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Light chain myeloma (LCM) has a reported worldwide incidence of approximately 15%–20% among all multiple myeloma (MM) patients. Few western studies have shown strong correlation of LCM with anemia, higher International Staging System scores, proclivity to renal failure, elevated lactate dehydrogenase levels, raised serum-free light chain ratio, higher frequency of extramedullary plasmacytomas, and poorer overall survival, attributable probably to lack of differentiation and skeletal destruction. The primary aim of this retrospective observational study was to define the clinical and hematological characteristics as well as prognostic outcome of Indian LCM patients in comparison with the IgG and IgA subtypes. Patients were defined according to the International Myeloma Working Group diagnostic criteria 2016 and staged as per the International Staging System. Out of 104 patients of newly diagnosed MM in which results of serum immunofixation (IFE) were available, 65 were of IgG isotype (62.5%), 15 had IgA (14.4%), and 24 had light chain myelomas (LCMs) (23.1%). It was observed that LCM patients significantly correlated with hypercalcemia and higher serum-free light chain ratios, whereas IgA patients were strongly associated with anemia and lower serum albumin levels. However, no difference was found among the three subgroups in terms of serum lactate dehydrogenase levels, proclivity to renal failure, presence of lytic bone lesions, prognostic scoring, pretransplant chemosensitivity, and progession-free survival (1 year). Thus, it may be concluded that Indian LCM patients have significantly different clinico-hematological profile in comparison with other published studies worldwide. Also, their prognostic outcomes are not worse when compared with patients of other protein isotypes, probably due to standardized treatment regimens applied.
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Objective To investigate the clinical and laboratory features of IgG-2κ light chain multiple myeloma. Methods The clinical data and laboratory results of 2 multiple myeloma (MM) patients with IgG-2κ light chain were analyzed and the related literatures were reviewed. Results Two male and 1 female patients were 50-82 years old and mainly suffered with backache, infection, anemia and renal dysfunction. Multiple osteolytic bone destruction was detected in X-ray as well as magnetic resonance imaging (MRI). The level of serum IgG was normal, slight or obviously increased, but the levels of IgA and IgM were decreased. The levels of κ light chain in serum and urine were both increased significantly, and Bence-Jones protein was positive. Double M protein peaks of serum in γ area were detected by protein electrophoresis in 2 patients. A single band of IgG and double bands of light chain κ were revealed by immunofixation electrophoresis. Bone marrow smear showed that abnormal plasma cells were increased obviously. One patient gave up chemotherapy because of lung infection, acute left heart failure and acute renal failure, the others 2 patients achieved partial remission and stable disease by receiving DVD and VAD chemotherapy. Conclusions IgG-2κ light chain MM lacks typical clinical presentation, but some laboratory characteristics may be different from those of IgG-κ light chain. Further researches are needed to confirm whether or not it belongs to biclonal MM.
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Objective To investigate the clinical value of laboratory markers in the diagnosis and treatment of light chain multi-ple myeloma (MM) .Methods Collected 31 cases of light chain MM patients and 60 cases of control group ,the control group con-sisted of 20 health subjects (healthy group) ,20 cases of type IgG κMM ,20 cases of type IgA κMM .The immune globulin ,serum protein electrophoresis ,immunofixation electrophoresis ,UREA ,Cr ,β2-microglobulin ,flow cytometry immunophenotyp and bone marrow cytology was detected .Results The positive rate of serum protein electrophoresis was 29 .03% ,the difference of the M protein comparison in Durie-Salmon stage of phase Ⅱ and phase Ⅲ was statistically significant(P<0 .05);light chain multiple mye-loma patient′s immunofixation electrophoresis results required reviewing by agarose gel electrophoresis plusing IgD and IgE anti-body ;the IgG ,IgA ,IgM ,UREA ,Cr ,β2-microglobulin of light chain MM patients were different compared with healthy group (P<0 .05);the morphological characteristics of MM cells changed significantly ,and the expression of cell antigen was mainly CD38 , CD138 and CD56 .Conclusion Quantitative of immunoglobulins and immunofixation electrophoresis could be used as screening method of M protein ,serum protein electrophoresis can be used for clinical staging and clinical observation of patients .Bone marrow smears plays an important role in the diagnosis of light chain MM .Light chain MM has more severe renal damage than other types of M M .
