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Farnsworth CW, Roemmich B, Spears GM, Murray DL, Dispenzieri A, Willrich MAV. Clinical specificity of two assays for immunoglobulin kappa and lambda free light chains. Clin Chem Lab Med 2024; 62:929-938. [PMID: 38044587 DOI: 10.1515/cclm-2023-0912] [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: 08/18/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES Free light chain (FLC) assays and the ratio of κ/λ are recommended for diagnosis, prognosis and monitoring of plasma cell dyscrasias (PCD). Limited data exists on FLC clinical specificity in patients diagnosed with other conditions. METHODS We assessed the κ, λ, and κ/λ FLC ratio using the FreeLite assay and the Sebia FLC ELISA assay in 176 patients with clinical presentations of fatigue, anemia, polyclonal hypergammaglobulinemia, joint disorders, kidney disease and non PCD-cancers with no monoclonal protein observed on serum protein electrophoresis or MASS-FIX immunoglobulin isotyping. Manufacturer defined reference intervals (RI) and glomerular filtration rate (GFR) specific RI (renal RI) were utilized. RESULTS For the κ/λ ratio, 68.7 % (121/176) of specimens on the FreeLite and 87.5 % (154/176) of specimens on the Sebia assay were within RI. For κ, 68.2 % (120/176) and 72.2 % (127/176) of results were outside RI for FreeLite and Sebia respectively. For λ, 37.5 % (66/176) and 84.1 % (148/176) of FreeLite and Sebia results were outside RI. With FreeLite and Sebia, patients with kidney disease (n=25) had the highest κ/λ ratios. 44 patients (25.0 %) had GFR <60 mL/min/BSA. When renal RI were applied, 13.6 % had a FLCr outside the renal RI with FreeLite, and 4.5 % with Sebia. CONCLUSIONS In a cohort of patients with signs and symptoms suggestive of PCDs, but ultimately diagnosed with other conditions, Sebia FLC had improved clinical specificity relative to FreeLite, if one was using an abnormal κ/λ ratio as a surrogate for monoclonality.
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Affiliation(s)
| | | | - Grant M Spears
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - David L Murray
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Angela Dispenzieri
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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2
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Caruso C, Ciasca G, Baglivo I, Di Santo R, Gasbarrini A, Firinu D, Bagnasco D, Passalacqua G, Schiappoli M, Caminati M, Canonica GW, Heffler E, Crimi C, Intravaia R, Basile V, Marino M, Colantuono S, Del Giacco S. Immunoglobulin free light chains in severe asthma patient: Could they be a new biomarker? Allergy 2024. [PMID: 38425088 DOI: 10.1111/all.16082] [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: 08/03/2023] [Revised: 01/31/2024] [Accepted: 02/08/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Increasing evidence is available about the presence of increased serum concentration of immunoglobulin (Ig) free light chains (FLCs) in both atopic and non-atopic inflammatory diseases, including severe asthma, providing a possible new biomarker of disease. METHODS We analyzed clinical and laboratory data, including FLCs, obtained from a cohort of 79 asthmatic subjects, clinically classified into different GINA steps. A control group of 40 age-matched healthy donors (HD) was considered. Particularly, HD have been selected according to the absence of monoclonal components (in order to exclude paraproteinemias), were tested for total IgE (that were in the normal ranges) and were negative for aeroallergens specific IgE. Moreover, no abnormality of common inflammatory markers (i.e., erythrocyte sedimentation rate and C-reactive protein) was detectable. RESULTS FLC-k levels were significantly increased in the asthmatic population, compared to the control group. Despite the absence of statistically significant differences in FLC-λ levels, the FLC-k/FLC-λ ratio displayed remarkable differences between the two groups. A positive correlation between FLC-κ and FLC-λ levels was found. FLC- λ level displayed a significant negative correlation with the FEV1 value. Moreover, the FLC-κ /FLC- λ ratio was negatively correlated with the SNOT-22 score and a positive correlation was observed between FLCs and Staphylococcus Aureus IgE enterotoxins sensitization. CONCLUSIONS Our findings confirmed the role of FLCs in asthma as a potential biomarker in an inflammatory disease characterized by different endotypes and phenotypes. In particular, FLC-κ and FLC-k/FLC-λ ratio could be a qualitative indicator for asthma, while FLC-λ levels could be a quantitative indicator for clinical severity parameters.
