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Chang L, Zheng Z, Zhou Y, Liu K, Li Y, Zhong B, Zhao Z, Chen C, Qian C, Ni Q, Zou Q, Wu Y, Li J, Zou L. B cell receptor repertoire analysis in primary Sjogren's syndrome salivary glands identifies repertoire features associated with clinical activity. Arthritis Res Ther 2024; 26:62. [PMID: 38454506 PMCID: PMC10918881 DOI: 10.1186/s13075-024-03283-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/31/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Primary Sjogren's syndrome (pSS) is a complex autoimmune disease featuring damage to salivary and lacrimal glands, with the possibility of manifestations across multiple organs. Antibody-producing B cells have long been appreciated to play a significant role in pSS pathogenesis, with a number of autoreactive antibody species having been identified to be elevated in pSS patients. While several studies have attempted to characterize the BCR repertoires of peripheral blood B cells in pSS patients, much remains unknown about the repertoire characteristics of gland-infiltrating B cells. METHODS Through paired scRNAseq and scBCRseq, we profiled the BCR repertoires of both infiltrating and circulating B cells in a small cohort of patients. We further utilize receptor reconstruction analyses to further investigate repertoire characteristics in a wider cohort of pSS patients previously profiled through RNAseq. RESULTS Via integrated BCR and transcriptome analysis of B cell clones, we generate a trajectory progression pattern for infiltrated memory B cells in pSS. We observe significant differences in BCR repertoires between the peripheral blood and labial gland B cells of pSS patients in terms of relative expansion, isotype usage, and BCR clustering. We further observe significant decreases in IgA2 isotype usage among pSS patient labial and parotid gland B cells these analyses relative to controls as well as a positive correlation between kappa/lambda light chain usage and clinical disease activity. CONCLUSIONS Through BCR repertoire analysis of pSS patient salivary glands, we identify a number of novel repertoire characteristics that may serve as useful indicators of clinical disease and disease activity. By collecting these BCR repertoires into an accessible database, we hope to also enable comparative analysis of patient repertoires in pSS and potentially other autoimmune disorders.
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Affiliation(s)
- Ling Chang
- Department of Rheumatology and Immunology, First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Zihan Zheng
- Biomedical Analysis Center, Army Medical University, Chongqing, China
- Department of Autoimmune Diseases, Chongqing International Institute for Immunology, Chongqing, China
| | - Yiwen Zhou
- Institute of Immunology PLA, Army Medical University, Army Medical University, 30 Gaotanyan Avenue, Shapingba District, Chongqing, 400000, China
| | - Kun Liu
- Biomedical Analysis Center, Army Medical University, Chongqing, China
| | - Yinong Li
- Biomedical Analysis Center, Army Medical University, Chongqing, China
| | - Bing Zhong
- Department of Rheumatology and Immunology, First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Zihua Zhao
- Institute of Immunology PLA, Army Medical University, Army Medical University, 30 Gaotanyan Avenue, Shapingba District, Chongqing, 400000, China
| | - Chengshun Chen
- Department of Rheumatology and Immunology, First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Can Qian
- Department of Rheumatology and Immunology, First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Qingshan Ni
- Biomedical Analysis Center, Army Medical University, Chongqing, China
| | - Qinghua Zou
- Department of Rheumatology and Immunology, First Affiliated Hospital of Army Medical University, Chongqing, China.
| | - Yuzhang Wu
- Institute of Immunology PLA, Army Medical University, Army Medical University, 30 Gaotanyan Avenue, Shapingba District, Chongqing, 400000, China.
| | - Jingyi Li
- Department of Rheumatology and Immunology, First Affiliated Hospital of Army Medical University, Chongqing, China.
| | - Liyun Zou
- Department of Rheumatology and Immunology, First Affiliated Hospital of Army Medical University, Chongqing, China.
- Institute of Immunology PLA, Army Medical University, Army Medical University, 30 Gaotanyan Avenue, Shapingba District, Chongqing, 400000, China.
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Rezvani A, Shahriarirad R, Fallahi MJ, Zeighami A. Extramedullary relapse of Immunoglobulin A-kappa myeloma manifesting as plasmacytoma of the pleura without bone marrow involvement and following autologous bone marrow transplant: a case report. J Med Case Rep 2023; 17:42. [PMID: 36759913 PMCID: PMC9912644 DOI: 10.1186/s13256-023-03765-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 01/06/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Recurrence of multiple myeloma is among the most challenging issues for patients and treating physicians reported after autologous stem cell transplantation. However, extramedullary involvement after chemotherapy and transplantation has been rarely reported, especially as pleural manifestations. Protein electrophoresis indicated immunoglobulin A monoclonal kappa plasma cell neoplasm in our case. CASE PRESENTATION A 48-year-old middle-eastern man was referred to our clinic with cough, dyspnea, fever, and left side pleural effusion. A year after chemotherapy and autologous bone marrow transplantation, the patient presented with features in favor of pleural relapse, without bone marrow involvement. Protein electrophoresis demonstrated immunoglobulin A monoclonal kappa plasma cell neoplasm in our case. The patient was effectively treated with dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide, and etoposide with no notable adverse effects. CONCLUSION Physicians should be aware of various presentations of multiple myeloma relapse, especially in autologous stem cell transplantation patients. Atypical and unique presentations such as the pleural involvement warrant further reporting of evidence to provide early management and treatment options.