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Objective To investigate the clinical value of laboratory markers in the diagnosis and treatment of light chain multi-ple myeloma (MM) .Methods Collected 31 cases of light chain MM patients and 60 cases of control group ,the control group con-sisted of 20 health subjects (healthy group) ,20 cases of type IgG κMM ,20 cases of type IgA κMM .The immune globulin ,serum protein electrophoresis ,immunofixation electrophoresis ,UREA ,Cr ,β2-microglobulin ,flow cytometry immunophenotyp and bone marrow cytology was detected .Results The positive rate of serum protein electrophoresis was 29 .03% ,the difference of the M protein comparison in Durie-Salmon stage of phase Ⅱ and phase Ⅲ was statistically significant(P<0 .05);light chain multiple mye-loma patient′s immunofixation electrophoresis results required reviewing by agarose gel electrophoresis plusing IgD and IgE anti-body ;the IgG ,IgA ,IgM ,UREA ,Cr ,β2-microglobulin of light chain MM patients were different compared with healthy group (P<0 .05);the morphological characteristics of MM cells changed significantly ,and the expression of cell antigen was mainly CD38 , CD138 and CD56 .Conclusion Quantitative of immunoglobulins and immunofixation electrophoresis could be used as screening method of M protein ,serum protein electrophoresis can be used for clinical staging and clinical observation of patients .Bone marrow smears plays an important role in the diagnosis of light chain MM .Light chain MM has more severe renal damage than other types of M M .
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ABSTRACT Introduction: Multiple myeloma (MM) is an incurable progressive hematological neoplasia characterized by heterogeneous evolution and by relapses after therapy. Objective: Compare the effectiveness of serum immunofixation (SIF) and electrophoresis (SPE) techniques in the detection of relapses in MM patients undergoing treatment at the University Hospital of Santa Maria (HUSM). Material and methods: The study was conducted from January 2012 to July 2014 and included 52 patients from HUSM with confirmed diagnosis of MM. The retrospective monitoring based on laboratory analyses indicated that nine of these patients relapsed, in whom it was possible to compare the effectiveness of SIF and SPE techniques for detecting relapses. Results: For the nine patients, SIF always detected MM relapses earlier than SPE, with a precocity ranging from 2.0 to 18.8 months, for an average of 6.6 months. Discussion and conclusion: The results indicated that SIF was more effective than SPE for the early detection of relapses, regardless of the class and type of M component (mono/biclonal). Therefore, the use of SIF allows for better monitoring of MM patients, especially for the detection of relapses, thereby helping in choosing the most appropriate therapy and resulting in increased duration of survival period free of disease.
RESUMO Introdução: O mieloma múltiplo (MM) é uma neoplasia hematológica progressiva e incurável, caracterizada pela evolução heterogênea e pela ocorrência de recidivas nos pacientes após o tratamento. Objetivo: Comparar as técnicas de imunofixação (IFS) e eletroforese (EFS) séricas quanto à eficácia em detectar precocemente as recidivas em pacientes com MM e em tratamento junto ao Hospital Universitário de Santa Maria (HUSM). Material e métodos: O estudo foi realizado no período de janeiro de 2012 a julho de 2014, sendo incluídos 52 pacientes do HUSM com diagnóstico confirmado de MM. O monitoramento retrospectivo, realizado por meio de análises laboratoriais, indicou que nove desses pacientes recidivaram, nos quais foi possível comparar a eficácia das técnicas de IFS e EFS na detecção de tais recidivas. Resultados: Nos nove pacientes em estudo, a IFS sempre detectou as recidivas do MM antes da EFS, sendo que essa precocidade variou de dois a 18,8 meses, com tempo médio de 6,6 meses. Discussão e conclusão: Os resultados indicaram que a IFS foi mais eficaz do que a EFS em detectar as recidivas, independentemente da classe e do tipo de componente M (mono/biclonal). Portanto, o uso da IFS permite monitorar melhor os pacientes com MM, principalmente na detecção das recidivas, o que pode auxiliar na escolha da terapia mais adequada, além de aumentar o tempo de sobrevida livre da doença.