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Affiliation(s)
- C Caruso
- UOSD DH Internal Medicine and Gastroenterology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Ciasca
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - I Baglivo
- CEMAD Digestive Diseases Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Di Santo
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - A Gasbarrini
- CEMAD Digestive Diseases Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - D Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - D Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | - G Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | - M Schiappoli
- Allergy and Asthma Unit, Verona University Hospital, Verona, Italy
| | - M Caminati
- Department of Medicine, Asthma, Allergy and Clinical Immunology Section, University of Verona, Verona, Italy
| | - G W Canonica
- Personalized Medicine, Asthma and Allergy-IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - E Heffler
- Personalized Medicine, Asthma and Allergy-IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - C Crimi
- Respiratory Medicine Unit, Policlinico "G. Rodolico-San Marco" University Hospital, Catania, Italy
| | - R Intravaia
- Unit of Cardiology, University Hospital Paolo Giaccone, University of Palermo, Palermo
| | - V Basile
- Clinical Pathology Unit and Cancer Biobank, Department of research and Advanced Technologies, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - M Marino
- Sezione di Patologia Generale, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - S Colantuono
- UOSD DH Internal Medicine and Gastroenterology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Goldis R, Kaplan B, Arad M, Dispenzieri A, Dasari S, Kukuy OL, Simon AJ, Dori A, Shavit-Stein E, Ziv T, Murray D, Kourelis T, Gertz MA, Dominissini D, Magen H, Muchtar E. Amino acid sequence homology of monoclonal serum free light chain dimers and tissue deposited light chains in AL amyloidosis: a pilot study. Clin Chem Lab Med 2024; 62:464-471. [PMID: 37747270 DOI: 10.1515/cclm-2023-0591] [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: 06/06/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES Diagnosis of light chain amyloidosis (AL) requires demonstration of amyloid deposits in a tissue biopsy followed by appropriate typing. Previous studies demonstrated increased dimerization of monoclonal serum free light chains (FLCs) as a pathological feature of AL. To further examine the pathogenicity of FLC, we aimed at testing amino acid sequence homology between circulating and deposited light chains (LCs). METHODS Matched tissue biopsy and serum of 10 AL patients were subjected to tissue proteomic amyloid typing and nephelometric FLC assay, respectively. Serum FLC monomers (M) and dimers (D) were analyzed by Western blotting (WB) and mass spectrometry (MS). RESULTS WB of serum FLCs showed predominance of either κ or λ type, in agreement with the nephelometric assay data. Abnormal FLC M-D patterns typical of AL amyloidosis were demonstrated in 8 AL-λ patients and in one of two AL-κ patients: increased levels of monoclonal FLC dimers, high D/M ratio values of involved FLCs, and high ratios of involved to uninvolved dimeric FLCs. MS of serum FLC dimers showed predominant constant domain sequences, in concordance with the tissue proteomic amyloid typing. Most importantly, variable domain sequence homology between circulating and deposited LC species was demonstrated, mainly in AL-λ cases. CONCLUSIONS This is the first study to demonstrate homology between circulating FLCs and tissue-deposited LCs in AL-λ amyloidosis. The applied methodology can facilitate studying the pathogenicity of circulating FLC dimers in AL amyloidosis. The study also highlights the potential of FLC monomer and dimer analysis as a non-invasive screening tool for this disease.
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Affiliation(s)
- Rivka Goldis
- Department of Neurology, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Batia Kaplan
- Institute of Hematology and Sheba Cancer Research Center, Sheba Medical Center, Ramat Gan, Israel
| | - Michael Arad
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Heart Failure Institute, Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel
| | | | - Surendra Dasari
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Olga Lesya Kukuy
- Institute of Nephrology and Hypertension, Sheba Medical Center, Ramat Gan, Israel
| | - Amos J Simon
- Institute of Hematology and Sheba Cancer Research Center, Sheba Medical Center, Ramat Gan, Israel
| | - Amir Dori
- Department of Neurology, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Shavit-Stein
- Department of Neurology, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Ziv
- Smoler Protein Center, Faculty of Biology, Technion - Israel Institute of Technology, Haifa, Israel
| | - David Murray
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Dan Dominissini
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Genomics Unit, Sheba Cancer Research Center, Sheba Medical Center, Ramat Gan, Israel
- Wohl Institute of Translational Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Hila Magen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Multiple Myeloma Unit, Hematology Department, Sheba Medical Center, Ramat Gan, Israel
| | - Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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Zeman D, Štork M, Švancarová L, Borský M, Pospíšilová M, Adam Z, Beňovská M, Pour L. Isoelectric focusing followed by affinity immunoblotting to detect monoclonal free light chains in monoclonal gammopathies: Comparison with immunofixation electrophoresis and free light chain ratio. Ann Clin Biochem 2024:45632231221439. [PMID: 38073192 DOI: 10.1177/00045632231221439] [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] [Indexed: 02/08/2024]
Abstract
BACKGROUND Isoelectric focusing (IEF) is a method with an exquisite resolution, and coupled with affinity immunoblotting (AIB), it can provide superior sensitivity to detect monoclonal free light chains (FLC). METHODS We tested the hypothesis that IEF/AIB is more sensitive and specific for monoclonal FLC detection in serum and urine samples than conventional methods, that is, electrophoresis (ELP), immunofixation (IF) and serum FLC ratio assessment. Investigation included 107 samples of 68 patients, among which 21 multiple myeloma patients were recently tested for minimal residual disease and 18 patients with AL amyloidosis. RESULTS Monoclonal FLC were detected by IEF/AIB in 37% of serum samples negative for monoclonal FLC on ELP/IF. As for urine samples, significant advantage of the IEF/AIB over ELP/IF was not demonstrated. Considering both serum and urine results, IEF/AIB definitely revealed monoclonal FLC in 20/83 (24%) of ELP/IF-negative samples. FLC ratio was abnormally high (>1.65) in all 11 patients definitely positive for monoclonal FLC kappa by IEF/AIB but also in 16/47 (34%) IEF/AIB-negative samples. Abnormally low values (<0.26) were found only in 10/28 samples (36%) positive for monoclonal FLC lambda. Appropriate use of renal FLC ratio reference range reduced the number of presumably false positives (6/47, i.e. 13%) but not false negatives (17/28, i.e. 61%). CONCLUSIONS The IEF/AIB method is more sensitive than IF and might be used in patients with negative IF results before deciding whether to proceed to minimal residual disease testing.
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Affiliation(s)
- David Zeman
- Department of Laboratory Medicine, Division of Clinical Biochemistry, University Hospital Brno, Brno, Czech Republic
- Department of Laboratory Methods, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martin Štork
- Department of Internal Medicine, Haematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lenka Švancarová
- Department of Laboratory Methods, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Marek Borský
- Department of Internal Medicine, Haematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Michaela Pospíšilová
- Department of Laboratory Medicine, Division of Clinical Biochemistry, University Hospital Brno, Brno, Czech Republic
- Department of Laboratory Methods, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Zdeněk Adam
- Department of Internal Medicine, Haematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Miroslava Beňovská
- Department of Laboratory Medicine, Division of Clinical Biochemistry, University Hospital Brno, Brno, Czech Republic
- Department of Laboratory Methods, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Luděk Pour
- Department of Internal Medicine, Haematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Luigetti M, Primiano G, Basile V, Vitali F, Pignalosa S, Romano A, Sabino A, Marino M, Di Santo R, Ciasca G, Basile U. Serum Neurofilament and Free Light Chain Levels in Patients Undergoing Treatment for Chronic Inflammatory Demyelinating Polyneuropathy. Int J Mol Sci 2024; 25:1254. [PMID: 38279256 PMCID: PMC10816730 DOI: 10.3390/ijms25021254] [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: 12/23/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 01/28/2024] Open
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an immune-mediated disorder affecting the peripheral nervous system. Despite the established diagnostic criteria, monitoring disease activity and treatment remains challenging. To address this limitation, we investigated serum neurofilament light chain (sNfL) and serum free light chains (sFLCs) as potential biomarkers. A total of 32 CIDP patients undergoing immunoglobulin therapy and 32 healthy controls enrolled in the present study, and agreed to have their blood plasma sNfL and sFLCs analyzed, while CIDP severity was assessed through the modified Rankin Scale (mRS) and the Overall Neuropathy Limitations Scale (ONLS). In line with the immunoglobulin treatment aimed at limiting neuronal damage administered to the majority of patients, sNfL levels did not exhibit significant differences between the two groups. However, CIDP patients showed significantly elevated sFLC and sFLC ratios, while the marker levels did not correlate with the clinical scores. The study confirms the potential of sFLCs as a sensitive biomarker of inflammatory processes in CIDP. Additionally, the present study results regarding neurofilaments strengthen the role of sNfL in monitoring CIDP treatments, confirming the effectiveness of immunoglobulin therapy. Overall, our results demonstrate how combining these markers can lead to better patient characterization for improved treatment.
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Affiliation(s)
- Marco Luigetti
- Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (M.L.); (A.R.)
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.V.); (A.S.)
| | - Guido Primiano
- Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (M.L.); (A.R.)
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.V.); (A.S.)