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Affiliation(s)
- Alireza Rezvani
- grid.412571.40000 0000 8819 4698Bone Marrow Transplantation Center, Nemazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran ,grid.412571.40000 0000 8819 4698Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, 71936-13311 Iran
| | - Reza Shahriarirad
- grid.412571.40000 0000 8819 4698Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, 71936-13311 Iran ,grid.412571.40000 0000 8819 4698Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Javad Fallahi
- grid.412571.40000 0000 8819 4698Department of Internal Medicine, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Zeighami
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, 71936-13311, Iran. .,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
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3
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Ursule-Dufait C, Bengoufa D, Theodorou I, Villesuzanne C, Arnulf B. Heavy chain/light chain assay is a useful biomarker for diagnosis and management of patients with cold agglutinin disease. Br J Haematol 2022; 198:e67-e70. [PMID: 35732557 DOI: 10.1111/bjh.18317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Cindy Ursule-Dufait
- Immuno-hematology Department, Saint-Louis Hospital, APHP.Nord/Université Paris Cité, Paris, France
| | | | | | - Camille Villesuzanne
- Immuno-hematology Department, Saint-Louis Hospital, APHP.Nord/Université Paris Cité, Paris, France
| | - Bertrand Arnulf
- Immuno-hematology Department, Saint-Louis Hospital, APHP.Nord/Université Paris Cité, Paris, France
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4
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Ríos-Tamayo R, Puig N, Algarín M, García de Veas Silva JL, Barbosa N, Encinas C, Hernández JÁ, Alonso R, Campos ML, Rodríguez T, Leivas A, Olivares MJ, Sánchez MJ, Paiva B, Lahuerta JJ, Martínez-López J. The Current Role of the Heavy/Light Chain Assay in the Diagnosis, Prognosis and Monitoring of Multiple Myeloma: An Evidence-Based Approach. Diagnostics (Basel) 2021; 11:2020. [PMID: 34829367 DOI: 10.3390/diagnostics11112020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 11/17/2022] Open
Abstract
Despite tremendous progress being made in recent years, multiple myeloma (MM) remains a challenging disease. The laboratory plays a critical role in the overall management of patients. The diagnosis, prognosis, clinical monitoring and evaluation of the response are key moments in the clinical care process. Conventional laboratory methods have been and continue to be the basis of laboratory testing in monoclonal gammopathies, along with the serum free light chain test. However, more accurate methods are needed to achieve new and more stringent clinical goals. The heavy/light chain assay is a relatively new test which can overcome some of the limitations of the conventional methods for the evaluation of intact immunoglobulin MM patients. Here, we report an update of the evidence accumulated in recent years on this method regarding its use in MM.
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5
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Visram A, Soof C, Rajkumar SV, Kumar SK, Bujarski S, Spektor TM, Kyle RA, Berenson JR, Dispenzieri A. Serum BCMA levels predict outcomes in MGUS and smoldering myeloma patients. Blood Cancer J 2021; 11:120. [PMID: 34168119 PMCID: PMC8225625 DOI: 10.1038/s41408-021-00505-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/24/2021] [Accepted: 05/28/2021] [Indexed: 11/09/2022] Open
Abstract
Soluble BCMA (sBCMA) levels are elevated in monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM). However, the association between sBCMA levels and prognosis in MGUS and SMM has not been studied. We retrospectively analyzed sBCMA levels in stored samples from 99 MGUS and 184 SMM patients. Baseline sBCMA levels were significantly higher in MGUS and SMM patients progressing to MM during clinical follow up. When stratified according to the median baseline sBCMA level for each cohort, higher levels were associated with a shorter PFS for MGUS (HR 3.44 comparing sBCMA ≥77 vs <77 ng/mL [95% CI 2.07-5.73, p < 0.001] and SMM (HR 2.0 comparing sBCMA ≥128 vs <128 ng/mL, 95% 1.45-2.76, p < 0.001) patients. The effect of sBCMA on PFS was similar even after adjusting for the baseline MGUS or SMM risk stratification. We evaluated paired serum samples and found that sBCMA increased significantly in MGUS and SMM patients who eventually progressed to MM, whereas among MGUS non-progressors the sBCMA level remained stable. While our results require independent validation, they suggest that sBCMA may be a useful biomarker to identify MGUS and SMM patients at increased risk of progression to MM independent of the established risk models.
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Affiliation(s)
- A Visram
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - C Soof
- Institute for Myeloma & Bone Cancer Research, West Hollywood, CA, California, USA
| | - S V Rajkumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S Bujarski
- Institute for Myeloma & Bone Cancer Research, West Hollywood, CA, California, USA
| | - T M Spektor
- OncoTracker, West Hollywood, CA, California, USA
| | - R A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - J R Berenson
- Institute for Myeloma & Bone Cancer Research, West Hollywood, CA, California, USA.,OncoTracker, West Hollywood, CA, California, USA.,Oncotherapeutics, West Hollywood, CA, California, USA.,Berenson Cancer Center, West Hollywood, CA, California, USA
| | - A Dispenzieri
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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6
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Visram A, Vaxman I, S Al Saleh A, Parmar H, Dispenzieri A, Kapoor P, Lacy MQ, Gertz MA, Buadi FK, Hayman SR, Dingli D, Warsame R, Kourelis T, Siddiqui M, Gonsalves W, Muchtar E, Lust JA, Leung N, Kyle RA, Murray D, Rajkumar SV, Kumar S. Disease monitoring with quantitative serum IgA levels provides a more reliable response assessment in multiple myeloma patients. Leukemia 2021; 35:1428-1437. [PMID: 33623138 PMCID: PMC8102180 DOI: 10.1038/s41375-021-01180-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/13/2021] [Accepted: 02/01/2021] [Indexed: 01/22/2023]
Abstract
Unlike IgG monoclonal proteins (MCPs), IgA MCP quantification is unreliable due to beta-migration of IgA MCPs on serum protein electrophoresis (SPEP). The utility of nephelometric quantitative IgA (qIgA) to monitor IgA multiple myeloma (MM) is unclear. We retrospectively studied disease response kinetics using qIgA versus MCPs by SPEP, and developed and validated novel qIgA disease assessment criteria in 491 IgA MM patients. The SPEP MCP nadir occurred a median of 41 (IQR 0-102) days before the qIgA. The median time to achieve a partial response (PR) was shorter using standard IMWG versus qIgA response criteria (32 vs 58 days, p < 0.001). Stratification by qIgA criteria, unlike IMWG criteria, led to clear separation of the progression-free survival curves of patients achieving a PR or very good PR. There was a consistent trend toward earlier detection of disease progression using qIgA versus IMWG progression criteria. In conclusion, monitoring IgA MM using MCP-based IMWG criteria may be falsely reassuring, given that MCP levels on SPEP decrease faster than qIgA levels. The qIgA response criteria more accurately stratify patients based on the progression risk and may detect disease progression earlier, which may lead to more consistent measurement of trial endpoints and improved patient outcomes.