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Objective To investigate the clinical value of immunophenotyping and quantitative analysis of serum immunoglobulin in the diagnosis and typing of monoclonal gammaglobulinemia.Methods 118 serum samples were collected from the patients with monoclonal gammaglobulinemia and performed the serum protein electrophoresis(SPE),serum immunofixation(IF)electrophoresis, immunoglobulins(Ig)quantitation and serum light chain κ,λdetection.The analysis was conducted aiming at the patients with im-munophenotyping positive and the Ig quantitation negative.Results 56 cases showed immunophenotyping positive and the immuno-globulin quantitation negative,among them,6 cases were free light chain type (κlight chain in 2 cases andλlight chain in 4 cases), 1 case was the non-secretion type;62 cases showed immunophenotyping positive and the Ig quantitation positive.Conclusion The IF technique has an important significance for the diagnosis and typing of monoclonal gammaglobulinemia,its diagnosis can be com-bined with the other laboratory tests of serum Ig and light chain quantitative detection.
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Objective To analysis the varying degrees of the M protein staining after immunofixation electrophoresis(IFE)and study its applications in clinical diagnosis.Methods 196 cases of clinical serum samples were tested by using IFE,we analyzed the positive electrophoretic bands of M protein and performed statistical analysis by using SPSS17.0.The M proteins were analyzed ret-rospectively.Results 103 patients were diagnosed with monoclonal gammopathy in 196 patients with positive M protein bands,in-cluding 96 cases of multiple myeloma(MM)and 7 cases of other monoclonal gammopathy;93 patients were non-monoclonal gam-mopathy.By analyzing the M band staining in different clinical groups,we found that M bands were mainly with dense and thick staining in monoclonal immunoglobulin group,the dense staining rate of MM was 90.6%,and the difference between MM and the other monoclonal gammopathy was not significant(P >0.05).In contrast,M bands were in light and narrow staining in non-mono-clonal immunoglobulin group,the rate of which was 25.8%,the difference between non-monoclonal immunoglobulin group and monoclonal immunoglobulin group was statistically significant(P <0.01).The proportion of allelic band in MM,other monoclonal gammopathy,non-monoclonal gammopathy were 39.6%,28.6% and 2.2% respectively,the differences were statistically significant (P <0.01).Conclusion The M band,accompanied by allelic band in IFE staining,is helpful in the diagnosis of monoclonal gam-mopathy,especially MM.The appearance of M protein provides early warning of monoclonal gammopathy.
