosis, an increased rate of detection of plasma cell disorders was observed when using our algorithm. CONCLUSIONS The above laboratory interventions agreed with clinicians, making use of laboratory technology resulted in early identification of MM.
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Affiliation(s)
- Maria Salinas
- Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain; Department of Biochemistry and Molecular Pathology, Universidad Miguel Hernandez, Elche, Spain.
| | - Emilio Flores
- Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain; Department of Clinical Medicine, Universidad Miguel Hernandez, Elche, Spain.
| | - Alvaro Blasco
- Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain
| | - Maite Lopez-Garrigós
- Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain; Department of Biochemistry and Molecular Pathology, Universidad Miguel Hernandez, Elche, Spain
| | - Ruth Torreblanca
- Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain
| | - María Leiva-Salinas
- Department of Dermatology, Hospital General Universitario Los Arcos del Mar Menor, Murcia, Spain
| | - Irene Gutierrez
- Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain.
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Lim SM, Wijeratne N, Choy KW, Nguyen TTH, Setiawan L, Loh TP. A review of clinical guidelines, laboratory recommendations and external quality assurance programs for monoclonal gammopathy testing. Crit Rev Clin Lab Sci 2024; 61:107-126. [PMID: 37776896 DOI: 10.1080/10408363.2023.2257306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/06/2023] [Indexed: 10/02/2023]
Abstract
Monoclonal gammopathy (MG) is a spectrum of diseases ranging from the benign asymptomatic monoclonal gammopathy of undetermined significance to the malignant multiple myeloma. Clinical guidelines and laboratory recommendations have been developed to inform best practices in the diagnosis, monitoring, and management of MG. In this review, the pathophysiology, relevant laboratory testing recommended in clinical practice guidelines and laboratory recommendations related to MG testing and reporting are examined. The clinical guidelines recommend serum protein electrophoresis, serum immunofixation and serum free light chain measurement as initial screening. The laboratory recommendations omit serum immunofixation as it offers limited additional diagnostic value. The laboratory recommendations offer guidance on reporting findings beyond monoclonal protein, which was not required by the clinical guidelines. The clinical guidelines suggested monitoring total IgA concentration by turbidimetry or nephelometry method if the monoclonal protein migrates in the non-gamma region, whereas the laboratory recommendations make allowance for involved IgM and IgG. Additionally, several external quality assurance programs for MG protein electrophoresis and free light chain testing are also appraised. The external quality assurance programs show varied assessment criteria for protein electrophoresis reporting and unit of measurement. There is also significant disparity in reported monoclonal protein concentrations with wide inter-method analytical variation noted for both monoclonal protein quantification and serum free light chain measurement, however this variation appears smaller when the same method was used. Greater harmonization among laboratory recommendations and reporting format may improve clinical interpretation of MG testing.
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Affiliation(s)
| | - Nilika Wijeratne
- Dorevitch Pathology, Melbourne, Australia
- School of Clinical Sciences at Monash Health, Department of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
- Eastern Health Pathology, Eastern Health, Box Hill, Australia
- Dorevitch Pathology, Heidelberg, Australia
| | | | | | - Lyana Setiawan
- Dharmais Hospital National Cancer Centre, West Jakarta, Indonesia
| | - Tze Ping Loh
- National University Hospital, Singapore, Singapore
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4
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Guan L, Su W, Zhong J, Qiu L. M-protein detection by mass spectrometry for minimal residual disease in multiple myeloma. Clin Chim Acta 2024; 552:117623. [PMID: 37924928 DOI: 10.1016/j.cca.2023.117623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 11/06/2023]
Abstract
Multiple myeloma (MM) is characterized by excessive production of monoclonal immunoglobulins (M proteins). Routine screening methods for M proteins to assess prognosis are unable to detect low levels of M proteins produced by residual tumor cells, ie, minimal residual disease (MRD). Assessment of MRD can be conducted by examining residual tumor cells in bone marrow or circulating M proteins. Advances in mass spectrometry have enabled reliable and highly sensitive detection of low abundance serum biomarkers making it a viable and significantly less invasive approach. Mass spectrometry can achieve dynamic monitoring of MRD and identify therapeutic monoclonal antibodies as well as oligoclonal proteins. In this review we summarize mass spectrometry methods in M protein detection and their applications of MRD detection in MM.
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Affiliation(s)
- Lihua Guan
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, PR China
| | - Wei Su
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, PR China
| | - Jian Zhong
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, PR China
| | - Ling Qiu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, PR China; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, PR China.
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5
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Cárdenas MC, García-Sanz R, Puig N, Pérez-Surribas D, Flores-Montero J, Ortiz-Espejo M, de la Rubia J, Cruz-Iglesias E. Recommendations for the study of monoclonal gammopathies in the clinical laboratory. A consensus of the Spanish Society of Laboratory Medicine and the Spanish Society of Hematology and Hemotherapy. Part I: Update on laboratory tests for the study of monoclonal gammopathies. Clin Chem Lab Med 2023; 61:2115-2130. [PMID: 37477188 DOI: 10.1515/cclm-2023-0326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/29/2023] [Indexed: 07/22/2023]
Abstract
Monoclonal gammopathies (MG) are characterized by the proliferation of plasma cells that produce identical abnormal immunoglobulins (intact or some of their subunits). This abnormal immunoglobulin component is called monoclonal protein (M-protein), and is considered a biomarker of proliferative activity. The identification, characterization and measurement of M-protein is essential for the management of MG. We conducted a systematic review of the different tests and measurement methods used in the clinical laboratory for the study of M-protein in serum and urine, the biochemistry and hematology tests necessary for clinical evaluation, and studies in bone marrow, peripheral blood and other tissues. This review included literature published between 2009 and 2022. The paper discusses the main methodological characteristics and limitations, as well as the purpose and clinical value of the different tests used in the diagnosis, prognosis, monitoring and assessment of treatment response in MG. Included are methods for the study of M-protein, namely electrophoresis, measurement of immunoglobulin levels, serum free light chains, immunoglobulin heavy chain/light chain pairs, and mass spectrometry, and for the bone marrow examination, morphological analysis, cytogenetics, molecular techniques, and multiparameter flow cytometry.
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Affiliation(s)
- María C Cárdenas
- Department of Clinical Analysis, Hospital Clinico San Carlos, Madrid, Spain
- Protein Commission, Spanish Society of Laboratory Medicine (SEQCML), Barcelona, Spain
| | - Ramón García-Sanz
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (University of Salamanca-CSIC), Salamanca, Spain
- Spanish Society of Hematology and Hemotherapy (SEHH), Madrid, Spain
| | - Noemí Puig
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (University of Salamanca-CSIC), Salamanca, Spain
- Spanish Society of Hematology and Hemotherapy (SEHH), Madrid, Spain
| | - David Pérez-Surribas
- Laboratori Pasteur, Andorra La Vella, Andorra
- Protein Commission, Spanish Society of Laboratory Medicine (SEQCML), Barcelona, Spain
| | - Juan Flores-Montero
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (University of Salamanca-CSIC), Salamanca, Spain
- Spanish Society of Hematology and Hemotherapy (SEHH), Madrid, Spain
| | - María Ortiz-Espejo
- Department of Clinical Analysis, Hospital Universitario Marqués de Valdecilla, Santander, Spain
- Protein Commission, Spanish Society of Laboratory Medicine (SEQCML), Barcelona, Spain
| | - Javier de la Rubia
- Hematology Department, Hospital Universitario y Politécnico La Fe & Universidad Católica de Valencia, Instituto de Investigación Sanitaria La Fe Centro de Investigación Biomédica en Red de Cáncer, CIBERONC CB16/12/00284, Instituto de Salud Carlos III, Valencia, Spain
- Spanish Society of Hematology and Hemotherapy (SEHH), Madrid, Spain
| | - Elena Cruz-Iglesias
- Department of Laboratory Medicine, Osakidetza Basque Health Service, Basurto University Hospital, Bilbao, Spain
- Protein Commission, Spanish Society of Laboratory Medicine (SEQCML), Barcelona, Spain
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6
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Chong YP, Lim SM, Loh TP, Mollee P, Wijeratne N, Choy KW. Screening for and diagnosis of monoclonal gammopathy. J Clin Pathol 2023; 76:727-733. [PMID: 37604683 DOI: 10.1136/jcp-2023-208774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/03/2023] [Indexed: 08/23/2023]
Abstract
Monoclonal gammopathy is a spectrum of disorders characterised by clonal proliferation of plasma cells or lymphocytes, which produce abnormal immunoglobulin or its components (monoclonal proteins). Monoclonal gammopathies are often categorised as low-tumour-burden diseases (eg, amyloid light chain (AL) amyloidosis), premalignant disorders (such as monoclonal gammopathy of undetermined significance and smouldering multiple myeloma), and malignancies (eg, multiple myeloma and Waldenström's macroglobulinaemia). Such diversity of concentration and structure makes monoclonal protein a challenging clonal marker. This article provides an overview on initial laboratory testing of monoclonal gammopathy to guide clinicians and laboratory professionals in the selection and interpretation of appropriate investigations.
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Affiliation(s)
- Yuh Ping Chong
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Say Min Lim
- Department of Pathology, Hospital Teluk Intan, Teluk Intan, Malaysia
| | - Tze Ping Loh
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Peter Mollee
- Pathology Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Nilika Wijeratne
- Dorevitch Pathology, Heidelberg, Victoria, Australia
- School of Clinical Sciences at Monash Health, Department of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Eastern Health Pathology, Eastern Health, Box Hill, Victoria, Australia
| | - Kay Weng Choy
- Department of Pathology, Northern Health, Epping, Victoria, Australia
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7
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Mundt F, Albrechtsen NJW, Mann SP, Treit P, Ghodgaonkar-Steger M, O’Flaherty M, Raijmakers R, Vizcaíno JA, Heck AJ, Mann M. Foresight in clinical proteomics: current status, ethical considerations, and future perspectives. OPEN RESEARCH EUROPE 2023; 3:59. [PMID: 37645494 PMCID: PMC10446044 DOI: 10.12688/openreseurope.15810.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 08/31/2023]
Abstract
With the advent of robust and high-throughput mass spectrometric technologies and bioinformatics tools to analyze large data sets, proteomics has penetrated broadly into basic and translational life sciences research. More than 95% of FDA-approved drugs currently target proteins, and most diagnostic tests are protein-based. The introduction of proteomics to the clinic, for instance to guide patient stratification and treatment, is already ongoing. Importantly, ethical challenges come with this success, which must also be adequately addressed by the proteomics and medical communities. Consortium members of the H2020 European Union-funded proteomics initiative: European Proteomics Infrastructure Consortium-providing access (EPIC-XS) met at the Core Technologies for Life Sciences (CTLS) conference to discuss the emerging role and implementation of proteomics in the clinic. The discussion, involving leaders in the field, focused on the current status, related challenges, and future efforts required to make proteomics a more mainstream technology for translational and clinical research. Here we report on that discussion and provide an expert update concerning the feasibility of clinical proteomics, the ethical implications of generating and analyzing large-scale proteomics clinical data, and recommendations to ensure both ethical and effective implementation in real-world applications.