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Affiliation(s)
- Alissa Visram
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.,University of Ottawa, Ottawa Hospital Research Institute, Ontario, Canada
| | - Iuliana Vaxman
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.,Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikvah, Israel.,Israel Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel
| | - Abdullah S Al Saleh
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.,Division of Hematology and HSCT, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Harsh Parmar
- Division of Hematology, John Theurer Cancer Center at Hackensack University, Hackensack, NJ, USA
| | | | | | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - John A Lust
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Nelson Leung
- Division of Nephrology, Mayo Clinic, Rochester, MN, USA
| | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - David Murray
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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7
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Habermehl GK, Nakashima MO, Cotta CV. IgA plasma cell neoplasms are characterized by poorer long-term survival and increased genomic complexity compared to IgG neoplasms. Ann Diagn Pathol 2019; 44:151449. [PMID: 31865247 DOI: 10.1016/j.anndiagpath.2019.151449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 09/03/2019] [Accepted: 09/17/2019] [Indexed: 12/19/2022]
Abstract
The characteristics of the IgA plasma cell neoplasms are not clearly reported in the literature. The main goal of this study is to examine IgA plasma cell neoplasms (PCN) and to compare them to IgG lesions. After at least 5 years from the identification of an M protein, 98 cases were selected, the presentation and clinical evolution of 45 IgA neoplasms were compared to 43 cases of IgG gammopathies. The classification at presentation as monoclonal gammopathy of undermined significance (MGUS)-22 of 45 IgA and 20 of 43 IgG (49 vs 46%), plasma cell myeloma (PCM)-22 of 45 IgA and 22 of 43 IgG (49 vs 51%) and smoldering PCM (SPCM)-1 each (2% for both) was essentially identical. No solitary plasmacytomas were identified. At presentation, IgA patients were younger (66.5 ± 11.3 vs. 69.2 ± 10.7 years), less likely to have bone lesions (12/45 vs 18/43, p < 0.14) or immunoparesis (51% vs. 63%), differences statistically insignificant. Cases with normal fluorescence in-situ hybridization (FISH) results, 27% for IgA vs 61% for IgG (p < 0.037) were statistically different. The IgA patients had worse survival (80 vs 108 months median IgA vs IgG, p < 0.013), difference not detectable in the first 5 years, but substantial after 10. In conclusion, poorer long-term survival and increased genomic complexity by FISH are characteristics of IgA PCNs.
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Affiliation(s)
- Gabriel K Habermehl
- R.J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Megan O Nakashima
- R.J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Claudiu V Cotta
- R.J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
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8
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Lopez-Anglada L, Cueto-Felgueroso C, Rosiñol L, Oriol A, Teruel AI, Lopez de la Guia A, Bengoechea E, Palomera L, de Arriba F, Hernandez JM, Granell M, Peñalver FJ, Garcia-Sanz R, Besalduch J, Gonzalez Y, Martinez RB, Hernandez MT, Gutierrez NC, Puerta P, Valeri A, Paiva B, Blade J, Mateos MV, San Miguel J, Lahuerta JJ, Martinez-Lopez J. Prognostic utility of serum free light chain ratios and heavy-light chain ratios in multiple myeloma in three PETHEMA/GEM phase III clinical trials. PLoS One 2018; 13:e0203392. [PMID: 30192814 PMCID: PMC6128544 DOI: 10.1371/journal.pone.0203392] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/20/2018] [Indexed: 11/18/2022] Open
Abstract
We investigated the prognostic impact and clinical utility of serum free light chains (sFLC) and serum heavy-light chains (sHLC) in patients with multiple myeloma treated according to the GEM2005MENOS65, GEM2005MAS65, and GEM2010MAS65 PETHEMA/GEM phase III clinical trials. Serum samples collected at diagnosis were retrospectively analyzed for sFLC (n = 623) and sHLC (n = 183). After induction or autologous transplantation, 309 and 89 samples respectively were available for sFLC and sHLC assays. At diagnosis, a highly abnormal (HA) sFLC ratio (sFLCr) (<0.03 or >32) was not associated with higher risk of progression. After therapy, persistence of involved-sFLC levels >100 mg/L implied worse survival (overall survival [OS], P = 0.03; progression-free survival [PFS], P = 0.007). Among patients that achieved a complete response, sFLCr normalization did not necessarily indicate a higher quality response. We conducted sHLC investigations for IgG and IgA MM. Absolute sHLC values were correlated with monoclonal protein levels measured with serum protein electrophoresis. At diagnosis, HA-sHLCrs (<0.29 or >73) showed a higher risk of progression (P = 0.006). Additionally, involved-sHLC levels >5 g/L after treatment were associated with shorter survival (OS, P = 0.001; PFS, P = 0.018). The HA-sHLCr could have prognostic value at diagnosis; absolute values of involved-sFLC >100 mg/L and involved-sHLC >5 g/L could have prognostic value after treatment.