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Objective To study the frequency and characteristics of secondary monoclonal gammopathy of undetermined significance(sMGUS) in multiple myeloma (MM),and analyze the impact on survival.Methods The data of 515 patients with MM admitted were analyzed retrospectively.73 cases of patients underwent stem cell transplantation and 442 patients received thalidomide or bortezomib based chemotherapy.Immunofixation electrophoresis(IFE) and clinical characteristics were respectively analyzed,and the comparison of survival between sMGUS group and non-sMGUS group was performed.Results Thirty-five cases (6.8 ％) of myeloma patients with sMGUS were found in all patients.The incidence of sMGUS after hematopoietic stem cell transplantation treatment is significantly higher than that of receiving chemotherapy (19.2 ％ versus 4.8 ％,x2 =20.587,P =0.002).The CR rates of sMGUS group and non-sMGUS group were 45.7 ％ (16/35) and 14.3 ％ (59/480) (x2 =22.961,P ＜ 0.001).The median survival time of patients with sMGUS was much prolonged compared with the control cohort (42.0 versus 14.0 months,P ＜ 0.001).However,when the analysis was restricted on patients underwent stem cell transplant,patients with sMGUS had a negative impact on outcome,and the median overall survival was 30.8 and 39.3 months (P =0.002).Conclusion The sMGUS may be attributed to either immune reconstitution or immune system dysregulation after highly immunosuppressive therapy.The incidenceof sMGUS after auto-SCT treatment is higher than chemotherapy.The sMGUS group has the higher response rate and longer survival.But for auto-SCT treatment patients,sMGUS may be not a good prognostic factor.
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IgD κ myeloma is a rare plasma cell neoplasm case and has never been reported before in Indonesia. In normal condition, IgD level in blood is very low, therefore increase of IgD level in myeloma could be missed by serum protein electrophoresis. A case of a 59 years old female with severe bone pain is reported. In radiology evaluation, there were thoracal compression fracture and thoracal foramen narrowing. For this patient, the myeloma diagnosis was based on WHO criteria, the stage IIIb was based on Durie and Salmon criteria, and bad prognosis with prognostic index stage III diagnosis was based on International Prognostic Index from International Myeloma Working Group, respectively. In serum protein electrophoresis we found a very small monoclonal spike and in immunofi xation there were monoclonal IgD κ and free light chain κ.
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Blood Protein Electrophoresis , Multiple MyelomaABSTRACT
Objective To evaluate the diagnostic and therapeutic significance of serum free light chain (sFLC) in primary systemic(AL) amyloidosis. Methods Twenty-five patients with AL amyloidosis,including 18 men and 7 women with a mean age of 54(47-77) years old, were enrolled from October, 2005to May, 2010. sFLC was measured by immunoturbidimetric assay. The type of monoclonal light chain was judged upon sFLC κ/λ and its sensibility was compared with serum immunofixation and immunohistochemical analysis. Four patients were treated with M (T)D (melphalan/thalidomideand, dexamethasone), one with VD (velcade and dexamethasone) and four with high-dose melphalan followed by autologous stem cell support. The changes of sFLC were serially determined before and after treatment. Results Among the 25 patients with AL amyloidosis, two were κ light chains of precursor protein and 23 were λ light chains. Mean plasma cell in bone marrow was 3.5% (0-15%). Nineteen (76%) patients had abnormal elevated sFLC and abnormal κ/λ ratios, and 17(68% ) patients with immunofixation positive. The sFLC test had similar sensitivity as serum immunofixation (P = 0. 727 ). Twenty-one (84%) patients were shown to have either κor λ immunoreactive amyloid deposits on biopsied tissues. The sFLC test combined with serum immunofixation allowed the M protein to be detected in 22 (88%) patients. The positive rates of immunohistochemical analysis combined with sFLC test and/or serum immunofixation were 96%. Four patients with hematologic response showed obvious improvement in visceral organ involvement, but illness of 5 patients without hematologic response kept stable or progressed. Conclusions sFLC test is a sensitive qualitative and quantitative method to detect M protein. Preliminary data show the patients with obvious sFLC level decrease and/or κ/λ recovery to normal may have a high percentage of improved organs function. sFLC is critical index in diagnosing AL amyloidosis, which might help efficacy assessment.