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Affiliation(s)
- Filip Mundt
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nicolai J. Wewer Albrechtsen
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, University Hospital, Bispebjerg Hospital, Bispebjerg, Denmark
| | | | - Peter Treit
- Max Planck Institute of Biochemistry, Proteomics and Signal Transduction, Martinsried, Germany
| | | | - Martina O’Flaherty
- Biomolecular Mass Spectrometry and Proteomics, Bijvoet Centre for Biomolecular Research and Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Padualaan 8, Utrecht 3584 CH, The Netherlands
| | - Reinout Raijmakers
- Biomolecular Mass Spectrometry and Proteomics, Bijvoet Centre for Biomolecular Research and Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Padualaan 8, Utrecht 3584 CH, The Netherlands
| | - Juan Antonio Vizcaíno
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Wellcome Trust Genome Campus, Hinxton, Cambridge, CB10 1SD, UK
| | - Albert J.R. Heck
- Biomolecular Mass Spectrometry and Proteomics, Bijvoet Centre for Biomolecular Research and Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Padualaan 8, Utrecht 3584 CH, The Netherlands
| | - Matthias Mann
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Max Planck Institute of Biochemistry, Proteomics and Signal Transduction, Martinsried, Germany
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8
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Moonen DH, Kohlhagen M, Dasari S, Willrich MA, Kourelis T, Dispenzieri A, Murray DL. Utilizing Mass Spectrometry to Detect and Isotype Monoclonal Proteins in Urine: Comparison to Electrophoretic Methods. Clin Chem 2023:7179826. [PMID: 37228061 DOI: 10.1093/clinchem/hvad053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 04/10/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Matrix assisted laser desorption ionization time of flight mass spectrometry coupled to immune enrichment (MASS-FIX) as an alternative to serum immunofixation electrophoresis has demonstrated increased sensitivity in monoclonal protein (MP) detection with improved laboratory workflow. This study explored similar replacement of urine immunofixation electrophoresis (u-IFE) with urine MASS-FIX (u-MASS-FIX) by method comparison. METHODS Residual urine (n = 1008) from Mayo Clinic patients with a known plasma cell disease were assayed neat by u-MASS-FIX analysis. Each sample was paired with the following: u-IFE, urine total protein, urine protein electrophoresis, serum κ/λ free light chain (LC) ratio (rFLC), and serum MASS-FIX (s-MASS-FIX). Analytical sensitivities were measured in pooled urine spiked with daratumumab. RESULTS u-IFE and u-MASS-FIX had 91% agreement in determining the presence/absence of MPs (Cohen kappa = 0.8200). In discrepant cases, serum rFLC statistically aligned more closely with positive u-MASS-FIX cases than u-IFE. Patients positive by both s-MASS-FIX and u-MASS-FIX had matching MP masses (±20 daltons) in 94% of cases. The u-MASS-FIX spectra further identified κ/λ LC fragments and glycosylated LCs not appreciated on u-IFE. The unconcentrated u-MASS-FIX limit of detection of 0.156 mg/mL was determined equivalent to 100× concentrated u-IFE. CONCLUSION u-MASS-FIX is a reliable alternative to u-IFE with the added benefits of LC glycosylation detection and MP mass tracking between serum and urine. Furthermore, u-MASS-FIX is performed using neat urine. Eliminating the need to concentrate urine for u-IFE has potential to increase productivity by decreasing labor minutes per test.
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Affiliation(s)
- Danelle H Moonen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Mindy Kohlhagen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Surendra Dasari
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Maria A Willrich
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Taxiarchis Kourelis
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Angela Dispenzieri
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - David L Murray
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
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Monroig-Rivera CA, Cruz CNF. Unusual biclonal IgA plasma cell myeloma with aberrant expression of high-risk immunophenotypes: first report of a new diagnostic and clinical challenge. J Pathol Transl Med 2023; 57:132-137. [PMID: 36950814 PMCID: PMC10028011 DOI: 10.4132/jptm.2023.02.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 02/07/2023] [Indexed: 03/24/2023] Open
Abstract
IgA plasma cell myeloma (PCM) has been linked to molecular abnormalities that confer a higher risk for adverse patient outcomes. However, since IgA PCM only accounts for approximately 20% of all PCM, there are very few reports on high-risk IgA PCM. Moreover, no such reports are found on the more infrequent biclonal IgA PCM. Hence, we present a 65-year-old Puerto Rican female with acute abdominal pain, concomitant hypercalcemia, and acute renal failure. Protein electrophoresis with immunofixation found high IgA levels and detected a biclonal IgA gammopathy with kappa specificity. Histomorphologically, bone marrow showed numerous abnormal plasma cells (32%) replacing over 50% of the marrow stroma. Immunophenotyping analysis detected CD45-negative plasma cells aberrantly expressing CD33, CD43, OCT-2, and c-MYC. Chromosomal analysis revealed multiple abnormalities including the gain of chromosome 1q. Thus, we report on an unusual biclonal IgA PCM and the importance of timely diagnosing aggressive plasma cell neoplasms.
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Affiliation(s)
| | - Clara N Finch Cruz
- Department of Basic Sciences, School of Medicine - Ponce Health Sciences University, Ponce, Puerto Rico, USA
- Southern Pathology Services, Inc., Ponce, Puerto Rico, USA
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10
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Pearson DS, McEvoy DS, Murali MR, Dighe AS. Use of Clinical Decision Support to Improve the Laboratory Evaluation of Monoclonal Gammopathies. Am J Clin Pathol 2023; 159:192-204. [PMID: 36622340 DOI: 10.1093/ajcp/aqac151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/03/2022] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES There is considerable variation in ordering practices for the initial laboratory evaluation of monoclonal gammopathies (MGs) despite clear society guidelines to include serum free light chain (sFLC) testing. We assessed the ability of a clinical decision support (CDS) alert to improve guideline compliance and analyzed its clinical impact. METHODS We designed and deployed a targeted CDS alert to educate and prompt providers to order an sFLC assay when ordering serum protein electrophoresis (SPEP) testing. RESULTS The alert was highly effective at increasing the co-ordering of SPEP and sFLC testing. Preimplementation, 62.8% of all SPEP evaluations included sFLC testing, while nearly 90% of evaluations included an sFLC assay postimplementation. In patients with no prior sFLC testing, analysis of sFLC orders prompted by the alert led to the determination that 28.9% (800/2,769) of these patients had an abnormal κ/λ ratio. In 452 of these patients, the sFLC assay provided the only laboratory evidence of a monoclonal protein. Moreover, within this population, there were numerous instances of new diagnoses of multiple myeloma and other MGs. CONCLUSIONS The CDS alert increased compliance with society guidelines and improved the diagnostic evaluation of patients with suspected MGs.
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Affiliation(s)
- Daniel S Pearson
- Department of Pathology Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Mandakolathur R Murali
- Department of Pathology Medicine, Massachusetts General Hospital, Boston, MA, USA.,Medicine, Massachusetts General Hospital, Boston, MA, USAand
| | - Anand S Dighe
- Department of Pathology Medicine, Massachusetts General Hospital, Boston, MA, USA.,Massachuscetts General Brigham, Somerville, MA, USA
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Şeneş M, Alpdemir M, Kırtıl G, Öğüş E, Çolak Samsum E, Alpdemir MF. Effects of lipemia on capillary serum protein electrophoresis in native ultra-lipemic material and intravenous lipid emulsion added sera. Clin Chem Lab Med 2022; 61:1054-1064. [PMID: 36583398 DOI: 10.1515/cclm-2022-0955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study aims to investigate the effect of natural ultralipemic material (NULM) and intravenous lipid emulsion (IVLE) on capillary serum protein electrophoresis (SPEP). METHODS NULM material was prepared from leftover patients' lipemic serum sample (triglyceride concentration >2,000 mg/dL) pool by a refrigerated high-speed centrifuge, and IVLE Omegaven lipid emulsion (30%) was used. Serum pools for interference study were prepared from patient samples for which serum protein electrophoresis was studied as Normal SPEP and M Peak SPEP. For both types of lipemia (DULM and IVLE), five pools with triglyceride concentrations of ∼4.52 mmol/L, ∼7.91 mmol/L, ∼14.69 mmol/L, ∼21.47 mmol/L, and ∼28.25 mmol/L were prepared. SPEP was studied in each pool with Sebia Capillarys Minicap. A repeated measure ANOVA test was used to determine the difference between the pools, and interferograms were used to evaluate the interference effect. RESULTS Interference was not detected in IVLE added Normal SPEP and M Peak SPEP pools, either % or concentrations of fractions. In NULM-added Normal SPEP and M Peak SPEP pools, significant positive interference in albumin % (p=0.002 and p<0.001 respectively) and significant negative interference in gamma% (p<0.001 and p=0.005 respectively) and M protein peak (p=0.002) fractions were detected. However, significant positive interference was seen only for albumin concentration fractions (p<0.001 for both pools). CONCLUSIONS It is vital to use NULM instead of IVLE solutions in lipemia interference studies for all laboratory tests, including CZE SPEP. The fractions concentration values calculated with the total protein concentration should be used for evaluating SPEP results.