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Affiliation(s)
- Lucia Lopez-Anglada
- Hematology Department, Hospital Universitario 12 de Octubre, CIBERONC, Madrid, Spain
- * E-mail: (JML); (LLA)
| | | | - Laura Rosiñol
- Hematology Department, Hospital Clinic, Institut d'Investigacions Biomédiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Ana Isabel Teruel
- Hematology Department, Hospital Clínico de Valencia, Valencia, Spain
| | | | | | - Luis Palomera
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | | | - Miquel Granell
- Haematology, Hospital Univarsitari de la Santa Creu i Sant Pau, Barcelona,Spain
| | | | - Ramon Garcia-Sanz
- Hematology Department, Hospital Universitario de Salamanca-IBSAL, IBMCC-CSIC, Salamanca, Spain
| | - Juan Besalduch
- Haematology Department, Hospital Univarsitari Son Espases, Mallorca, Spain
| | - Yolanda Gonzalez
- Haematology Department, Institutd’Oncologia Dr Josep Trueta de Girona, Girona, Spain
| | | | | | - Norma C. Gutierrez
- Hematology Department, Hospital Clinic, Institut d'Investigacions Biomédiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Paloma Puerta
- Clinical Biochemistry Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Antonio Valeri
- Hematology Department, Hospital Universitario 12 de Octubre, CIBERONC, Madrid, Spain
| | - Bruno Paiva
- Haematology Department, Clínica Universitaria de Navarra/ CIMA,IDISNA, CIBERONC,Pamplona, SPAIN
| | - Joan Blade
- Hospital Germans i Trials, Barcelona, Spain
| | - Maria-Victoria Mateos
- Hematology Department, Hospital Clinic, Institut d'Investigacions Biomédiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Jesus San Miguel
- Haematology Department, Clínica Universitaria de Navarra/ CIMA,IDISNA, CIBERONC,Pamplona, SPAIN
| | - Juan Jose Lahuerta
- Hematology Department, Hospital Universitario 12 de Octubre, CIBERONC, Madrid, Spain
| | - Joaquin Martinez-Lopez
- Hematology Department, Hospital Universitario 12 de Octubre, CIBERONC, Madrid, Spain
- * E-mail: (JML); (LLA)
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9
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Sarto C, Cappellini F, Giagnacovo M, Brambilla P. IgMκ-IgMλ pair quantitation in the clinical laboratory practice. Clin Biochem 2018; 51:56-60. [DOI: 10.1016/j.clinbiochem.2016.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/06/2016] [Accepted: 11/05/2016] [Indexed: 12/30/2022]
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Abstract
There have been several advances in the diagnosis of multiple myeloma (MM) in recent years. Serum free light chains have improved the ability to diagnose light chain MM; however, there are still difficulties in the serologic diagnosis of MM in some cases, particularly IgA MM. A novel heavy/light chain assay is able to improve the accuracy of diagnosis in these cases. Free light chains may also improve the diagnosis of extramedullary disease in difficult cases such as disease involving the central nervous system, pleura, or ascites. Advances in imaging such as whole body low-dose computed tomography (CT) whole body magnetic resonance imaging (MRI), and positron emission tomography/computed tomography (PET/CT) have improved sensitivity in identifying lytic bone lesions, which would enable earlier treatment, and monitoring of osseous disease particularly in non- or oligosecretory disease. New techniques such as fused PET/MRI may further enhance the diagnosis of both bone lesions and extramedullary disease.
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11
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Altinier S, Proko K, Zaninotto M, Ciubotaru D, Seguso M, Varagnolo M, Lessi F, Briani C, Adami F, Plebani M. Free light chains and heavy/light chains in monitoring POEMS patients. Clin Chem Lab Med 2017; 54:1065-71. [PMID: 27071150 DOI: 10.1515/cclm-2015-0910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 03/02/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND POEMS syndrome is defined by Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy and Skin changes. The vascular endothelial growth factor (VEGF) appears to play a key role in the pathogenesis of the syndrome, and its concentrations are deemed to correlate to disease activity. The aim of the present study was to verify whether other biochemical markers including serum free light chains (FLC) and heavy/light chains (HLC) would be of value in monitoring POEMS patients. METHODS Fifty-three serum samples were collected from seven POEMS patients at diagnosis and during a follow-up period (range 14-56 months). VEGF was measured using an ELISA method, while FLC and HLC concentrations were measured using Binding Site reagents on a BNII (Siemens) nephelometer. RESULTS At diagnosis all patients presented high VEGF concentrations, while the κ/λFLC ratio (FLCr) was within the reference range. Four patients had abnormal HLC, HLCκ/HLCλ (HLCr) and FLC values. The relationship between the trend of VEGF and both HLC and FLC during the follow-up was analysed by means of Cohen's κ coefficient. VEGF and HLC values displayed a significant κ-Cohen (0.537, p=0.002) in all chemotherapy-responder patients while in non-responders it did not. Conversely, in both responders and non-responders, VEGF and FLC values did not attain a significance on κ-Cohen analysis. In three out of four responders HLCr values increased, thus reflecting an improved clinical condition. CONCLUSIONS The findings made in the present study indicate that HLC, either as intact immunoglobulin or as HLCr, may provide useful information, particularly in identifying responders and confirm that the role of FLC is unreliable in monitoring patients with POEMS syndrome.