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BACKGROUND: Free light chain (FLC) is widely used to evaluate B-cell proliferative diseases. Herein, we estimated the clinical usefulness of serum FLC in multiple myeloma (MM). METHODS: Fifty-one patients were enrolled. We performed FLC analysis, protein electrophoresis (PEP), and immunofixation electrophoresis (IFE). FLC was measured using Toshiba 200 FR Neo with FREELITE(TM), and kappa/lambda (kappa/lambda) ratio was calculated. We compared these parameters in 41 patients with increased FLC before and after bortezomib treatment. Complete response (CR) was defined as the disappearance of monoclonal (M) protein in serum and/or urine as measured by IFE. Partial response (PR) was defined as > or =50% reduction of serum M protein. Early objective response (EOR) included both CR and PR. Minimal response (MR) was defined as 25-49% reduction of M protein and stable disease (SD) as <25% reduction. RESULTS: Forty-one (80.4%) of the 51 patients studied revealed increment of FLC and the five patients with no increment revealed an abnormal kappa/lambda ratio. Especially, all of the light chain myeloma and non-secretory myeloma showed increased FLC concentrations. Among the patients with EOR, 72.4% (21/29) showed a normal or subnormal FLC concentration after the first cycle of treatment. Otherwise, PEP and IFE normalized in 24.1% (7/29) and 24.1% (7/29), respectively. The ratio of decreased FLC after the first cycle of treatment was significantly different between EOR and other response groups (MR, SD) (90.6% vs 51.8%, P=0.011). CONCLUSIONS: FLC was considered as a good diagnostic method in complement with PEP and IFE in MM, especially in light chain myeloma or non-secretory myeloma. Moreover, FLC is a useful monitoring tool because it reflects therapy results more rapidly owing to a short serum half-life.
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Adult , Aged , Female , Humans , Male , Middle Aged , Boronic Acids/therapeutic use , Immunoelectrophoresis , Immunoglobulin Light Chains/blood , Multiple Myeloma/diagnosis , Pyrazines/therapeutic use , Reagent Kits, DiagnosticABSTRACT
As gamopatias monoclonais resultam de hiperprodução de um único clone anormal de células plasmocitárias ou linfócitos B. O objetivo da avaliação laboratorial nas gamopatias é demonstrar a presença, a quantidade e o tipo de proteína anormal presente no soro e/ou na urina através do estudo do perfil protéico, quantificação das imunoglobulinas e cadeias leves e avaliação da proteinúria. Este artigo descreve as principais técnicas laboratoriais disponíveis, bem como suas indicações e limitações.
Monoclonal gammopathies result from an overproduction of a single abnormal clone of a plasma cell or B lymphocyte. The purpose of the laboratory protocols in these situations is to demonstrate the presence, the characterization and the concentration of an abnormal protein detected in serum and/or urine samples. The laboratory investigation is based on the electrophoretic protein profile, quantification of immunoglobulins, free light chains and proteinuria. This paper describes the major available laboratory methods as well their indications and limitations.
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Humans , Blood Protein Electrophoresis , Electrophoresis , Immunoelectrophoresis , Immunoglobulin kappa-Chains , Immunoglobulin lambda-Chains , Immunoglobulins , Paraproteinemias , Diagnostic Techniques and ProceduresABSTRACT
Objective To study the application of immunofixation electrophoresis(IFE) in typing M proteins. Methods Serum M proteins were detected in 43 patients and 20 normal controls by agarose gel IFE and rate nephelometery. Results Of 43 patients, 29 were affirmed to have M proteins, including 20 cases of IgG ?, 5 IgG ?, 2 IgM ?, 1 IgA ? and 1 ?. Conclusion The technology of IFE, characterized by easy differentiation of electrophoretic bands, simple operation and rapidity, has great value in typing M proteins.