- Fondazione UILDM Lazio Onlus, 00167 Rome, Italy
| | - Valerio Basile
- Clinical Pathology Unit and Cancer Biobank, Department of Research and Advanced Technologies, I.R.C.C.S. Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Francesca Vitali
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.V.); (A.S.)
| | - Stefano Pignalosa
- Dipartimento di Patologia Clinica, Ospedale Santa Maria Goretti, A.U.S.L. Latina, 04100 Latina, Italy; (S.P.); (U.B.)
| | - Angela Romano
- Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (M.L.); (A.R.)
| | - Andrea Sabino
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.V.); (A.S.)
| | - Mariapaola Marino
- Sezione di Patologia Generale, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
- Fondazione Policlinico Universitario “A. Gemelli” I.R.C.C.S., 00168 Rome, Italy; (R.D.S.); (G.C.)
| | - Riccardo Di Santo
- Fondazione Policlinico Universitario “A. Gemelli” I.R.C.C.S., 00168 Rome, Italy; (R.D.S.); (G.C.)
- Sezione di Fisica, Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Gabriele Ciasca
- Fondazione Policlinico Universitario “A. Gemelli” I.R.C.C.S., 00168 Rome, Italy; (R.D.S.); (G.C.)
- Sezione di Fisica, Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Umberto Basile
- Dipartimento di Patologia Clinica, Ospedale Santa Maria Goretti, A.U.S.L. Latina, 04100 Latina, Italy; (S.P.); (U.B.)
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Banderker RB, Fazel FB, Zemlin AE, Khine AA, Jalavu TP. Serum-free light chain test utilisation at a South African academic laboratory and comparison with serum protein electrophoresis results. Afr J Lab Med 2023; 12:2201. [PMID: 38058849 PMCID: PMC10696567 DOI: 10.4102/ajlm.v12i1.2201] [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: 03/24/2023] [Accepted: 09/05/2023] [Indexed: 12/08/2023] Open
Abstract
Background Serum protein electrophoresis (SPE), urine protein electrophoresis and immunofixation electrophoresis were traditionally utilised for the diagnosis of monoclonal gammopathies. The quantitative serum-free light chain (SFLC) assay is reportedly more sensitive and has been introduced to recent clinical guidelines. Objective This study aimed to investigate SFLC test utilisation and describe SPE findings in patients with abnormal SFLC ratios. Methods A retrospective audit of SFLC analyses was conducted in Cape Town, South Africa, from May 2018 to April 2020. Agreement between abnormal SFLC ratios and SPE results was determined in a sub-group of patients screened for monoclonal gammopathies. Serum-free light chains were analysed using Freelite® Kappa and Lambda assays. Results Of the 1425 patients included in the audit, 741 (52%) had abnormal SFLC ratios; 636 (45%) had increased and 105 (7%) had decreased SFLC ratios. In a sub-group analysis of 117 new patients with an abnormal SFLC ratio, 57 had a monoclonal protein (M-protein) on SPE (49%), and 60 (51%) did not. Four out of 60 patients without M-protein had a plasma cell dyscrasia, while renal impairment or inflammatory response accounted for the rest. Of the 57 patients with a M-protein and abnormal SFLC ratio, 41 (72%) had a plasma cell dyscrasia, seven (12%) had lymphomas and nine patients (16%) were unclassifiable. Conclusion Serum-free light chains should be requested when there is a high index of clinical suspicion. Neither SFLC nor SPE should be performed in isolation when screening patients for monoclonal gammopathy, to ensure that no patient is missed. What this study adds The study adds to the evidence on SFLC test utilisation. Serum protein electrophoresis alone may miss cases of light chain myeloma, while SFLC performed in isolation may produce false positive results in the setting of inflammatory disorders or renal impairment, leading to unnecessary further investigation.