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Affiliation(s)
- Mehmet Şeneş
- Medical Biochemistry, University of Health Sciences Ankara Training and Research Hospital, Ankara, Türkiye
| | - Medine Alpdemir
- Medical Biochemistry, University of Health Sciences Ankara Training and Research Hospital, Ankara, Türkiye
| | - Gül Kırtıl
- Medical Biochemistry, University of Health Sciences Ankara Training and Research Hospital, Ankara, Türkiye
| | - Elmas Öğüş
- Medical Biochemistry, University of Health Sciences Ankara Training and Research Hospital, Ankara, Türkiye
| | - Emel Çolak Samsum
- Medical Biochemistry, Ministry of Health Pursaklar State Hospital, Ankara, Türkiye
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Faisatjatham S, Uaprasert N, Iampenkhae K, Udomkarnjananun S. Detectable serum IgM monoclonal gammopathy in non-hepatitis-associated mixed cryoglobulinemic glomerulonephritis: A case report and literature review. SAGE Open Med Case Rep 2022; 10:2050313X221140648. [PMID: 36507058 PMCID: PMC9726840 DOI: 10.1177/2050313x221140648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022] Open
Abstract
Cryoglobulinemia is the presence of circulating cryoglobulin which can cause systemic vasculitis and glomerulonephritis. Monoclonal gammopathy of renal significance is strongly associated with type I cryoglobulinemia, but the role of detectable serum monoclonal gammopathy in mixed (type II) cryoglobulinemia is not clearly established. We report a case of a 71-year-old woman who presented with skin rash, leg edema, and azotemia. Investigations showed a positive result for rheumatoid factor, low complement C4 level, positive result for serum cryoglobulin, and positive M-spike on serum protein electrophoresis and IgM kappa monoclonal gammopathy on serum immunofixation. Kidney biopsy revealed membranoproliferative glomerulonephritis, polytypic IgM-dominant deposits in an immunofluorescence study, and microtubular substructures in an electron microscopic study. After an extensive workup, no evidence of myeloma or lymphoma was found. A diagnosis of monoclonal gammopathy of renal significance-associated mixed cryoglobulinemic glomerulonephritis was made. Due to the detectable IgM kappa monoclonal gammopathy in the patient's serum, clonal-directed therapy was administered. The patient had been in clinical remission after treatment with clone-directed therapy with cyclophosphamide and steroids. The literature review for cases of type II cryoglobulinemic glomerulonephritis that have detectable serum monoclonal gammopathy are summarized in this study.
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Affiliation(s)
- Surasak Faisatjatham
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand,Department of Medicine, Khon Kaen Hospital, Khon Kaen, Thailand
| | - Noppacharn Uaprasert
- Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Kroonpong Iampenkhae
- Department of Pathology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Suwasin Udomkarnjananun
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand,Suwasin Udomkarnjananun, Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, 1873, Rama 4 Road, Pathumwan, Bangkok 10330, Thailand.
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Cárdenas MC, Iñigo B, Ortega I, Palomar MA, Menéndez M, Plaza P, Martínez-Novillo M, Benavente C. Can urine studies be replaced by serum free light chains measurements to assign responses in multiple myeloma patients? Front Oncol 2022; 12:1056293. [DOI: 10.3389/fonc.2022.1056293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/07/2022] [Indexed: 12/05/2022] Open
Abstract
Serum and urine protein electrophoresis and immunofixation are the preferred techniques for monitoring monoclonal proteins and evaluating treatment response in multiple myeloma (MM) patients with measurable disease. However, urine studies are subjected to limitations that may lead to inaccuracies or prevent guidelines compliance. We retrospectively studied if the substitution of urine studies by measuring serum free light chains (sFLCs) results in a comparable disease monitoring, both in intact immunoglobulin (II) and light chain (LC) MM patients. In our cohort, equal or higher percentages of disease were identified by sFLCs at baseline and maximum response as compared to urine studies. Achieving very good partial response or better (≥VGPR) according to the response criteria proposed by the French group (evaluating sFLCs instead of urine) and the IMWG response criteria were associated to a 62% and 63% reduced risk of progression, respectively. A similar prognostic value for reaching ≥VGPR was also observed among LCMM patients when the French group and the IMWG response criteria were applied. Overall, these results support the replacement of urine studies by the sFLCs assay in IIMM. In LCMM, sFLCs could be used for monitoring and urine studies could be performed only to confirm complete remissions and progressions.
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Lyubimova NV, Timofeev YS, Abaev VM, Votyakova OM, Osmanov EA, Kushlinskii NE. Biochemical profile of Bence-Jones type multiple myeloma. Klin Lab Diagn 2022; 67:570-574. [PMID: 36315171 DOI: 10.51620/0869-2084-2022-67-10-570-574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Multiple myeloma (MM) is a malignant tumor occurring from plasma cells that produce an abnormal monoclonal immunoglobulin - a paraprotein. A distinctive feature of Bence-Jones myeloma is the excretion of monoclonal free light chains of immunoglobulins with 24h urine, and the absence of monoclonal intact immunoglobulins secretion. Comprehensive analysis of biochemical parameters in blood serum and 24h urine in patients with Bence-Jones multiple myeloma using electrophoretic and immunoturbidimetric methods to assess their sensitivity as biomarkers. 50 patients with a morphologically confirmed diagnosis of MM of the Bence-Jones immunochemical type were examined. 28 people without oncological diseases were examinedas a control. Detection of monoclonal secretion in blood serum and daily urine was performed by immunofixation electrophoresis on the Hydrasys 2 electrophoretic system (Sebia). The determination of free light chains of immunoglobulins (FLC) was performed by the immunoturbidimetric method (Binding Site) on an Advia 1800 analyzer (Siemens). Analysis of IgG, IgA, IgM, β2-microglobulin and C-reactive protein was performed on Cobas 6000 analyzer (Roche). The median excretion of Bence-Jones protein in 24h urine of MM patients was 0.49 g/24h (0.06-2.45 g/24h). In the blood serum, in 86% of cases, the presence of paraproteinemia, represented by κ and λ type light chains of immunogloublins was detected. At the same time, the frequency of detection of monoclonal secretion in blood serum in Bence-Jones type λ myeloma was 95.7%, which was statistically significantly higher than the frequency of detection of monoclonal secretion of type κ - 77.8%. In patients with identified paraproteinemia, Bence-Jones protein excretion in daily urine (median 0.82 g/day) was statistically significantly higher than in patients without a monoclonal component detected in blood serum (median 0.04 g/24h). The levels of FLC in blood serum obtained by immunoturbidimetry in Bence-Jones myeloma of the corresponding type were higher than the reference levels in 100% of cases. The median level of κ-FLC reached 4358 mg/l, λ-FLC - 2225 mg/l, which was statistically significantly higher than the control levels. The median concentrations of IgG, IgA and IgM in patients with Bence-Jones myeloma were statistically significantly lower than in the control group, while the medians of β2-microglobulin and C-reactive protein were significantly higher than in the control. Our investigation showed high diagnostic efficiency of electrophoretic and immunoturbidimetric analysis of monoclonal secretion in patients with Bence-Jones MM, while FLC analysis demonstrated maximum sensitivity. Bence-Jones MM revealed biochemical signs of secondary immunodeficiency and general inflammatory syndrome.
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Affiliation(s)
- Nina Vasilyevna Lyubimova
- N.N. Blokhin National Medical Research Center of Oncology Ministry of Health of the Russian Federation
| | - Yu S Timofeev
- N.N. Blokhin National Medical Research Center of Oncology Ministry of Health of the Russian Federation
| | - V M Abaev
- N.N. Blokhin National Medical Research Center of Oncology Ministry of Health of the Russian Federation
| | - O M Votyakova
- N.N. Blokhin National Medical Research Center of Oncology Ministry of Health of the Russian Federation
| | - E A Osmanov
- N.N. Blokhin National Medical Research Center of Oncology Ministry of Health of the Russian Federation
| | - N E Kushlinskii
- N.N. Blokhin National Medical Research Center of Oncology Ministry of Health of the Russian Federation
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15
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Lee N, Jeong S, Jeon K, Song W, Park MJ. Development and validation of a deep learning-based protein electrophoresis classification algorithm. PLoS One 2022; 17:e0273284. [PMID: 36001575 PMCID: PMC9401151 DOI: 10.1371/journal.pone.0273284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 08/05/2022] [Indexed: 12/03/2022] Open
Abstract
Background Protein electrophoresis (PEP) is an important tool in supporting the analytical characterization of protein status in diseases related to monoclonal components, inflammation, and antibody deficiency. Here, we developed a deep learning-based PEP classification algorithm to supplement the labor-intensive PEP interpretation and enhance inter-observer reliability. Methods A total of 2,578 gel images and densitogram PEP images from January 2018 to July 2019 were split into training (80%), validation (10%), and test (10.0%) sets. The PEP images were assessed based on six major findings (acute-phase protein, monoclonal gammopathy, polyclonal gammopathy, hypoproteinemia, nephrotic syndrome, and normal). The images underwent processing, including color-to-grayscale and histogram equalization, and were input into neural networks. Results Using densitogram PEP images, the area under the receiver operating characteristic curve (AUROC) for each diagnosis ranged from 0.873 to 0.989, and the accuracy for classifying all the findings ranged from 85.2% to 96.9%. For gel images, the AUROC ranged from 0.763 to 0.965, and the accuracy ranged from 82.0% to 94.5%. Conclusions The deep learning algorithm demonstrated good performance in classifying PEP images. It is expected to be useful as an auxiliary tool for screening the results and helpful in environments where specialists are scarce.
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Affiliation(s)
- Nuri Lee
- Department of Laboratory Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Seri Jeong
- Department of Laboratory Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Kibum Jeon
- Department of Laboratory Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Wonkeun Song
- Department of Laboratory Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Min-Jeong Park
- Department of Laboratory Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
- * E-mail:
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16
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Van Hoovels L, Vercammen M, Nevejan L, Cornette M, Briers PJ, Deeren D, Van Droogenbroeck J, Fostier K, De Smet D. Serum free light chain analysis: persisting limitations with new kids on the block. Clin Chem Lab Med 2022; 60:1440-1448. [PMID: 35781357 DOI: 10.1515/cclm-2022-0347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/21/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Serum free light chain (sFLC) measurements have inherent analytical limitations impacting sFLC clinical interpretation. We evaluated analytical and diagnostic performance of three polyclonal sFLC assays on four analytical platforms. METHODS sFLC concentration was measured using Diazyme FLC assays (Diazyme) on cobas c501/c503 analyzer (Roche); Freelite assays (The Binding Site) on Optilite analyzer (The Binding Site) and cobas c501 analyzer and Sebia FLC ELISA assays (Sebia) on AP22 ELITE analyzer (DAS). Imprecision, linearity, method comparison vs. Freelite/Optilite, antigen excess detection and reference value verification were assessed. Diagnostic performance was compared on 120 serum samples and on follow-up samples of five patients with κ and λ monoclonal gammopathy. RESULTS Method comparison showed excellent correlation with Freelite/Optilite method for all assays. A large proportional negative bias was shown for both Sebia κ and λ ELISA and a significant positive proportional bias for λ in the low (<10 mg/L) Freelite/cobas c501 method. Clinically relevant underestimation of κ sFLC levels due to antigen excess was shown for 7% of each Diazyme/cobas application and for 11 and 32.1% of λ sFLC assay of respectively Diazyme/cobas and Sebia/AP22. sFLC reference values revealed application specific. Cohen's κ values were (very) good for κ sFLC but only moderate to good for λ sFLC. In 4/10 follow-up patients, significant differences in clinical interpretation between sFLC assays were noticed. CONCLUSIONS Important analytical limitations remain for all sFLC applications. Differences in reference values and diagnostic performance hamper interchangeability of sFLC assays. Assay specific sFLC decision guidelines are warranted.
