Emergence of Oligoclonal Bands in Association with the use of Chemotherapy and Hematopoietic Stem Cell Transplantation.

Multiple myeloma (MM) is a rare malignant condition with an abnormal clonal proliferation of plasma cells in the bone marrow. Chemotherapy and Hematopoietic Stem cell transplantation (HCT) are the main modalities of myeloablative therapy. The study aimed to determine the frequency of oligoclonal bands (OB) in multiple myeloma patients receiving primary therapy alone with chemotherapy as well as patients undergoing HCT at a single institution. The clinical and laboratory records of 76 MM patients were reviewed who underwent HCT from January 2012 to January 2019. Another 74 cases receiving chemotherapy alone, were also reviewed. In total 85 patients were selected by the availability of at least 3 serial immunofixation electrophoresis(IFE) results in non-transplanted cases and 2 post-transplant IFE results in the HCT cases after attainment of very good partial response(VGPR). 40 patients were non transplanted cases while 45 patients underwent HCT. Oligoclonal bands emerged in twenty-four (28%) patients. 15% (6/40) of the patients treated without HCT and, 40% (18/45) of patients treated with HCT from their respective cohorts. To conclude, this is the first Indian report showing a higher frequency of oligoclonal response in patients in VGPR attained after hematopoietic stem cell transplantation versus chemotherapy. This difference could be due to a stronger immune reconstitution, or graft vs. host reaction, or autoimmune response to myeloma antigens and may not be an active disease process or relapse. However to determine the prognostic impact of OB further investigations and follow-ups are required.

Audit of the Prevalence of Noncorrelation of Immunofixation with Protein Electrophoresis and Serum Free Light Chain Assays in Multiple Myeloma in a Tertiary Cancer Care Center.

Multiple myeloma (MM) is diagnosed and monitored by correlating panel of test results including serum Protein electrophoresis (SPE), Immunofixation electrophoresis (IFE), serum Free Light chain (sFLC) measurements. This audit is aimed to evaluate the prevalence of non-correlation and discrepancies amongst the three investigations (SPE/IFE/sFLC) for assessment of MM. 106 MM patients were reviewed over 16 months in a tertiary cancer care center by the availability of 3 serum test results (SPE/IFE/sFLC). Patients were divided into 2 groups: group1, newly diagnosed MM patients who were yet to receive myeloma specific treatment (n = 48); and group2, already diagnosed MM patients on treatment and followup (n = 58). Treatment modalities included stem cell transplantation and standard chemotherapy regimens. Non-correlation between the three test results (IFE/SPE/sFLC) was observed (21% in group1 and 45% in group2). Three types of discrepancies were detected as follows: (a) IFE showing less number of restriction bands as compared to SPE (8.6% patients in group2); (b) SPE/IFE negative with an abnormal sFLC ratio (12.5% patients in group1 and 13.7% in group2); (c) SPE/IFE positive but normal sFLC ratio (8% in group1 and 22% in group2). To conclude, IFE may sometimes provide information that does not always correlate with either of the SPE or sFLC results due to different sensitivities, antigen-antibody interactions, or treatment. Hence, SPE plus sFLC may be more useful particularly for patients on follow-up while IFE plus sFLC may help screen the new patients. The judicious selection of the biochemical assays can effectively reduce the treatment cost in a developing country like India.

Constitutional Mismatch Repair Deficiency Syndrome in a patient from India.

This report highlights an extremely rare genetic condition constitutional mismatch repair deficiency (CMMRD) in an Indian pediatric patient with dual malignancies, who suffered from transient encephalopathy, a rare side effect of the drug Nivolumab and the associated challenge during CSF protein electrophoresis interpretation.

An efficient module-less synthesis approach for Digital Microfluidic Biochip.

Digital Microfluidic Biochips (DMFBs) will require error-free synthesis techniques which can function at much higher speed while implementing on real-time systems and capable of tackling more complex assay operations. Until now various bio-assays are successfully implemented based on different mixing modules present on such lab-on-chips. In present work, the concept of such dedicated virtual modules has been eliminated and a novel module-less-synthesis (MLS) method is proposed for accomplishing high-performance bio-protocols. Various shift-patterns (movements) of the micro-droplets are identified to accomplish entire mixing in lesser time compared to earlier module-based synthesis methods. We have also computed the percentage of mixing accomplishment for each directional-shift of the mixer-droplet. However, path congestion problem and operational errors are inevitable in MLS approach. Hence, the path congestion and washing problem in MLS is addressed by tweaking the earlier MLS approach and a new modified-MLS (MMLS) method is proposed. Finally, washing optimization technique on MMLS method is also given. Different real-life bio assays like PCR, IVD are tested with the proposed technique as well as synthetic benchmarks (hard test benches) are also incorporated in the experiments. For both kind of benchmarks synthesis performance improved with bioassay completion time ( T max ) significantly reduced compared to existing synthesis approaches on DMFB platform.