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Affiliation(s)
- Razia B Banderker
- Department of Pathology, Division of Chemical Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Pathology, Division of Chemical Pathology, National Health Laboratory Service, Cape Town, South Africa
| | - Fatima B Fazel
- Department of Internal Medicine, Division of Clinical Haematology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Annalise E Zemlin
- Department of Pathology, Division of Chemical Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Pathology, Division of Chemical Pathology, National Health Laboratory Service, Cape Town, South Africa
| | - Aye-Aye Khine
- Division of Chemical Pathology, National Health Laboratory Service, Green Point, Cape Town, South Africa
| | - Thumeka P Jalavu
- Department of Pathology, Division of Chemical Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Pathology, Division of Chemical Pathology, National Health Laboratory Service, Cape Town, South Africa
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7
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Theodorakakou F, Briasoulis A, Fotiou D, Petropoulos I, Georgiopoulos G, Lama N, Kelekis N, Repasos E, Migkou M, Stamatelopoulos K, Dimopoulos MA, Kastritis E. Outcomes for patients with systemic light chain amyloidosis and Mayo stage 3B disease. Hematol Oncol 2023; 41:725-732. [PMID: 36974438 DOI: 10.1002/hon.3135] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/12/2022] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 03/29/2023]
Abstract
Patients with cardiac light chain amyloidosis and Mayo stage 3b disease define a high-risk population with very poor prognosis. Here, we report treatment outcomes of 80 consecutive patients with newly diagnosed AL and Mayo 3b who received novel regimens. Early mortality (<1 month) rate was 12.5%. On intention-to-treat, overall hematologic response rate was 40%, with complete response (CR)/very good partial response (VGPR) in 25% and partial response (PR) in 15%. At 1- and 3- month landmark analysis CR or VGPR/PR rates were 25%/23.5% and 34%/25.5%, respectively. Among patients that were treated with daratumumab-based therapies, 52.6% and 85.7% achieved at least VGPR within one 1 and 3 months, respectively. Three-month cardiac response rate was 11.3% and 6-month was 18.8%. At least hemVGPR at 3 months was associated with cardiac response at 6 months (p = 0.034). Median overall survival (OS) was 6.3 months. At 1-month landmark at least hemPR was associated with better median OS (24.1 vs. 4.9 months, p = 0.017) and at 3-month landmark, at least hemVGPR was associated with a median OS of 40.7 versus 17 months for hemPR and 7.4 months for those without hematologic response (p = 0.028). Cardiac response at 3 months was associated with longer median OS (59.7 vs. 10.9 months, p = 0.044). Factors associated with poorer survival were κ-light chain amyloidosis (median OS 2.9 vs. 7.4 months, p = 0.028), peripheral nerve involvement (3.4 vs. 10.45 months, p = 0.024), systolic blood pressure <90 mmHg (2 vs. 8 months, p = 0.002), baseline LVEF <55% (median OS 3.4 vs. 32 months, p = 0.29) and New York Heart Association (NYHA) class (2.7 months for NYHA 3B-4 vs. 8 months for NYHA 2-3A, p = 0.02). Twenty-one patients (26.3%) received salvage therapy and ORR was 57.1%. Median OS for patients who received second line therapy was 24 months. In conclusion, patients with Mayo 3b disease benefit from early hematologic response but cardiac response rates remain low.
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Affiliation(s)
- Foteini Theodorakakou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Alexandros Briasoulis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Despina Fotiou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Ioannis Petropoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Niki Lama
- 2nd Department of Radiology, Research Unit of Radiology and Medical Imaging, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, Research Unit of Radiology and Medical Imaging, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Evangelos Repasos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Magdalini Migkou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Schaaf CW, Braunisch MC, Holzmann-Littig C, Pfister F, Hannemann L, Hausinger RI, Verbeek M, Schmaderer C, Renders L, Heemann U, Küchle C. Extracorporeal light-chain elimination in myeloma with simple medium cutoff membrane hemodialysis: a retrospective cohort study. Front Oncol 2023; 13:1193504. [PMID: 37746285 PMCID: PMC10514899 DOI: 10.3389/fonc.2023.1193504] [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: 03/30/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
Background We determined the efficacy of free light chain (FLC) removal by regular dialysis equipment (high-flux filtration) with medium cutoff (MCO) membrane hemodialysis (HD) as an adjuvant treatment to standard chemotherapy for patients with acute kidney injury complicating multiple myeloma (MM) and its impact on further dialysis dependency. Methods Sixty patients with acute dialysis-dependent renal failure secondary to MM were treated with MCO-HD (55 patients) or HCO (high cutoff)-HD (5 patients) as a control. FLC serum concentration, total protein, immunoglobulins, and LDH were measured throughout the dialysis therapy. The kidney function of the patients was followed up for 1 year. Results The median age was 69 years; 25 female and 35 male patients were enrolled. HD significantly reduced FLC kappa levels in the MCO/HCO group by 58%/84% (MCO/HCO group; p < 0.05) and FLC lambda by 39%/33% (MCO/HCO group; p < 0.05). Single HD data (MCO) showed a relative reduction of 70% in kappa and 37% in lambda FLC concentration, as expected by the different sizes of the light chains. Renal function improved significantly and continuously from starting creatinine 5.7/3.8 mg/dl (MCO/HCO group) before HD to 1.4/2.0 mg/dl (MCO/HCO group; p < 0.001) after 1 year. No significant alteration of total protein, immunoglobulins, and LDH concentrations by HD (HCO and MCO group) was observed. After 1 year, 37 of 60 patients were alive and 34 of them were off dialysis. Conclusion FLC elimination with MCO-HD is effective, technically easy, and less cost-intensive as compared with HCO-HD. Kidney function recovery in MM patients is achievable.