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Affiliation(s)
- Lieve Van Hoovels
- Department of Laboratory Medicine, OLV Hospital Aalst, Aalst, Belgium.,Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Martine Vercammen
- Department of Laboratory Medicine, AZ Sint-Jan Hospital Brugge - Oostende AV, Bruges, Belgium.,Research group REIM, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Louis Nevejan
- Department of Laboratory Medicine, OLV Hospital Aalst, Aalst, Belgium.,Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
| | - Margot Cornette
- Department of Laboratory Medicine, AZ Delta Hospital, Roeselare, Belgium.,Department of Laboratory Medicine, University Hospital Ghent, Ghent, Belgium
| | - Pieter-Jan Briers
- Department of Laboratory Medicine, AZ Sint-Jan Hospital Brugge - Oostende AV, Bruges, Belgium.,Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
| | - Dries Deeren
- Department of Hematology, AZ Delta Hospital, Roeselare, Belgium
| | - Jan Van Droogenbroeck
- Department of Hematology, AZ Sint-Jan Hospital Brugge - Oostende AV, Bruges, Belgium
| | - Karel Fostier
- Department of Hematology, OLV Hospital, Aalst, Belgium
| | - Dieter De Smet
- Department of Laboratory Medicine, AZ Delta Hospital, Roeselare, Belgium
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17
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Assessment of M-protein quantification using capillary electrophoresis and immunosubtraction-based integration in clinical samples with low M-protein concentrations. Clin Biochem 2022; 107:7-12. [DOI: 10.1016/j.clinbiochem.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 11/22/2022]
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18
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The Role of DNA Repair in Genomic Instability of Multiple Myeloma. Int J Mol Sci 2022; 23:ijms23105688. [PMID: 35628498 PMCID: PMC9144728 DOI: 10.3390/ijms23105688] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 02/01/2023] Open
Abstract
Multiple Myeloma (MM) is a B cell malignancy marked by genomic instability that arises both through pathogenesis and during disease progression. Despite recent advances in therapy, MM remains incurable. Recently, it has been reported that DNA repair can influence genomic changes and drug resistance in MM. The dysregulation of DNA repair function may provide an alternative explanation for genomic instability observed in MM cells and in cells derived from MM patients. This review provides an overview of DNA repair pathways with a special focus on their involvement in MM and discusses the role they play in MM progression and drug resistance. This review highlights how unrepaired DNA damage due to aberrant DNA repair response in MM exacerbates genomic instability and chromosomal abnormalities, enabling MM progression and drug resistance.
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19
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Keren DF, Bocsi G, Billman BL, Etzell J, Faix JD, Kumar S, Lipe B, McCudden C, Montgomery R, Murray DL, Rai AJ, Redondo TC, Souter L, Ventura CB, Ansari MQ. Laboratory Detection and Initial Diagnosis of Monoclonal Gammopathies. Arch Pathol Lab Med 2022; 146:575-590. [PMID: 34347866 DOI: 10.5858/arpa.2020-0794-cp] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The process for identifying patients with monoclonal gammopathies is complex. Initial detection of a monoclonal immunoglobulin protein (M protein) in the serum or urine often requires compilation of analytical data from several areas of the laboratory. The detection of M proteins depends on adequacy of the sample provided, available clinical information, and the laboratory tests used. OBJECTIVE.— To develop an evidence-based guideline for the initial laboratory detection of M proteins. DESIGN.— To develop evidence-based recommendations, the College of American Pathologists convened a panel of experts in the diagnosis and treatment of monoclonal gammopathies and the laboratory procedures used for the initial detection of M proteins. The panel conducted a systematic literature review to address key questions. Using the Grading of Recommendations Assessment, Development, and Evaluation approach, recommendations were created based on the available evidence, strength of that evidence, and key judgements as defined in the Grading of Recommendations Assessment, Development, and Evaluation Evidence to Decision framework. RESULTS.— Nine guideline statements were established to optimize sample selection and testing for the initial detection and quantitative measurement of M proteins used to diagnose monoclonal gammopathies. CONCLUSIONS.— This guideline was constructed to harmonize and strengthen the initial detection of an M protein in patients displaying symptoms or laboratory features of a monoclonal gammopathy. It endorses more comprehensive initial testing when there is suspicion of amyloid light chain amyloidosis or neuropathies, such as POEMS (polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes) syndrome, associated with an M protein.
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Affiliation(s)
- David F Keren
- From the Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor (Keren).,Keren and Ansari served as guideline cochairs
| | - Gregary Bocsi
- The Department of Pathology, University of Colorado Anschutz, Aurora (Bocsi)
| | - Brooke L Billman
- Governance Services (Billman), College of American Pathologists, Northfield, Illinois
| | - Joan Etzell
- The Department of Pathology, Sutter Health Shared Laboratory, Livermore, California (Etzell)
| | - James D Faix
- tHe Department of Pathology, Montefiore Medical Center, Bronx, New York (Faix)
| | - Shaji Kumar
- The Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota (Kumar)
| | - Brea Lipe
- The Department of Medicine, University of Rochester Medical Center, Rochester, New York (Lipe)
| | - Christopher McCudden
- The Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada (McCudden)
| | | | - David L Murray
- The Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Murray)
| | - Alex J Rai
- The Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York (Rai)
| | | | - Lesley Souter
- Methodology Consultant, Hamilton, Ontario, Canada (Souter)
| | | | - Mohammad Qasim Ansari
- and the Department of Pathology and Laboratory Medicine, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio (Ansari).,Keren and Ansari served as guideline cochairs
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20
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Cystatin C-Based Equations Detect Hidden Kidney Disease and Poor Prognosis in Newly Diagnosed Patients with Multiple Myeloma. Adv Hematol 2022; 2022:4282226. [PMID: 35469191 PMCID: PMC9034967 DOI: 10.1155/2022/4282226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/16/2022] [Accepted: 03/24/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives. The aim of this study was to compare the creatinine equations with cystatin C (CysC) equations to define renal impairment (RI) in newly diagnosed multiple myeloma (MM) patients and to analyse the equation that allows for identifying patients with more and worse prognostic factors. Methods. Renal function was evaluated prospectively in 61 patients with newly diagnosed untreated MM employing CKD-EPI and CAPA equations. The comparison was conducted using Bland–Altman graphics and Cohen’s Kappa statistic. Mann–Whitney T and Chi-square tests were used, and univariate and multivariate analyses were carried out. Results. According to the IMWG criteria, 26% of patients showed RI (3 women/13 men) whilst the use of CysC equations allowed us to identify up to 39% of patients (7 women/17 men). The CAPA equation was less biased and dispersed and more sensitive than CKD-EPI-creatinine. Furthermore, univariate analysis unveiled an association between decreased CKD-EPI-CysC and poor prognosis based on R-ISS-3. Conclusions. The IMWG criteria may underestimate kidney disease, mostly in women, which could affect the dose received as well as its toxicity. Altogether, our data suggest that equations that include CysC are more accurate to detect hidden kidney disease, as well as patients with more and worse prognostic factors, in newly diagnosed MM.
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21
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Saadeh RS, Bryant SC, McKeon A, Weinshenker B, Murray DL, Pittock SJ, Willrich MAV. CSF Kappa Free Light Chains: Cutoff Validation for Diagnosing Multiple Sclerosis. Mayo Clin Proc 2022; 97:738-751. [PMID: 34893322 DOI: 10.1016/j.mayocp.2021.09.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/09/2021] [Accepted: 09/09/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine and validate a cerebrospinal fluid (CSF) κ (KCSF) value statistically comparable to detection of CSF-specific oligoclonal bands (OCB) to support the diagnosis of multiple sclerosis (MS). PATIENTS AND METHODS A total of 702 retrospective and 657 prospective paired CSF/serum samples from residual waste samples of physician-ordered OCB tests were obtained and tested for KCSF at Mayo Clinic. Charts were reviewed by a neurologist blinded to KCSF results. Specificity and sensitivity for MS diagnosis were evaluated to establish a diagnostic cutoff value for KCSF in the retrospective cohort and then validated in the prospective cohort. RESULTS Retrospective and prospective subgroups, respectively, included MS (n=85, 70), non-MS (n=615, 585), and undetermined diagnosis (excluded, n=2, 2). The retrospective data established a KCSF cutoff value of 0.1 mg/dL to be comparable to OCB testing. In the retrospective subgroup, KCSF vs OCB sensitivities for diagnosis of MS were 68.2% vs 75.0% (P=.08) and specificities were 86.1% vs 87.6% (P=.27). The KCSF area under the receiver operating characteristic curve was 0.772 (95% CI, 0.720 to 0.824), and for OCB was 0.813 (95% CI, 0.764 to 0.861). The prospective cohort was then used to validate the diagnostic KCSF value of 0.1 mg/dL; KCSF vs OCB sensitivities were 78.6% for both (P>.99) and specificities were 87.1% vs 89.4% (P=.09). CONCLUSION The KCSF value of 0.1 mg/dL is a valid alternative to OCB testing, offering a standardized quantitative measure, eliminating human error, reducing cost and turnaround time, with no significant difference in sensitivity and specificity. This study provides class I evidence that a KCSF value of 0.1 mg/dL can be used in place of OCB testing to support the diagnosis of MS.