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BACKGROUND: CSF can be leaked from the nose or ear due to fractures, tumors or surgical procedures in the skull base region, and the threat of impending meningitis necessitates early identification of it. Since 2-transferrin occurs practically in cerebrospinal fluid (CSF) and not in other body fluid, its detection from the rhinorrhea or otorrhea can be used for the diagnosis of CSF leakage. We carried out immunofixation-silver stain (IF-SS) method for detection of 2-transferrin in the CSF in order to know optimal identification condition of specific cerebrogenic marker. METHODS: The fresh CSF sample was collected by spinal tapping. 2-Transferrin was estimated by quantifying the total transferrin by nephelomertry (Behring, Germany). 2-Transferrin of CSF was identified by electrophoresis using Titan gel high resolution protein system (Beckman, USA), immunofixation with anti-human transferrin antibody (Dako, Denmark) and then stained with silver nitrate. Serial dilutions of CSF were performed to know the detection limit of 2-transferrin. To know the influence of blood mixing, tests for mixed specimen of serum and hemolysate in CSF were performed. To evaluate the specimen storage condition, tests for different temperature and storage time were performed . RESULTS: By IF-SS method, identification limit of 2-transferrin was 0.5 mg/dL in 1:4 diluted CSF with distilled water. And 2-transferrin could be detected in condition of mixing serum protein (7.5 g/dL) or hemoglobin (13 g/dL) with CSF up to 6 : 4. At various sample storage condition, such as 37degrees C, room temperature, and 4degrees C, band intensity decreased abruptly after 1 day, and it was not detected 5 days later. Mean while, in -20degrees C and -70degrees C, 2-transferin band was detected after 10 days. CONCLUSIONS: IF-SS method was sufficiently sensitive and specific for invalidation by blood contamination, and seems to be used as effective identification of 2-transferrin in the CSF without sample concentration, less diagnostic test for CSF leakage.
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Body Fluids , Cerebrospinal Fluid , Diagnosis , Diagnostic Tests, Routine , Ear , Electrophoresis , Limit of Detection , Meningitis , Nose , Saturn , Silver Nitrate , Skull Base , Spinal Puncture , Transferrin , WaterABSTRACT
Two M-protein peaks in serum protein electrophoresis are rarely present in patients with plasma cell discrasia. We describe a 72-year-old male patient with multiple myeloma secreting biclonal M-proteins, which were confirmed by immunofixation. Immunoelectrophoresis has some difficulties to dectect M components when a very small amount of M-protein develops an equivocally abnormal precipitation arc. In this case, serum protein electrophoresis revealed two M peaks, one in beta and the other in gamma globulin region. An immunoelectrophoresis revealed unequivocally abnormal precipitation arcs in IgA and K light chain regions, but the arc in IgG region was equivocal. We performed an immunofixation and confirmed biclonal gammopathy, IgA-K and IgG-K types. This result supports the view that immunofixation is an useful confirmatory test when immunoelectrophoresis results are equivocal.
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Aged , Humans , Male , Electrophoresis , gamma-Globulins , Immunoelectrophoresis , Immunoglobulin A , Immunoglobulin G , Multiple Myeloma , Myeloma Proteins , Plasma CellsABSTRACT
An improved method for Ge phenotyping using sulfosalicylic acid staining after IEF is reported. Gc subtyping had been achieved and Gc variants were detected using this method without using anfi-Gc serum for immunofixation. Two new Gc variants Gc~(1c3) and Gc~(2c7) were discovered in Chinese people, and their frequencies were 0.0008 and 0.0004 respectively.
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The phenotype frequencies of Gc and Tf in blood and bloodstains from the Hannationality in Bejing was studied using the agarose gel simultaneous electrophresisfollowed by the immunofixation method.Their gene frequencies were calculated.
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273 chinese have been studied with high voltage electrophoresis and immumofixation to survey the polymorphism of the third component of human complement in Shaanxi Provice Two C_3 phenotypes were found in this population, they are C_3SS and C_3FS The frequencies of C_3SS and C_3FS are 98.53% and 1.47% respectively. The frequency of C_3S gene is 0.9926 and C_3F gene 0.0073. These results are similar to other studies in China and this group was in Hardy-Weinberg equilibrium. Compared with Negro and Caucasian, the chinese population in Shaanxi Province has a significant difference in C_3 polymorphism.