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Affiliation(s)
- Christian W. Schaaf
- Department of Nephrology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Matthias C. Braunisch
- Department of Nephrology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Christopher Holzmann-Littig
- Department of Nephrology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Frederick Pfister
- Department of Nephropathology of the Institute of Pathology, School of Medicine, University of Erlangen, Erlangen, Germany
| | - Liya Hannemann
- Department of Nephrology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Renate I. Hausinger
- Department of Nephrology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Mareike Verbeek
- Department of Hematology and Oncology, Klinikum rechts der Isar, III. Medical Clinic, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christoph Schmaderer
- Department of Nephrology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Lutz Renders
- Department of Nephrology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Uwe Heemann
- Department of Nephrology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Claudius Küchle
- Department of Nephrology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
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Deschamps R, Shor N, Papeix C, Boudot de la Motte M, Bensa C, Marignier R, Lecler A, Vignal-Clermont C, Ghillani P, Gazzano M, Maillart E, Sterlin D. Relevance of kappa free light chains index in patients with aquaporin-4 or myelin-oligodendrocyte-glycoprotein antibodies. Eur J Neurol 2023; 30:2865-2869. [PMID: 37243935 DOI: 10.1111/ene.15897] [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: 03/16/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND The kappa free light chains index (κ-index) is increasing in importance as a fast, easy, cost-effective, and quantitative biomarker in multiple sclerosis (MS), which can replace cerebrospinal fluid (CSF)-restricted oligoclonal bands (OCB) detection. In previous studies, controls often included mixed patients with several inflammatory central nervous system disorders. The aim of the present study was to assess the κ-index in patients with serum aquaporin-4 (AQP4)-IgG or myelin-oligodendrocyte-glycoprotein (MOG)-IgG. METHODS We analyzed CSF/serum samples of patients with AQP4-IgG or MOG-Ig and evaluated distinct κ-index cut-offs. We described clinical and magnetic resonance imaging (MRI) features of patients with the highest κ-index values. RESULTS In 11 patients with AQP4-IgG, median κ-index was 16.8 (range 0.2; 63) and 6/11 (54.5%) had κ-index >12. Among 42 patients with MOG-IgG, 2 had low positive MOG-IgG titers, were ultimately diagnosed with MS, and had a markedly increased κ-index (54.1 and 102.5 respectively). For the remaining 40 MOG-IgG-positive patients the median κ-index was 0.3 (range 0.1; 15.5). Some 6/40 (15%) and 1/40 (2.5%) patients had a κ-index >6 and >12, respectively. None fulfilled MRI dissemination in space and dissemination in time (DIS/DIT) criteria and the final diagnosis was MOG-IgG-associated disease (MOGAD) for these 40 patients. Four of the 40 (10%) MOG-IgG-positive patients had OCB. CONCLUSION While a marked increase in κ-index could discriminate MS from MOGAD, a low κ-index threshold could lead to confusion between MS and MOGAD or AQP4 antibody-positive neuromyelitis optica spectrum disorder.
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Affiliation(s)
- Romain Deschamps
- Department of Neurology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Natalia Shor
- Department of Neuroradiology, Assistance Publique Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière - Sorbonne Université, Paris, France
- Department of Neuroradiology, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France
| | - Caroline Papeix
- Department of Neurology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | | | - Caroline Bensa
- Department of Neurology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Romain Marignier
- Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- Department of Neurology, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Lyon, France
| | - Augustin Lecler
- Department of Radiology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | | | - Pascale Ghillani
- Department of Immunology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Marianne Gazzano
- Department of Immunology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Elisabeth Maillart
- Department of Neurology, Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM). Assistance Publique Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière- Sorbonne Université, Paris, France
| | - Delphine Sterlin
- Department of Immunology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
- Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Sorbonne Université, Inserm, Paris, France
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10
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Heim X, Hubert AM, Raouak I, Nzepa AC, Mege JL, Delmont E, Attarian S, Koric L, Pelletier J, Brodovitch A, Boucraut J. Validation of ELISA assays for the calculation of FLC indices for the diagnosis of intrathecal immunoglobulin synthesis. Clin Chem Lab Med 2023; 61:1623-1629. [PMID: 37015059 DOI: 10.1515/cclm-2022-0602] [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: 06/22/2022] [Accepted: 03/20/2023] [Indexed: 04/06/2023]
Abstract
OBJECTIVES Define the cutoff thresholds of the Kappa (K) and Lambda (L) free light chains (FLC) indices for the detection of intrathecal immunoglobulin synthesis (IIS) using the new K and L FLC ELISA from SEBIA. The reference technique, which is not readily standardized between laboratories, is based on the demonstration of oligoclonal banding (OCB) in cerebrospinal fluid (CSF) which is absent in serum. For the past 6 years, we have also routinely calculated the K FLC index using The Binding Site (TBS) reagents on an Optilite instrument, an approach increasingly used as an alternative and/or a complement to electrophoretic analysis. METHODS We analyzed 391 serum/CSF pairs divided into three groups. The first group were cases without OCB and with normal albumin CSF/serum ratio (n=174). The second group were cases with specific OCB (n=73). The last group included patients with increased albumin CSF/sera ratio without OCB (n=142). RESULTS Analysis of the first group determined that the cutoffs for detection of IIS are respectively 2.55 and 1.02 for the K FLC and L FLC indices. Of the 73 cases with IIS, only 2 had a K FLC index below this threshold (sensitivity of 97.26%), while 16 out of 73 cases (78.08%) and 13 out of 72 cases (81.94%) had an IgG and L FLC index below the cutoffs, respectively. Additionally, we illustrate equivalent performances for prediction of the presence of OCB between SEBIA and TBS methods. CONCLUSIONS Sebia K FLC and L FLC assays are adequate alternative methods for the diagnosis of IIS.