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Affiliation(s)
- Ruba S Saadeh
- Departments of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN; Neurology, Mayo Clinic, Rochester, MN
| | | | - Andrew McKeon
- Departments of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN; Neurology, Mayo Clinic, Rochester, MN
| | | | - David L Murray
- Departments of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Sean J Pittock
- Departments of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN; Neurology, Mayo Clinic, Rochester, MN
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Bansal K, Singh S, Gupta A, Chhabra HS, Kalidindi KKV. Extraosseous Spread of Multiple Myeloma Mimicking Pancoast Tumor. Cureus 2022; 14:e22412. [PMID: 35345749 PMCID: PMC8942157 DOI: 10.7759/cureus.22412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2022] [Indexed: 11/20/2022] Open
Abstract
A 55-year-old man presented with upper backache for one month, inability to move both the lower limbs for two weeks and retention of urine for five days. Examination revealed spastic paraplegia and reduced breath sounds in the right upper zone. Initial imaging revealed a soft tissue lesion in the apex of the right lung, suggesting a Pancoast tumor. It also showed a lytic, expansile lesion of the T2 vertebra extending to the right second posterior rib on subsequent imaging. High serum calcium, M-spike in beta-gamma globulin region on serum electrophoresis, 50%-60% plasmacytoid cells on bone marrow aspiration, concertina collapse of the vertebral body, and pattern of neurological deficit pointed towards multiple myeloma. T2 corpectomy and mesh cage placement, C7-T4 posterior stabilization, and resection of the second rib were done. Histopathology confirmed multiple myeloma. Postoperatively, the patient was managed with radiotherapy and bortezomib. The patient had a good neurological recovery. Timely intervention is critical for disease control and leads to better recovery.
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23
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Šegulja D, Šparakl T, Rogić D. Applied capillary electrophoresis system affects screening for monoclonal gammopathy in serum: verification study of two eight-capillary systems. Scandinavian Journal of Clinical and Laboratory Investigation 2022; 82:85-89. [PMID: 35112636 DOI: 10.1080/00365513.2022.2034035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Capillary electrophoresis is a method with a long history of developments which enables monitoring of several pathological processes and has an irreplaceable role in screening for presence of M-protein. The aim of this study was to assess analytical performance of Sebia and Helena systems, as well as their screening efficiency for M-protein by identifying characteristic electrophoretic pattern abnormalities. The controls were analyzed in triplicate over a five-day period. Comparability testing was performed on 46 (Capillarys3Octa) and 49 (V8Nexus) serum samples with routinely used Capillarys2. Electropherograms (EPGs) were reviewed by two specialists independently to select samples for further processing by immunofixation. All precision test results met the eligibility criteria by Ricos et al. The correlation coefficients higher than 0.8 indicated excellent comparability although the results were slightly more comparable among the same manufacturer systems. There were no variations in observed abnormalities in EPGs when Capillarys systems were compared, but a disparity was detected in 11/49 EPGs on comparing Capillarys2 and V8Nexus. The cause of the detected difference could be in a different graphical presentation of the findings and in a lesser resolution of the applied buffer. The impression is that the V8Nexus system combined with the utilized buffer provides greater resolution in the alpha-1 and alpha-2 globulin fractions, but that it declines in the gamma globulin fraction. The precision and estimated accuracy criteria were met by both systems. Comparison results implied that capillary systems are not equally effective in M-protein screening, highlighting the necessity to include system screening efficiency in analytical evaluation.
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Affiliation(s)
- Dragana Šegulja
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Tajana Šparakl
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Dunja Rogić
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
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24
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Kitson AL, Taylor AS, Giacherio DA, Keren DF. Reflexing Suspicious β-Region Findings on Capillary Serum Protein Electrophoresis to Immunofixation or Immunosubtraction for Detecting Monoclonal Proteins. Am J Clin Pathol 2022; 157:171-179. [PMID: 34519791 DOI: 10.1093/ajcp/aqab108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/23/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Monoclonal immunoglobulins (M-proteins) that migrate in the β region on serum protein electrophoresis (SPEP) are often cloaked by this region's normal constituents. The present study interrogates the utility of using both quantitative and qualitative alterations in β-region bands for detection of β-migrating M-proteins. METHODS Consecutive SPEP cases analyzed by capillary electrophoresis were searched to identify the initial workup on 1,841 patients with increased total β regions, suspicious β-region findings resulting in reflex immunofixation (IFE), or immunosubtraction (ISUB). To augment quantitative information, separate β1 and β2 measurements were established and retrospectively used to evaluate their sensitivity for M-protein detection. RESULTS We identified M-proteins in 205 (11.1%) cases, including immunoglobulin A (IgA) (54%), IgG (24%), IgM (13%), and free light chain (9%) isotypes. Of the 15 cases flagged by separate β1 and β2 measurements that were not identified by total β-region measurement, 1 progressed to myeloma. Of the 56 β-migrating M-proteins identified by qualitative features but without increase in any of the β-region measurements, 1 progressed to myeloma. CONCLUSIONS A combination of separate measurements for β1 and β2 regions together with detection of β-region distortions increase sensitivity for identifying β-migrating M-proteins via reflex IFE or ISUB.
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Affiliation(s)
- Amanda L Kitson
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Alexander S Taylor
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Donald A Giacherio
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - David F Keren
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
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Chae H, Kim H, Choi A, Oh EJ, Min CK. A rare case of the IgE prozone phenomenon in IgE multiple myeloma. Clin Biochem 2022; 104:59-61. [DOI: 10.1016/j.clinbiochem.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/05/2022] [Accepted: 02/01/2022] [Indexed: 11/03/2022]
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26
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Rekhtina IG, Mendeleeva LP, Soboleva NP, Dubina IA, Pervakova MI, Lapin SV. Detection of paraprotein in plasma cell tumors. TERAPEVT ARKH 2022. [DOI: 10.26442/10.26442/00403660.2022.01.201326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Paraprotein is a laboratory biomarker of plasma cell tumors and other lymphoproliferative diseases. Its determination is necessary for diagnosing, monitoring and assessment of therapy effectiveness. The lecture presents the main methods of qualitative and quantative analysis of monoclonal proteins: gel electrophoresis, capillary electrophoresis, immunofixation and nephelometry features, possibilities and limitations are reviewed. The main sources of errors and artifacts during these studies are considered. Also the difficulties in the diagnosis and interpretation of the results of serum and urine tests are highlighted.
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Lee J, Lee HS, Chu K. Successful treatment with rituximab for central nervous system vasculitis caused by Epstein-Barr virus-associated lymphoproliferative disorder with immunoglobulin M gammopathy. ENCEPHALITIS 2022; 2:14-18. [PMID: 37469608 PMCID: PMC10295905 DOI: 10.47936/encephalitis.2021.00143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/11/2021] [Accepted: 10/15/2021] [Indexed: 07/21/2023] Open
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) is associated with several autoimmune conditions, including central nervous system (CNS) vasculitis. Epstein-Barr virus (EBV) is a pathogen capable of triggering a systemic immune response and is involved in the occurrence of a wide range of B-cell lymphoproliferative disorders. In systemic autoimmune diseases, EBV infection is suspected to play a central role in pathogenesis. Here, we present a case that was thought to be a systemic autoimmune disease and CNS vasculitis that developed after EBV infection, demonstrating that rituximab is effective for the treatment.
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Affiliation(s)
- Juhee Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Han Sang Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Center for Hospital Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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28
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Mrosewski I, Urbank M. Identification of Paraproteins via Serum Immunofixation or Serum Immunosubtraction and Immunoturbidimetric Quantitation of Serum Immunoglobulins in the Laboratory Testing for Monoclonal Gammopathies. Arch Pathol Lab Med 2021; 145:1552-1557. [DOI: 10.5858/arpa.2020-0441-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2020] [Indexed: 11/06/2022]
Abstract
Context.—
In laboratory testing for monoclonal gammopathies, paraproteins are identified via serum immunofixation or serum immunosubtraction, and immunoturbidimetric quantitation of serum immunoglobulins is often used.
Objective.—
To evaluate methodologic differences between serum immunofixation and serum immunosubtraction, as well as in the quantitation of serum immunoglobulins on different clinical chemical platforms.
Design.—
Three hundred twenty-two unique routine patient samples were blinded and used for comparison between serum immunofixation on Sebia's HYDRASIS 2 and serum immunosubtraction on Sebia's CAPILLARYS 2, as well as between quantitation results of immunoglobulin A, G, and M on Abbott's ARCHITECT c16000PLUS and Roche's Cobas c 502 module. Microsoft Excel 2019 with the add-on Abacus 2.0 and MedCalc were used for statistical analysis and graphic depiction via bubble diagram, Passing-Bablok regressions, and Bland-Altman plots.
Results.—
The median age of patients was 75 years, and samples with paraproteinemia were nearly evenly split between sexes. Paraprotein identification differed remarkably between immunofixation and immunosubtraction. Quantitation of serum immunoglobulins showed higher values on Abbott's ARCHITECT c16000PLUS when compared with Roche's Cobas c 502 module.
Conclusions.—
Identification of paraproteins via serum immunosubtraction is inferior to serum immunofixation, which can have implications on the diagnosis and monitoring of patients with monoclonal gammopathy. If immunoturbidimetric quantitation of immunoglobulins is used for follow-up, the same clinical-chemical platform should be used consistently.
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Affiliation(s)
- Ingo Mrosewski
- From the Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Germany
| | - Matthias Urbank
- From the Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Germany
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29
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Non secretory myeloma in young man mimicking the Gorham disease: case report and the literature review. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MÉDECINE INTERNE 2021; 60:77-84. [PMID: 34610233 DOI: 10.2478/rjim-2021-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Indexed: 11/20/2022]
Abstract
Multiple myeloma is a neoplasm of plasma cells affecting mostly the elderly with incidence peaks between 60 and 70 years. This disease is exceedingly rare in younger people, especially in adults under 30-year-old. Non-secretory multiple myeloma accounts for 1-5% of all cases of multiple myeloma. It is also a rare condition in young adult patients, and only six cases have been reported [1]. We herein describe a rare case of non-secretory myeloma in a 22- year-old male, explaining from chest wall pain, without general manifestation. Plain radiography and CT scans revealed diffuse osteolytic lesion mimicking the Gorham disease. A bone marrow biopsy was conducted, revealing the diagnosis of myeloma.