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12
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D'Auria F, La Rocca F, Simeon V, Statuto T, Pietrantuono G, D'Arena G, Villani O, Mansueto G, Traficante A, Musto P. Heavy/light chain ratio for the assessment of minimal residual disease in myeloma patients achieving complete response. Br J Haematol 2017; 181:550-552. [PMID: 28439880 DOI: 10.1111/bjh.14662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Fiorella D'Auria
- Laboratory of Clinical Research and Advanced Diagnostics, IRCCS-CROB, Referral Cancer Centre of Basilicata, Rionero in Vulture (Pz), Italy
| | - Francesco La Rocca
- Laboratory of Clinical Research and Advanced Diagnostics, IRCCS-CROB, Referral Cancer Centre of Basilicata, Rionero in Vulture (Pz), Italy
| | - Vittorio Simeon
- Laboratory of Preclinical and Translational Research, IRCCS-CROB, Referral Cancer Centre of Basilicata, Rionero in Vulture (Pz), Italy
| | - Teodora Statuto
- Laboratory of Clinical Research and Advanced Diagnostics, IRCCS-CROB, Referral Cancer Centre of Basilicata, Rionero in Vulture (Pz), Italy
| | - Giuseppe Pietrantuono
- Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Centre of Basilicata, Rionero in Vulture (Pz), Italy
| | - Giovanni D'Arena
- Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Centre of Basilicata, Rionero in Vulture (Pz), Italy
| | - Oreste Villani
- Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Centre of Basilicata, Rionero in Vulture (Pz), Italy
| | - Giovanna Mansueto
- Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Centre of Basilicata, Rionero in Vulture (Pz), Italy
| | - Antonio Traficante
- Unit of Clinical Pathology, IRCCS-CROB, Referral Cancer Centre of Basilicata, Rionero in Vulture (Pz), Italy
| | - Pellegrino Musto
- Scientific Direction, IRCCS-CROB, Referral Cancer Centre of Basilicata, Rionero in Vulture (Pz), Italy
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Andrade-Campos M, Murillo-Flórez I, García-Sanz R, Giraldo P. Immunoparesis in IgM gammopathies as a useful biomarker to predict disease progression. ACTA ACUST UNITED AC 2017; 55:1598-1604. [DOI: 10.1515/cclm-2016-0748] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 01/25/2017] [Indexed: 12/26/2022]
Abstract
AbstractBackground:The management of IgM monoclonal gammopathies undetermined significance (IgM-MGUS) and Waldenstrom’s macroglobulinemia (WM) may be challenging. Modern immunoassays that quantify specific monoclonal heavy and light chain immunoglobulins are promising for their use in these applications.Methods:Ninety consecutive patients (39 IgM-MGUS, 32 indolent WM [iWM], and 19 WM) seen between January 2007 and March 2014 were analyzed. Heavy/light chain (HLC) and serum free light chains assays (FLC) were determined at diagnosis to study their utility as biomarkers in IgM monoclonal gammopathies.Results:The HLC involved to uninvolved IgM ratios (iHLC/uHLC) showed a progressive increase when going from IgM-MGUS, to iWM and to WM (p=0.002). Furthermore, an iHLC/uHLC>62 identified a group of iWM patients with a shorter time-to-progression (TTP) (108 vs. 133 months, p=0.033). Separate analysis of the involved and uninvolved components showed that only the suppression of the uninvolvedimmunoglobulin was predictive of shorter TTP (HR=3.04, p=0.03) suggesting that it could be the majorcontributor to the prognostic value of the Hevylite assay. Additionally, a multivariate analysis showed that immunosuppression (either classical immunoparesis or Hevylite immunosuppression) was an independent prognostic factor (p=0.016) reinforcing its relevance in the disease mechanism. Finally, monoclonal sFLC levels were highest in WM patients, with 83% presenting values>60 mg/L.Conclusions:The results suggest that the levels of immunosuppression and/or the iHLC/uHLC ratio of IgM immunoglobulins measured by Hevylite are associated with greater disease activity which significantly impacts in the outcome of WM patients and may also help in the differentiation of IgMMGUS from iWM.
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Prokaeva T, Spencer B, Sun F, O'Hara RM, Seldin DC, Connors LH, Sanchorawala V. Immunoglobulin heavy light chain test quantifies clonal disease in patients with AL amyloidosis and normal serum free light chain ratio. Amyloid 2016; 23:214-220. [PMID: 27677679 DOI: 10.1080/13506129.2016.1219715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Serum and urine immunofixation electrophoreses (SIFE/UIFE) are used for clonal detection in plasma cell dyscrasias, while serum free light chain (sFLC) testing provides quantitation of clonal disease. Up to 20% of patients with light chain (AL) amyloidosis may present with normal FLC ratio (FLCr). METHODS We assessed the diagnostic, quantitative and prognostic potential of serum heavy light chain ratio (HLCr) in 199 untreated patients at initial evaluation. RESULTS An abnormal HLCr was found in 37.2%, abnormal FLCr in 81.9% and positivity by SIFE/UIFE in 94% of patients. HLCr together with SIFE/UIFE identified clonality in 94% patients; the combination with FLCr yielded 100% sensitivity. An HLCr abnormality was significantly over-represented in normal compared to abnormal FLCr group (63.9% versus 31.3%). HLCr did not predict overall survival (OS) (log rank, p = 0.09), while an abnormal FLCr was associated with decreased OS (log rank, p = 0.03). The combined use of both ratios trended toward increased OS in the abnormal HLCr/normal FLCr group (log rank, p = 0.11; Wilcoxon, p = 0.04). On multivariate analysis, HLCr was not predictive of OS, whereas an abnormal FLCr was associated with shorter OS (HR = 1.7, p = 0.04). CONCLUSIONS The HLC assay has potential as a supplemental test to quantify monoclonal protein in patients with normal FLCr results.
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Affiliation(s)
- Tatiana Prokaeva
- a Amyloidosis Center , Boston University School of Medicine , Boston , MA , USA
| | - Brian Spencer
- a Amyloidosis Center , Boston University School of Medicine , Boston , MA , USA
| | - Fangui Sun
- b Boston University School of Public Health , Boston , MA , USA
| | | | - David C Seldin
- a Amyloidosis Center , Boston University School of Medicine , Boston , MA , USA.,d Department of Medicine , Section of Hematology and Oncology, Boston Medical Center , Boston , MA , USA
| | - Lawreen H Connors
- a Amyloidosis Center , Boston University School of Medicine , Boston , MA , USA
| | - Vaishali Sanchorawala
- a Amyloidosis Center , Boston University School of Medicine , Boston , MA , USA.,d Department of Medicine , Section of Hematology and Oncology, Boston Medical Center , Boston , MA , USA
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Zhai L, Zhao Y, Peng S, Zhu K, Yu R, Chen H, Lin T, Lin L. Detection of the value of consecutive serum total light chain (sTLC) in patients diagnosed with diffuse large B cell lymphoma. Ann Hematol 2016; 95:1999-2007. [PMID: 27623628 DOI: 10.1007/s00277-016-2794-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 08/08/2016] [Indexed: 11/25/2022]
Abstract
There are limited data on serum total light chain (sTLC) in lymphoma and its relative role on the outcome of diffuse large B cell lymphoma (DLBCL) patients. Blood samples from 46 cases newly diagnosed with DLBCL were collected consecutively during chemotherapy to detect sTLC, IgG, IgA, and IgM levels. Clinical data and survival outcomes were analyzed according to the results of sTLC measurements. In summary, 22 patients (47.8 %) had abnormal k or λ light chain, respectively, and 6 patients (13.0 %) had both abnormal k and λ light chains before chemotherapy. Patients with elevated k light chain more frequently displayed multiple extra-nodal organ involvement (P = 0.01) and had an inferior overall survival (OS) (P = 0.041) and progression-free survival (PFS) (P = 0.044) compared to patients with normal level of k light chain. Furthermore, patients with elevated level of both k and λ also exhibited significant association with shorter OS (P = 0.002) and PFS (P = 0.009). Both elevated k alone and concurrent elevated k and λ had independent adverse effects on PFS (P = 0.031 and P = 0.019, respectively). sTLC level was reduced gradually by treatment in this study and reached the lowest point after the fourth cycle of chemotherapy, which was consistent with the disease behavior during chemotherapy. Considering the small sample size of this study, these results should be confirmed in a larger prospective study.