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30
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Zamani F, Shokripour M, Mokhtari M. Evaluation of Correlation between Serum Free Light-Chain Assay and Bone Marrow Study in Multiple Myeloma Patients. Int J Hematol Oncol Stem Cell Res 2021; 15:152-159. [PMID: 35082996 PMCID: PMC8748244 DOI: 10.18502/ijhoscr.v15i3.6845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 04/21/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Multiple myeloma is a hematologic malignancy manifested by the secretion of abnormal immunoglobulin. Different methods have been described for diagnosis and patient response to management. Serum free light-chain assay is recently approved in the diagnosis of multiple myeloma patients. This study aimed to evaluate the diagnostic accuracy of serum free light-chain assay and its agreement to bone marrow findings. Materials and Methods: Forty-six patients with the diagnosis of multiple myeloma were enrolled in the study. The patients were grouped into newly diagnosed cases (22 patients,47.8%) and known cases who were under treatment (24 patients,52.2%). Bone marrow study was done and percentage and clonal status of plasma cells were evaluated by a combination of immunohistochemistry and flow cytometry. Free light-chain assay was done in all patients and sensitivity, specificity, positive predictive value, and negative predictive value were analyzed. Results: Thirty of 46 patients showed monoclonal plasma cell infiltration and 16 patients showed polyclonal plasma cell infiltration based on bone marrow findings. An abnormal κ/λ ratio was seen in 15(68.18%) of new cases and 16(66.6%) of known cases. Sensitivity, specificity, PPV and NPV for κ⁄λ ratio were 72.73%, 46.15%, 71%, and 50%, respectively. Conclusion: In conclusion, due to high false positive and false negative results, the presence of an abnormal serum FLC ratio was not equal to the presence of monoclonal gammopathy, and observation of a normal ratio does not exclude the presence of monoclonal gammopathy.
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Affiliation(s)
- Fatemeh Zamani
- Department of Pathology, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mansoureh Shokripour
- Department of Pathology, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maral Mokhtari
- Department of Pathology, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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31
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Campbell L, Simpson D, Ramasamy K, Sadler R. Using quantitative immunoprecipitation mass spectrometry (QIP-MS) to identify low level monoclonal proteins. Clin Biochem 2021; 95:81-83. [PMID: 34058191 DOI: 10.1016/j.clinbiochem.2021.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/19/2021] [Accepted: 05/26/2021] [Indexed: 10/21/2022]
Abstract
Mass spectrometry has recently been proposed as a novel sensitive screening tool for monoclonal gammopathies. In a small study we have tested the ability of quantitative immunoprecipitation mass spectrometry (QIP-MS) to identify low level monoclonal immunoglobulins not currently detected by the initial serum protein electrophoresis (SPEP) screen. QIP-MS positively identified the primary monoclonal immunoglobulins in all 11 patient samples alongside additional monoclonal immunoglobulins in a subset of patient samples. We conclude that QIP-MS has clinical utility as a first-line screening tool for monoclonal gammopathy investigation, identifying monoclonality in patients with higher sensitivity and resolution compared to the current standard methods.
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Affiliation(s)
- Lauren Campbell
- Oxford University Hospitals NHS Foundation Trust, United Kingdom.
| | - Dawn Simpson
- Oxford University Hospitals NHS Foundation Trust, United Kingdom
| | - Karthik Ramasamy
- Oxford University Hospitals NHS Foundation Trust, United Kingdom
| | - Ross Sadler
- Oxford University Hospitals NHS Foundation Trust, United Kingdom
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32
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Turner KA, Frinack JL, Ettore MW, Tate JR, Graziani MS, Jacobs JFM, Booth RA, McCudden CR, Keren DF, Delgado JC, Zemtsovskaja G, Fullinfaw RO, Caldini A, de Malmanche T, Katakouzinos K, Burke M, Palladini G, Altinier S, Zaninotto M, Righetti G, Melki MT, Bell S, Willrich MAV. An international multi-center serum protein electrophoresis accuracy and M-protein isotyping study. Part I: factors impacting limit of quantitation of serum protein electrophoresis. Clin Chem Lab Med 2021; 58:533-546. [PMID: 31940284 DOI: 10.1515/cclm-2019-1104] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 12/02/2019] [Indexed: 11/15/2022]
Abstract
Background Serum protein electrophoresis (SPEP) is used to quantify the serum monoclonal component or M-protein, for diagnosis and monitoring of monoclonal gammopathies. Significant imprecision and inaccuracy pose challenges in reporting small M-proteins. Using therapeutic monoclonal antibody-spiked sera and a pooled beta-migrating M-protein, we aimed to assess SPEP limitations and variability across 16 laboratories in three continents. Methods Sera with normal, hypo- or hypergammaglobulinemia were spiked with daratumumab, Dara (cathodal migrating), or elotuzumab, Elo (central-gamma migrating), with concentrations from 0.125 to 10 g/L (n = 62) along with a beta-migrating sample (n = 9). Provided with total protein (reverse biuret, Siemens), laboratories blindly analyzed samples according to their SPEP and immunofixation (IFE) or immunosubtraction (ISUB) standard operating procedures. Sixteen laboratories reported the perpendicular drop (PD) method of gating the M-protein, while 10 used tangent skimming (TS). A mean percent recovery range of 80%-120% was set as acceptable. The inter-laboratory %CV was calculated. Results Gamma globulin background, migration pattern and concentration all affect the precision and accuracy of quantifying M-proteins by SPEP. As the background increases, imprecision increases and accuracy decreases leading to overestimation of M-protein quantitation especially evident in hypergamma samples, and more prominent with PD. Cathodal migrating M-proteins were associated with less imprecision and higher accuracy compared to central-gamma migrating M-proteins, which is attributed to the increased gamma background contribution in M-proteins migrating in the middle of the gamma fraction. There is greater imprecision and loss of accuracy at lower M-protein concentrations. Conclusions This study suggests that quantifying exceedingly low concentrations of M-proteins, although possible, may not yield adequate accuracy and precision between laboratories.
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Affiliation(s)
- Katherine A Turner
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Jody L Frinack
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Michael W Ettore
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Jillian R Tate
- Department of Chemical Pathology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | | | - Joannes F M Jacobs
- Department of Laboratory Medicine, Radboud University Medical Center, Laboratory Medical Immunology, Nijmegen, the Netherlands
| | - Ronald A Booth
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Christopher R McCudden
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | | | - Julio C Delgado
- ARUP Laboratories, Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Galina Zemtsovskaja
- Clinical Chemistry Laboratory, North Estonia Medical Centre, Tallinn, Estonia
| | - Robert O Fullinfaw
- Department of Chemical Pathology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Anna Caldini
- General Laboratory, Careggi University Hospital, Florence, Italy
| | - Theo de Malmanche
- NSW Health Pathology, Immunology Department, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Katina Katakouzinos
- Immunopathology Department, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia
| | - Matthew Burke
- Department of Chemical Pathology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Giovanni Palladini
- Amyloidosis Research and Treatment Center, Foundation IRCCS Policlinico San Matteo, and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Sara Altinier
- Laboratory Medicine of the University Hospital of Padova, Padova, Italy
| | - Martina Zaninotto
- Laboratory Medicine of the University Hospital of Padova, Padova, Italy
| | | | | | | | - Maria Alice Vieira Willrich
- Division of Clinical Biochemistry and Immunology, Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Report of the Survey Conducted by RCPAQAP on Current Practices for Beta-Migrating Paraprotein Reporting. Clin Biochem Rev 2021; 42:11-16. [PMID: 34305209 DOI: 10.33176/aacb-21-00001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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34
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Vertical cutoff methods in serum protein electrophoresis for the measurement of monoclonal protein concentrations: Which is best? Clin Chim Acta 2020; 510:573-580. [PMID: 32791139 DOI: 10.1016/j.cca.2020.07.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/26/2020] [Accepted: 07/26/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Monoclonal protein (M-protein) concentrations are measured by serum protein electrophoresis (SPE). Two methods are used for demarcating the M-protein area in the electropherogram: perpendicular drop (PD) and tangent skimming (TS). The aim of this study was tocompare both methods and to establish which is the most accurate and precise. METHODS We studied 24 sera containing M-protein (5-44 g/L). The systematic error (SE) was evaluated in a dilution series of 12 sera. Within-day, between-day, and interobserver variability were assessed. SPE was performed by capillary and agarose gel electrophoresis. M-protein concentrations were measured using both cutoff methods. RESULTS The PD method shows a constant SE ranged 1.00-2.27 g/L, while constant SE for TS is ranged -0.30--0.57 g/L. None of the cutoff methods or electrophoretic methods showed a proportional SE, with the exception of the TS method in capillary electrophoresis for β-migrating M-protein. The PD method was more precise than the TS method in all three estimates of imprecision. An increased CV for concentrations < 10 g/L in between-day imprecision was observed with the TS method. Interobserver imprecision was greater for M-protein concentrations < 17 g/L for both cutoff methods (14.85%, 26.42% respectively). CONCLUSIONS Despite being less precise, the TS method provides a more accurate measurement of M-protein concentration.
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Zhang C, Sha Y, Liu H, Guo D, Jiang Y, Hong L, Shi L, Huang H. Type 2 diabetes mellitus does not increase the risk of multiple myeloma: a systematic review and meta-analysis. Transl Cancer Res 2020; 9:2884-2894. [PMID: 35117645 PMCID: PMC8798954 DOI: 10.21037/tcr.2020.03.36] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/28/2020] [Indexed: 01/11/2023]
Abstract
Background Epidemiological studies have shown that patients with type 2 diabetes mellitus (T2DM) are at a higher risk of secondary tumors. However, no consensus has been made about whether T2DM can increase the risk of multiple myeloma (MM). Methods We searched the databases of PubMed, Cochrane Library and EMBASE and cross-checked the bibliography. Data quality was assessed using the Newcastle-Ottawa scale (NOS). Heterogeneity was calculated as the odds ratio (OR) using a random-effects model. Data were analyzed using Stata version 12.0 software. Results A total of 13 articles were selected into this meta-analysis. Initially, we found that diabetic patients had a higher risk of myeloma than non-diabetic patients (OR =1.60, 95% CI: 1.13–2.26, I2=98%, P=0.000). But the data in these articles were highly heterogeneous (I2>75%). Therefore, eight of the included articles showed a moderate heterogeneity (I2=71.6%). We used Galbraith heterogeneity map to analyze the causes of heterogeneity. Two articles with high heterogeneity were excluded. Then, we found the heterogeneity of the left six articles was reduced from moderate to mild (I2=45.9%, P=0.100). The final results of this meta-analysis showed that T2DM was not a risk factor for increased incidence of MM (OR =1.05, 95% CI: 0.83–1.33, I2=45.9%, P=0.100). Also, the subgroup analysis (case-control studies vs. cohort studies) showed no statistical difference (OR =1.19, 95% CI: 0.76–1.85, I2=1%, P=0.364; OR =1.00, 95% CI: 0.75–1.33, I2=71.2%, P=0.031; respectively). Conclusions T2DM is not a risk factor for the increased incidence of MM, a finding that should be validated with more strictly designed randomized controlled trials (RCTs).
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Affiliation(s)
- Chenlu Zhang
- Department of Hematology, The Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Yuou Sha
- Department of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Haiyan Liu
- Department of Hematology, The Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Dan Guo
- Department of Hematology, The Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Yijing Jiang
- Department of Hematology, The Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Lemin Hong
- Department of Hematology, The Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Lili Shi
- Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, China
| | - Hongming Huang
- Department of Hematology, The Affiliated Hospital of Nantong University, Nantong 226001, China
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Plebani M. New insights on the analytical performances for detecting and quantifying monoclonal proteins. Clin Chem Lab Med 2020; 58:457-459. [DOI: 10.1515/cclm-2019-1266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
- Mario Plebani
- Department of Laboratory, Medicine , University-Hospital of Padova , Via Giustiniani 2 , Padova 35128 , Italy , Phone: +39 0498212792, Fax: +39 049663240
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Uljon SN, Simmons DP, Rudolf JW, Baron JM, Dutta S, McEvoy DS, Murali M, Dighe AS. Validation and Implementation of an Ordering Alert to Improve the Efficiency of Monoclonal Gammopathy Evaluation. Am J Clin Pathol 2020; 153:396-406. [PMID: 31776551 DOI: 10.1093/ajcp/aqz180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To evaluate the use of a provider ordering alert to improve laboratory efficiency and reduce costs. METHODS We conducted a retrospective study to assess the use of an institutional reflex panel for monoclonal gammopathy evaluation. We then created a clinical decision support (CDS) alert to educate and encourage providers to change their less-efficient orders to the reflex panel. RESULTS Our retrospective analysis demonstrated that an institutional reflex panel could be safely substituted for a less-efficient and higher-cost panel. The implemented CDS alert resulted in 79% of providers changing their high-cost order panel to an order panel based on the reflex algorithm. CONCLUSIONS The validated decision support alert demonstrated high levels of provider acceptance and directly led to operational and cost savings within the laboratory. Furthermore, these studies highlight the value of laboratory involvement with CDS efforts to provide agile and targeted provider ordering assistance.
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Affiliation(s)
- Sacha N Uljon
- Departments of Pathology, Massachusetts General Hospital, Boston
| | - Daimon P Simmons
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA
| | - Joseph W Rudolf
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis
| | - Jason M Baron
- Departments of Pathology, Massachusetts General Hospital, Boston
| | - Sayon Dutta
- Departments of Pathology, Massachusetts General Hospital, Boston
- Emergency Medicine, Massachusetts General Hospital, Boston
| | | | | | - Anand S Dighe
- Departments of Pathology, Massachusetts General Hospital, Boston
- Partners HealthCare, Somerville, MA
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Consensus Guidelines on the Diagnosis of Multiple Myeloma and Related Disorders: Recommendations of the Myeloma Canada Research Network Consensus Guideline Consortium. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e352-e367. [PMID: 32249195 DOI: 10.1016/j.clml.2020.01.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/17/2020] [Accepted: 01/24/2020] [Indexed: 02/07/2023]
Abstract
Multiple myeloma (MM) is a plasma cell (PC) malignancy of terminally differentiated B lymphocytes that is typically associated with the secretion of partial and/or complete monoclonal immunoglobulins and a constellation of particular symptoms and signs. MM is a treatable condition, and timely diagnosis is essential to limit or avoid irreversible target-organ damage and to prolong survival. The Myeloma Canada Research Network Consensus Guideline Consortium (MCRN-CGC) proposes national consensus recommendations for the diagnosis of MM and associated PC neoplasms. The focus is on widely available tests but also highlights recent advancements that are important to include in the diagnostic paradigm. By clarifying and updating the required laboratory, radiographic, and bone marrow investigations, the MCRN-CGC hopes to address the needs of Canadian physicians and people living with MM across the country through accurate and timely diagnosis of MM, as well as appropriate initial stratification to improve treatment selection and outcomes. The MCRN-CGC will periodically review the recommendations herein and update as necessary. Recommendations on the therapeutic approaches and associated monitoring of MM will follow.
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Senger RS, Sullivan M, Gouldin A, Lundgren S, Merrifield K, Steen C, Baker E, Vu T, Agnor B, Martinez G, Coogan H, Carswell W, Kavuru V, Karageorge L, Dev D, Du P, Sklar A, Pirkle J, Guelich S, Orlando G, Robertson JL. Spectral characteristics of urine from patients with end-stage kidney disease analyzed using Raman Chemometric Urinalysis (Rametrix). PLoS One 2020; 15:e0227281. [PMID: 31923235 PMCID: PMC6954047 DOI: 10.1371/journal.pone.0227281] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/16/2019] [Indexed: 12/20/2022] Open
Abstract
Raman Chemometric Urinalysis (RametrixTM) was used to discern differences in Raman spectra from (i) 362 urine specimens from patients receiving peritoneal dialysis (PD) therapy for end-stage kidney disease (ESKD), (ii) 395 spent dialysate specimens from those PD therapies, and (iii) 235 urine specimens from healthy human volunteers. RametrixTM analysis includes spectral processing (e.g., truncation, baselining, and vector normalization); principal component analysis (PCA); statistical analyses (ANOVA and pairwise comparisons); discriminant analysis of principal components (DAPC); and testing DAPC models using a leave-one-out build/test validation procedure. Results showed distinct and statistically significant differences between the three types of specimens mentioned above. Further, when introducing “unknown” specimens, RametrixTM was able to identify the type of specimen (as PD patient urine or spent dialysate) with better than 98% accuracy, sensitivity, and specificity. RametrixTM was able to identify “unknown” urine specimens as from PD patients or healthy human volunteers with better than 96% accuracy (with better than 97% sensitivity and 94% specificity). This demonstrates that an entire Raman spectrum of a urine or spent dialysate specimen can be used to determine its identity or the presence of ESKD by the donor.
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Affiliation(s)
- Ryan S. Senger
- Department of Biological Systems Engineering, Virginia Tech, Blacksburg, Virginia, United States of America
- Department of Chemical Engineering, Virginia Tech, Blacksburg, Virginia, United States of America
- DialySenors, Inc., Blacksburg, Virginia, United States of America
- * E-mail:
| | - Meaghan Sullivan
- Department of Biological Systems Engineering, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Austin Gouldin
- Department of Biological Systems Engineering, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Stephanie Lundgren
- Department of Biological Systems Engineering, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Kristen Merrifield
- Department of Biological Systems Engineering, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Caitlin Steen
- Department of Biological Systems Engineering, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Emily Baker
- Department of Biological Systems Engineering, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Tommy Vu
- Department of Chemical Engineering, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Ben Agnor
- Department of Biological Systems Engineering, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Gabrielle Martinez
- Department of Biological Systems Engineering, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Hana Coogan
- Department of Biological Systems Engineering, Virginia Tech, Blacksburg, Virginia, United States of America
| | - William Carswell
- Department of Biological Systems Engineering, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Varun Kavuru
- Veteran Affairs Medical Center, Salem, Virginia, United States of America
| | - Lampros Karageorge
- Veteran Affairs Medical Center, Salem, Virginia, United States of America
| | - Devasmita Dev
- Veteran Affairs Medical Center, Salem, Virginia, United States of America
| | - Pang Du
- Department of Statistics, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Allan Sklar
- Lewis-Gale Medical Center, Salem, Virginia, United States of America
| | - James Pirkle
- Department of Internal Medicine–Nephrology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, United States of America
| | - Susan Guelich
- Valley Nephrology Associates, Roanoke, Virginia, United States of America
| | - Giuseppe Orlando
- Department of Surgical Sciences–Transplant, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, United States of America
| | - John L. Robertson
- DialySenors, Inc., Blacksburg, Virginia, United States of America
- Veteran Affairs Medical Center, Salem, Virginia, United States of America
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, United States of America
- Virginia Tech-Carilion School of Medicine and Research Institute, Blacksburg, Virginia, United States of America
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Liu L, Shurin MR, Wheeler SE. A novel approach to remove interference of therapeutic monoclonal antibody with serum protein electrophoresis. Clin Biochem 2020; 75:40-47. [PMID: 31669513 PMCID: PMC6928417 DOI: 10.1016/j.clinbiochem.2019.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/03/2019] [Accepted: 10/14/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Multiple myeloma (MM) is characterized by malignant growth of plasma cells, usually producing a monoclonal antibody (mAb). New treatments for MM include therapeutic monoclonal antibodies (tmAbs), but patients treated with tmAb demonstrate interference on serum electrophoresis (SPE) and immunoprecipitation electrophoresis (IEP). Evaluation of treatment efficacy and determination of MM remission include SPE and IEP which identifies mAb, but cannot differentiate between disease associated mAb and tmAb. We hypothesized that tmAb could be removed from patient sera before testing by SPE and IEP to provide accurate diagnoses for clinicians. DESIGN AND METHODS We developed the Antigen Specific therapeutic monoclonal Antibody Depletion Assay (ASADA), that utilizes magnetic beads coated with the cognate antigen of the tmAbs, to deplete two different tmAb (daratumumab, elotuzumab) from saline and patient sera and assessed for complete removal of tmAb by SPE and IEP. RESULTS We found that tmAb could be efficiently removed from saline and patient sera. ASADA demonstrated acceptable analytical specificity and sensitivity in IEP. Recovery of appropriate quantitative values by SPE was demonstrated with clinically acceptable precision. A single bead cocktail could be used to treat both daratumumab and elotuzumab. CONCLUSIONS This demonstrates proof of principle that ASADA can be used to remove current and future tmAb from patient sera, regardless of platform. This research provides for accurate diagnosis, disease monitoring, and remission status in MM patients being treated with tmAb.
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Affiliation(s)
- Li Liu
- University of Pittsburgh Medical Center, Department of Pathology, Clinical Laboratory Building, 3477 Euler Way, Pittsburgh, PA 15213, United States.
| | - Michael R Shurin
- University of Pittsburgh Medical Center, Department of Pathology, Clinical Laboratory Building, 3477 Euler Way, Pittsburgh, PA 15213, United States; University of Pittsburgh, Departments of Pathology and Immunology, Clinical Laboratory Building, 3477 Euler Way, Pittsburgh, PA 15213, United States.
| | - Sarah E Wheeler
- University of Pittsburgh Medical Center, Department of Pathology, Clinical Laboratory Building, 3477 Euler Way, Pittsburgh, PA 15213, United States; University of Pittsburgh, Department of Pathology, Clinical Laboratory Building, 3477 Euler Way, Pittsburgh, PA 15213, United States.