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Affiliation(s)
- Linzhu Zhai
- Department of Medical Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Yuanyuan Zhao
- Department of Medical Oncology, Cancer Centre of Sun Yat-sen University, State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, People's Republic of China
| | - Songguo Peng
- Department of Medical Oncology, Cancer Centre of Sun Yat-sen University, State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, People's Republic of China
| | - Ke Zhu
- Department of Medical Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Rongjian Yu
- Department of Medical Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Hailong Chen
- Department of Medical Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Tongyu Lin
- Department of Medical Oncology, Cancer Centre of Sun Yat-sen University, State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, People's Republic of China
| | - Lizhu Lin
- Department of Medical Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, People's Republic of China.
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Mills JR, Kohlhagen MC, Dasari S, Vanderboom PM, Kyle RA, Katzmann JA, Willrich MAV, Barnidge DR, Dispenzieri A, Murray DL. Comprehensive Assessment of M-Proteins Using Nanobody Enrichment Coupled to MALDI-TOF Mass Spectrometry. Clin Chem 2016; 62:1334-44. [DOI: 10.1373/clinchem.2015.253740] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 07/18/2016] [Indexed: 01/20/2023]
Abstract
Abstract
BACKGROUND
Electrophoretic separation of serum and urine proteins has played a central role in diagnosing and monitoring plasma cell disorders. Despite limitations in resolution and analytical sensitivity, plus the necessity for adjunct methods, protein gel electrophoresis and immunofixation electrophoresis (IFE) remain front-line tests.
METHODS
We developed a MALDI mass spectrometry–based assay that was simple to perform, automatable, analytically sensitive, and applicable to analyzing the wide variety of monoclonal proteins (M-proteins) encountered clinically. This assay, called MASS-FIX, used the unique molecular mass signatures of the different Ig isotypes in combination with nanobody immunoenrichment to generate information-rich mass spectra from which M-proteins could be identified, isotyped, and quantified. The performance of MASS-FIX was compared to current gel-based electrophoresis assays.
RESULTS
MASS-FIX detected all M-proteins that were detectable by urine or serum protein electrophoresis. In serial dilution studies, MASS-FIX was more analytically sensitive than IFE. For patient samples, MASS-FIX provided the same primary isotype information for 98% of serum M-proteins (n = 152) and 95% of urine M-proteins (n = 55). MASS-FIX accurately quantified M-protein to <1 g/dL, with reduced bias as compared to protein electrophoresis. Intraassay and interassay CVs were <20% across all samples having M-protein concentrations >0.045 g/dL, with the ability to detect M-proteins <0.01 g/dL. In addition, MASS-FIX could simultaneously measure κ:λ light chain ratios for IgG, IgA, and IgM. Retrospective serial monitoring of patients with myeloma posttreatment demonstrated that MASS-FIX provided equivalent quantitative information to either protein electrophoresis or the Hevylite™ assay.
CONCLUSIONS
MASS-FIX can advance how plasma cell disorders are screened, diagnosed, and monitored.
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Affiliation(s)
- John R Mills
- Departments of Laboratory Medicine and Pathology
| | | | | | | | - Robert A Kyle
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | | | | | - Angela Dispenzieri
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
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D'Souza A, Pasquini M, Logan B, Giralt S, Krishnan A, Antin J, Howard A, Goodman S, Qazilbash M, Knust K, Sahebi F, Weisdorf D, Vesole D, Stadtmauer E, Maloney D, Hari P. Heavy/light chain ratio normalization prior to transplant is of independent prognostic significance in multiple myeloma: a BMT CTN 0102 correlative study. Br J Haematol 2016; 178:816-819. [PMID: 27292583 DOI: 10.1111/bjh.14170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
| | | | - Brent Logan
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sergio Giralt
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | | | - Alan Howard
- National Marrow Donor Program, Minneapolis, MN, USA
| | - Stacy Goodman
- Vanderbilt University Medical Center and Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
| | | | | | - Firoozeh Sahebi
- City of Hope Cancer Center, Los Angeles, CA, USA.,Southern California Kaiser Permanente Medical Group, Los Angeles, USA
| | | | - David Vesole
- Hackensack University Medical Center, Hackensack, NJ, USA
| | - Edward Stadtmauer
- University of Pennsylvania Abramson Cancer Center, Philadelphia, PA, USA
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Boyle E, Manier S, Lejeune J, Fouquet G, Guidez S, Bonnet S, Debarri H, Demarquette H, Dulery R, Gay J, Hennache B, Onraed B, Faucompré JL, Schraen S, Facon T, Avet-Loiseau H, Chevret S, Leblond V, Harding S, Leleu X. IgMκ and IgMλ Measurements for the Assessment of Patients with Waldenström's Macroglobulinaemia. Clin Cancer Res 2016; 22:5152-5158. [DOI: 10.1158/1078-0432.ccr-15-2899] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 04/05/2016] [Indexed: 11/16/2022]
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19
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Sanchez E, Gillespie A, Tang G, Ferros M, Harutyunyan NM, Vardanyan S, Gottlieb J, Li M, Wang CS, Chen H, Berenson JR. Soluble B-Cell Maturation Antigen Mediates Tumor-Induced Immune Deficiency in Multiple Myeloma. Clin Cancer Res 2016; 22:3383-97. [PMID: 26960399 DOI: 10.1158/1078-0432.ccr-15-2224] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 02/23/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Eric Sanchez
- Institute for Myeloma and Bone Cancer Research, West Hollywood, California
| | - Abigail Gillespie
- Institute for Myeloma and Bone Cancer Research, West Hollywood, California
| | - George Tang
- Institute for Myeloma and Bone Cancer Research, West Hollywood, California
| | - Morgan Ferros
- Institute for Myeloma and Bone Cancer Research, West Hollywood, California
| | | | - Suzie Vardanyan
- Institute for Myeloma and Bone Cancer Research, West Hollywood, California
| | - Jillian Gottlieb
- Institute for Myeloma and Bone Cancer Research, West Hollywood, California
| | - Mingjie Li
- Institute for Myeloma and Bone Cancer Research, West Hollywood, California
| | - Cathy S Wang
- Institute for Myeloma and Bone Cancer Research, West Hollywood, California
| | - Haiming Chen
- Institute for Myeloma and Bone Cancer Research, West Hollywood, California
| | - James R Berenson
- Institute for Myeloma and Bone Cancer Research, West Hollywood, California.