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Evliyaoglu O, van Helden J, Jaruschewski S, Imöhl M, Weiskirchen R. Reference change values of M-protein, free light chain and immunoglobulins in monoclonal gammopathy. Clin Biochem 2019; 74:42-46. [DOI: 10.1016/j.clinbiochem.2019.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/09/2019] [Accepted: 09/12/2019] [Indexed: 01/06/2023]
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Flow Cytometric Evaluation of Traditional and Novel Surface Markers for the Diagnosis of Plasma Cell Dyscrasias. Indian J Hematol Blood Transfus 2019; 35:673-682. [PMID: 31741619 DOI: 10.1007/s12288-019-01105-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 02/23/2019] [Indexed: 10/27/2022] Open
Abstract
Increasing interest has been expressed for flow cytometric immunophenotyping for diagnosis and monitoring in plasma cell dyscrasias over the last decades. The aim of this investigation was to compare the expression strength of various cell surface markers used traditionally or currently under investigation on normal and abnormal PC populations. We enrolled 295 consecutive patients undergoing bone marrow aspiration in the workup of monoclonal gammopathies, selecting 54 normal and 241 abnormal PC populations via flow cytometry to characterize the expression of CD45, CD38, CD138, CD19, CD56, CD20, CD27, CD28, CD81, CD117 and CD200 on the cell surface of PCs. We observed significant differences in the expression strength of all assessed markers between normal and abnormal PC populations in all markers except for CD20. While none of them was conclusive on its own, the combination of CD81 positivity and CD117 negativity was present in 98.1% of normal PC populations tested. In contrast, particularly CD117 positivity, but also CD81 negativity was indicative of an abnormal PC phenotype. Our results highlight the descriptive value of CD81 and CD117 for the allocation of bone marrow PCs to a normal or abnormal phenotype.
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Abstract
Laboratory testing plays an essential role in the diagnosis and management of patients with multiple myeloma. A variety of chemistry and molecular assays are routinely used to monitor patient progress, response to treatment and relapse. Here, we have reviewed current literature and core guidelines on the details of laboratory testing in myeloma-related investigations. This includes the use and value of protein electrophoresis, serum free light chain and cytogenetic testing. Furthermore, we discuss other traditional chemistry assays essential to myeloma investigation, and potential interferences that may arise due to the disease nature of myeloma, that is, the presence of a monoclonal immunoglobulin. Finally, we discuss the importance of communication in protein electrophoresis results, where laboratorians are required to relate clinically relevant myeloma-relevant information to the ordering physician on the background of a complex pattern of serum or urine proteins. Laboratory testing in myeloma-related investigation relies on several traditional chemistry assays. However, we anticipate new tests and technologies to become available in the future with improved analytical sensitivity, as well as improved clinical sensitivity in identifying patients who are at high risk of progression to multiple myeloma.
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Affiliation(s)
| | - Ronald A Booth
- Division of Biochemistry, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada; Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kristin Hauff
- Interior Health Corporate Office, Kelowna, BC, Canada
| | - Philip Berardi
- Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada; Division of Anatomical Pathology, The Ottawa Hospital/University of Ottawa, Ottawa, ON, Canada
| | - Alissa Visram
- Division of Haematology, The Ottawa Hospital General Campus, Ottawa, ON, Canada
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Myronovskij S, Shalay O, Spivak V, Stoika R, Kit Y. Characteristics of Potential Protein Biomarkers Extracted with 10% TCA from Blood Serum of Non-Hodgkin's Lymphoma and Multiple Myeloma Patients. INTERNATIONAL JOURNAL OF MOLECULAR AND CELLULAR MEDICINE 2018; 6:235-238. [PMID: 29988205 PMCID: PMC6004295 DOI: 10.22088/bums.6.4.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 10/07/2017] [Indexed: 10/31/2022]
Affiliation(s)
- Severyn Myronovskij
- Department of Regulation of Cell Proliferation and Apoptosis, Institute of Cell Biology, National Academy of Sciences of Ukraine, Lviv, Ukraine
| | - Olga Shalay
- Laboratory of Immunocytology and Genetics of Blood Tumors , Institute of Blood Pathology and Transfusion Medicine, National Academy of Medical Sciences of Ukraine, Lviv, Ukraine
| | - Veronika Spivak
- Biological Faculty of Ivan Franko Lviv National University, Lviv, Ukraine
| | - Rostyslav Stoika
- Department of Regulation of Cell Proliferation and Apoptosis, Institute of Cell Biology, National Academy of Sciences of Ukraine, Lviv, Ukraine .,Biological Faculty of Ivan Franko Lviv National University, Lviv, Ukraine
| | - Yuriy Kit
- Department of Regulation of Cell Proliferation and Apoptosis, Institute of Cell Biology, National Academy of Sciences of Ukraine, Lviv, Ukraine
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45
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Heavy/light chain assay as a biomarker for diagnosis and follow-up of multiple myeloma. Clin Chim Acta 2018; 479:7-13. [PMID: 29324245 DOI: 10.1016/j.cca.2018.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 12/07/2017] [Accepted: 01/07/2018] [Indexed: 01/23/2023]
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Willrich MA, Murray DL, Kyle RA. Laboratory testing for monoclonal gammopathies: Focus on monoclonal gammopathy of undetermined significance and smoldering multiple myeloma. Clin Biochem 2018; 51:38-47. [DOI: 10.1016/j.clinbiochem.2017.05.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 05/01/2017] [Accepted: 05/03/2017] [Indexed: 02/07/2023]
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47
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Genzen JR, Murray DL, Abel G, Meng QH, Baltaro RJ, Rhoads DD, Delgado JC, Souers RJ, Bashleben C, Keren DF, Ansari MQ. Screening and Diagnosis of Monoclonal Gammopathies: An International Survey of Laboratory Practice. Arch Pathol Lab Med 2017; 142:507-515. [DOI: 10.5858/arpa.2017-0128-cp] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Serum tests used for the screening and diagnosis of monoclonal gammopathies include serum protein electrophoresis (SPE; agarose gel or capillary zone), immunofixation (IFE) and immunosubtraction capillary electrophoresis, serum free light chains, quantitative immunoglobulins, and heavy/light–chain combinations. Urine protein electrophoresis and urine IFE may also be used to identify Bence-Jones proteinuria.
Objective.—
To assess current laboratory practice for monoclonal gammopathy testing.
Design.—
In April 2016, a voluntary questionnaire was distributed to 923 laboratories participating in a protein electrophoresis proficiency testing survey.
Results.—
Seven hundred seventy-four laboratories from 38 countries and regions completed the questionnaire (83.9% response rate; 774 of 923). The majority of participants (68.6%; 520 of 758) used agarose gel electrophoresis as their SPE method, whereas 31.4% (238 of 758) used capillary zone electrophoresis. The most common test approaches used in screening were SPE with reflex to IFE/immunosubtraction capillary electrophoresis (39.3%; 299 of 760); SPE only (19.1%; 145 of 760); SPE and IFE or immunosubtraction capillary electrophoresis (13.9%; 106 of 760); and SPE with IFE, serum free light chain, and quantitative immunoglobulins (11.8%; 90 of 760). Only 39.8% (305 of 767) of laboratories offered panel testing for ordering convenience. Although SPE was used by most laboratories in diagnosing new cases of myeloma, when laboratories reported the primary test used to follow patients with monoclonal gammopathy, only 55.7% (403 of 724) chose SPE, with the next most common selections being IFE (18.9%; 137 of 724), serum free light chain (11.7%; 85 of 724), and immunosubtraction capillary electrophoresis (2.1%; 15 of 724).
Conclusions.—
Ordering and testing practices for the screening and diagnosis of monoclonal gammopathy vary widely across laboratories. Improving utilization management and report content, as well as recognition and development of laboratory-directed testing guidelines, may serve to enhance the clinical value of testing.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Mohammad Q. Ansari
- From the Department of Pathology, University of Utah, Salt Lake City, and ARUP Laboratories, Salt Lake City, Utah (Drs Genzen and Delgado); the Department of Laboratory Medicine, Mayo Clinic, Rochester, Minnesota (Dr Murray); the Department of Laboratory Medicine, Lahey Hospital & Medical Center, Burlington, Massachusetts (Dr Abel); the Department of Laboratory Medicine, University of Texas MD An
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Analytical Criticalities Associated to Different Immunological Methods for Serum Free Light Chain Detection in Plasma Cell Dyscrasias: A Description of Particular Clinical Cases. Int J Mol Sci 2017; 18:ijms18040804. [PMID: 28417905 PMCID: PMC5412388 DOI: 10.3390/ijms18040804] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/03/2017] [Accepted: 04/05/2017] [Indexed: 11/17/2022] Open
Abstract
Current criteria for differential diagnosis of multiple myeloma (MM), Monoclonal gammopathy of undetermined significance (MGUS), and smoldering multiple myeloma (SMM) are included in the 2003 guidelines by the International Myeloma Working Group (IMWG). An updated version was then published in 2014, highlighting the importance of serum free light chain (sFLC) detection, as well as the κ/λ ratio as excellent indicators of clonality. At present, two commercial assays for sFLC quantification are available: the Freelite™ assay and the N-Latex assay. The first was developed by The Binding Site based on a mixture of polyclonal antibodies directed against a variety of FLC epitopes. It may be run on a wide range of nephelometers, as well as on turbidimeters. The second method was developed by Siemens and runs exclusively on Siemens instruments. It employs a probe mixture of mouse monoclonal antibodies. The aim of our study was to evaluate sFLC measurement and calculated κ/λ ratio in 85 patients with monoclonal gammopathies (MGs) in order to compare methods. We demonstrated that there is only a moderate concordance between the two FLC assays. In particular, in one case, we observed no qualitative alterations of the serum protein pattern, and in the absence of a Freelite™ assay, sFLC measurement would not have been possible to highlight the increase of λ FLC.
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Mills JR, Murray DL. Identification of Friend or Foe: The Laboratory Challenge of Differentiating M-Proteins from Monoclonal Antibody Therapies. ACTA ACUST UNITED AC 2016; 1:421-431. [DOI: 10.1373/jalm.2016.020784] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 10/14/2016] [Indexed: 11/06/2022]
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