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Ludwig H, Milosavljevic D, Berlanga O, Zojer N, Hübl W, Fritz V, Harding S. Suppression of the noninvolved pair of the myeloma isotype correlates with poor survival in newly diagnosed and relapsed/refractory patients with myeloma. Am J Hematol 2016; 91:295-301. [PMID: 26662888 PMCID: PMC4832268 DOI: 10.1002/ajh.24268] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/01/2015] [Accepted: 12/03/2015] [Indexed: 01/09/2023]
Abstract
Heavy light chain (HLC) assays allow precise measurement of the monoclonal and of the noninvolved polyclonal immunoglobulins of the same isotype as the M‐protein (e.g., monoclonal IgAκ and polyclonal IgAλ in case of an IgAκ myeloma), which was not possible before. The noninvolved polyclonal immunoglobulin is termed ‘HLC‐matched pair’. We investigated the impact of the suppression of the HLC‐matched pair on outcome in 203 patients with multiple myeloma, a phenomenon that likely reflects the host's attempt to control the myeloma clone. Severe (>50%) HLC‐matched pair suppression was identified in 54.5% of the 156 newly diagnosed patients and was associated with significantly shorter survival (45.4 vs. 71.9 months, P = 0.019). This correlation was statistically significant in IgG patients (46.4 vs. 105.1 months, P = 0.017), but not in patients with IgA myelomas (32.9 vs. 54.1 months, P = 0.498). At best response, HLC‐matched pair suppression improved only in patients with ≥VGPR, indicating partial or complete humoral immune reconstitution during remission in those with excellent response. Severe HLC‐matched pair suppression retained its prognostic impact also during follow‐up after first response. In the 47 pretreated patients with relapsed/refractory disease, a similar correlation between severe HLC suppression and survival was noted (22.8 vs. not reached, P = 0.028). Suppression of the polyclonal immunoglobulins of the other isotypes than the myeloma protein correlated neither with HLC‐matched pair suppression, nor with outcome. Multivariate analysis identified severe HLC‐matched pair suppression as independent risk factor for shorter survival, highlighting the impact of isotype specific immune dysregulation on outcome in multiple myeloma. Am. J. Hematol. 91:295–301, 2016. © 2015 The Authors. American Journal of Hematology Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Heinz Ludwig
- Wilhelminen Cancer Research Institute, C/O Department of Medicine ICenter of Oncology, Hematology with Outpatient Department and Palliative Care, WilheminenhospitalVienna Austria
| | | | | | - Niklas Zojer
- Department of Medicine ICenter of Oncology, Hematology with Outpatient Department and Palliative Care, WilheminenhospitalVienna Austria
| | - Wolfgang Hübl
- Department of Laboratory MedicineWilhelminenhospitalVienna Austria
| | - Veronique Fritz
- Wilhelminen Cancer Research Institute, C/O Department of Medicine ICenter of Oncology, Hematology with Outpatient Department and Palliative Care, WilheminenhospitalVienna Austria
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Paolini L. Quantification of β region IgA paraproteins – should we include immunochemical “heavy/light chain” measurements? Counterpoint. ACTA ACUST UNITED AC 2016; 54:1059-64. [DOI: 10.1515/cclm-2015-0692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 12/13/2015] [Indexed: 11/15/2022]
Abstract
AbstractSerum protein electrophoresis (SPE), serum immunofixation (s-IFE), free light chain measurement (FLC) and nephelometric measurements of total immunoglobulin in serum (IgTot) are some of the laboratory tests required for the management of plasma cell proliferative disorders. The monoclonal protein is usually visible on SPE as a spike (M-spike) in the γ region and the derived densitogram is used to quantify it relative to serum total protein concentration. IgA M-protein, however, often migrates in the β region on SPE and its quantification can be masked by other serum proteins that migrate in this region. The immunoassay Hevylite™ (heavy/light chain, HLC) seems to solve this problem: it quantifies the involved/uninvolved isotype, calculating the ratio IgAκ/IgAλ, considered indicative of clonal proliferation. However, this test seems redundant in the case of artifacts on SPE such as obvious hemolysis or lipemia, or if the IgA M-spike is clearly visible in the β region. In conclusion whereas the IgA HLC assay does not represent an alternative to SPE and s-IFE in the diagnostic patient workup, it may prove to be an alternative to SPE, s-IFE and total IgA quantification in risk stratification and evaluation of response to therapy in patients affected by MM and other monoclonal plasma proliferative disorders.
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22
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Evans JA, Jenner EL, Carr Smith HD, Berlanga O, Harding SJ. Quantification of β-region IgA monoclonal proteins – should we include immunochemical Hevylite® measurements? Point. ACTA ACUST UNITED AC 2016; 54:1053-7. [DOI: 10.1515/cclm-2015-0696] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 09/23/2015] [Indexed: 11/15/2022]
Abstract
AbstractAccurate measurement of IgA monoclonal proteins presents a significant challenge to laboratory staff. IgA heavy/light chain (Hevylite, HLC) analysis is an alternative methodology for monoclonal protein assessment, giving an independent measure of IgAκ and IgAλ concentrations. Clonality is assessed by calculating the ratio of involved immunoglobulin to background uninvolved immunoglobulin concentrations (e.g. IgAκ/IgAλ in an IgAκ patient). Here we discuss the challenges faced by the laboratory in IgA monoclonal protein assessment, and compare the performance of Hevylite assays with electrophoresis and total IgA results. We present data which validates the use of Hevylite for response assessment: in most cases, Hevylite provides comparable response assignment to that provided by serum protein electrophoresis (SPE) and total IgA; in other cases Hevylite provides additional information, such as detection of residual disease or relapse.
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Kraj M, Kruk B, Endean K, Warzocha K, Budziszewska K, Dąbrowska M. Light Chain Escape in 3 Cases: Evidence of Intraclonal Heterogeneity in Multiple Myeloma from a Single Institution in Poland. Case Rep Hematol 2015; 2015:809840. [PMID: 26881153 DOI: 10.1155/2015/809840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 12/03/2015] [Accepted: 12/07/2015] [Indexed: 11/18/2022] Open
Abstract
We report three cases of light chain escape (LCE) at a single institution in Poland, including an interesting case of biclonal monoclonal gammopathy of undetermined significance (MGUS) that satisfied the criteria for progression to light chain multiple myeloma (LCMM) with a rapid rise in serum free light chain (FLC) levels, following steroidal treatment for simultaneous temporal artery inflammation and polymyalgia rheumatica (PMR). In the three cases discussed, progression of the disease by light chain escape was associated with rapid and severe renal impairment, highlighting the necessity for prompt detection of such free light chain-only producing clones in order to prevent the possible development of irreversible end-organ damage. Interestingly, monitoring of these three patients by serum free light chain assay (sFLC) and retrospective heavy/light chain analysis (HLC) detected this clonal evolution prior to clinical relapse and suggests that these assays represent important additional tools for more accurate monitoring of multiple myeloma patients.
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Beaumont-Epinette MP, Moreau C, Besnard S, Latute F, Collet N, Sebillot M, Grosbois B, Bendavid C, Guenet L, Decaux O. Heavy/light chain specific immunoglobulin ratios provides no additional information than serum proteins electrophoresis and immunofixation for the diagnosis and the follow-up of intact immunoglobulin multiple myeloma patients. ACTA ACUST UNITED AC 2015; 63:215-21. [DOI: 10.1016/j.patbio.2015.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/12/2015] [Indexed: 10/23/2022]
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Affiliation(s)
- Boris Calderon
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
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Paolini L, Di Noto G, Maffina F, Martellosio G, Radeghieri A, Luigi C, Ricotta D. Comparison of Hevylite™ IgA and IgG assay with conventional techniques for the diagnosis and follow-up of plasma cell dyscrasia. Ann Clin Biochem 2014; 52:337-45. [DOI: 10.1177/0004563214564225] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2014] [Indexed: 11/15/2022]
Abstract
Background Heavy/light chain assay allows the characterization and quantification of immunoglobulin light chains bound to heavy chains for each Ig’k and Ig’λ immunoglobulin class, discriminating between the involved/uninvolved isotypes in plasma cell dyscrasia. The Ig’k/Ig’λ ratio (heavy/light chain ratio) enables to monitor the trend of monoclonal component during therapy and disease evolution. Objective In this study, we evaluate the impact of the heavy/light chain assay in monitoring multiple myeloma patients in comparison with conventional techniques. Methods Serum samples of 28 patients with IgG or IgA monoclonal component were collected for a mean of 109 days and analyzed. The heavy/light chain assay was compared with classical immunoglobulin quantification (Ig’Tot), serum immunofixation electrophoresis, serum protein electrophoresis, and serum-free light chains quantification. Serum samples from 30 healthy patients were used as control (polyclonal). Results Heavy/light chain ratio and serum immunofixation electrophoresis were comparable in 86% of the cases, and free light chain ratio and heavy/light chain ratio in 71.8%. Heavy/light chain assay and Ig’Tot measurements showed a concentration-dependent agreement in monoclonal patients. The heavy/light chain assay was able to quantify the monoclonal component migrating in SPE β region: this occurred in 10% of our IgG and 50% of our IgA patients. Conclusions The concordance scores indicate that heavy/light chain and Ig’Tot assays show differences at high monoclonal component values. The heavy/light chain ratio, serum immunofixation electrophoresis, and free light chain ratio showed partial concordance. Our study confirmed that, in the context of heavy/light chain assay, heavy/light chain Ig’k and Ig’λ absolute values and heavy/light chain ratio are both important tools to monitor the presence of monoclonal component that are difficult to be identified in SPE.
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Affiliation(s)
- Lucia Paolini
- Department of Molecular and Translational Medicine, Faculty of Medicine, University of Brescia, Brescia, Italy
| | - Giuseppe Di Noto
- Department of Molecular and Translational Medicine, Faculty of Medicine, University of Brescia, Brescia, Italy
| | - Francesca Maffina
- Department of Molecular and Translational Medicine, Faculty of Medicine, University of Brescia, Brescia, Italy
| | - Giovanni Martellosio
- Department of Molecular and Translational Medicine, Faculty of Medicine, University of Brescia, Brescia, Italy
| | - Annalisa Radeghieri
- Department of Molecular and Translational Medicine, Faculty of Medicine, University of Brescia, Brescia, Italy
| | - Caimi Luigi
- Department of Molecular and Translational Medicine, Faculty of Medicine, University of Brescia, Brescia, Italy
| | - Doris Ricotta
- Department of Molecular and Translational Medicine, Faculty of Medicine, University of Brescia, Brescia, Italy
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