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Affiliation(s)
- Xavier Heim
- Immunology Laboratory, CHU Timone AP-HM, Marseille, France
| | | | - Issam Raouak
- Immunology Laboratory, CHU Timone AP-HM, Marseille, France
| | | | | | - Emilien Delmont
- Referral Centre for Neuromuscular Diseases and ALS, CHU Timone, Marseille, France
| | - Shahram Attarian
- Referral Centre for Neuromuscular Diseases and ALS, CHU Timone, Marseille, France
| | - Lejla Koric
- Department of Neurology and Neuropsychology, CHU Timone, AP-HM and UMR 7249, CNRS, Centrale Marseille, Institut Fresnel, AMU, Marseille, France
| | - Jean Pelletier
- Department of Neurology, CHU Timone, APHM, Marseille, and CRMBM/UMR CNRS 7339, AMU, Marseille, France
| | | | - José Boucraut
- Immunology Laboratory, CHU Timone AP-HM, Marseille, France
- AMU, Institut de Neurosciences des Systèmes (INS, UMR1106), Marseille, France
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11
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Karakala N, Juncos LA. High-Cutoff Hemodialysis Therapy for Patients with Light Chain Cast Nephropathy and AKI Requiring Dialysis: CON. Kidney360 2023; 4:1024-1026. [PMID: 37212742 PMCID: PMC10476674 DOI: 10.34067/kid.0000000000000150] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/22/2022] [Indexed: 05/23/2023]
Affiliation(s)
- Nithin Karakala
- Department of Medicine, Division of Nephrology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Luis A. Juncos
- Department of Medicine, Division of Nephrology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Department of Medicine, Division of Nephrology, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas
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12
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Basile U, Santini G, Napodano C, Macis G, Pocino K, Gulli F, Malerba M, Bush A, Adcock IM, Montuschi P. Elevated serum polyclonal immunoglobulin free light chains in patients with severe asthma. Front Pharmacol 2023; 14:1126535. [PMID: 37397489 PMCID: PMC10311563 DOI: 10.3389/fphar.2023.1126535] [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: 12/18/2022] [Accepted: 05/09/2023] [Indexed: 07/04/2023] Open
Abstract
Background: Inflammation plays a pivotal role in the pathophysiology of asthma. Free light chains (FLC) can cause inflammation by mast cell antigen-activation. Serum immunoglobulin (Ig) FLC κ, but not λ, were shown elevated in adult males with asthma. We sought to investigate if serum Ig FLC concentrations are affected by asthma severity and their relationships with inflammatory outcomes. Methods: By using immunoassays, we measured serum κ and λ Ig FLCs in 24 severe persistent asthma patients, 15 patients with moderate persistent asthma, 15 steroid-naïve mild persistent asthma patients and 20 healthy control subjects in a cross-sectional observational study. Total and specific serum IgE concentrations, fractional exhaled nitric oxide (FENO), lung function, peripheral blood eosinophils and neutrophils, and C reactive protein (CRP) were also measured. Results: Serum κ FLC concentrations were elevated in severe asthma patients compared mild asthma patients (p < 0.05) and healthy subjects (p < 0.05). Serum λ FLCs were higher in severe asthma patients than in healthy subjects (p < 0.05) and correlated with blood eosinophil counts (percentage, κ: r = 0.51, p = 2.9678-6; λ: r = 0.42, p = 1.7377-4; absolute values, κ: r = 0.45, p = 6.1284-5; λ: r = 0.38, p = 7.8261-4), but not with total or specific serum IgE. In severe asthma patients, serum Ig FLC correlated with serum CRP (κ: r = 0.33; p = 0.003; λ: r = 0.38, p = 8.8305-4) and blood neutrophil cell counts (percentage, κ: r = 0.31; p = 0.008; λ: r = 0.29, p = 0.01; absolute values, κ: r = 0.40; p = 3.9176-4; λ: r = 0.40, p = 4.5479-4), were elevated in subjects with blood eosinophilia (≥300 cells/µL) (n = 13) compared with non-eosinophilic subjects (n = 10) (κ: 19.2 ± 1.2 mg/L versus 12.1 ± 1.3 mg/L, p < 0.001; λ: 27.2 ± 2.6 mg/L versus 16.8 ± 2.5 mg/L, p < 0.01), but were similar in atopic (n = 15) versus nonatopic subjects (n = 9) (κ: p = 0.20; λ: p = 0.80). Serum FLC were negatively correlated with lung function tests, including forced expiratory volume in one second (FEV1) (κ: r = -0.33; p = 0.0034; λ: r = -0.33; p = 0.0035), and FEV1/forced vital capacity ratio (κ: r = -0.33; p = 0.0034; λ: r = -0.33; p = 0.0036). Conclusion: Serum Ig FLCs are elevated in severe asthma adults and might represent new surrogate markers of inflammation. The pathophysiological implications of these findings require further research. This study was approved by the ethics committee of the University Hospital Agostino Gemelli Foundation and Catholic University of the Sacred Heart (approval number P/1034/CE2012).
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Affiliation(s)
- Umberto Basile
- Department of Translational Medicine, Catholic University of the Sacred Heart, University Hospital Agostino Gemelli Foundation IRCCS, Rome, Italy
- Clinical Pathology Unit, Santa Maria Goretti Hospital, ASL, Latina, Italy
| | - Giuseppe Santini
- Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy
- Clinical Pathology Unit, Belcolle Hospital, ASL Viterbo, Rome, Italy
| | - Cecilia Napodano
- Department of Laboratory Medicine and Pathology, S. Agostino Estense Hospital, Modena, Italy
| | - Giuseppe Macis
- Department of Radiological Sciences, University Hospital Agostino Gemelli Foundation IRCCS, Rome, Italy
| | - Krizia Pocino
- Clinical Pathology Unit, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Francesca Gulli
- Clinical Biochemistry Laboratory, IRCCS, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Mario Malerba
- Respiratory Unit, S. Andrea Hospital, University of Piemonte Orientale, Vercelli, Italy
| | - Andrew Bush
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Ian M. Adcock
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Paolo Montuschi
- Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
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13
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Terrades NR, Senin A, Azancot MA, Gironella M, Toapanta N, Bermejo S, Martin L, Caravaca-Fontán F, Cuellar C, Martínez-Lopez J, Rodríguez E, Bestard O, Soler MJ. Role of light chain clearance in the recovery of renal function in multiple myeloma: another point of view. Clin Kidney J 2023; 16:1014-1021. [PMID: 37260999 PMCID: PMC10229297 DOI: 10.1093/ckj/sfad022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/11/2022] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) in patients with multiple myeloma (MM) requiring renal replacement treatment (RRT) is associated with high morbidity and mortality. Early reduction of serum free light chains (FLC) using both targeted therapy against MM and intensive hemodialysis (IHD) may improve renal outcomes. We evaluated the effectiveness of two different RRT techniques on renal recovery in an MM patient population: standard dialysis procedure vs IHD with either polymethylmethacrylate (PMMA) or hemodiafiltration with endogenous reinfusion (HFR). METHODS This was a multicentric retrospective study with severe AKI related to MM, between 2011 and 2018. Twenty-five consecutive patients with AKI secondary to MM requiring RRT were included. Patients that underwent IHD received six dialysis sessions per week during the first 14 days (PMMA vs HFR). All patients were diagnosed with de novo MM or first relapsed MM. Primary outcome was renal recovery defined as dialysis-free at 6 months follow-up. RESULTS A total of 25 patients were included. Seventeen patients received IHD and eight standard dialysis. All patients were treated with targeted therapy, 84% bortezomib-based. Of the 25 patients included, 14 (56%) became dialysis independent. We observed a higher proportion of patients who received IHD in the group who recovered kidney function compared with those who remained in HD (92.9% vs 36.4%, P = .007). In our study, the use of IHD to remove FLC had a statistically significant association with renal recovery compared with the standard dialysis group (P = .024). CONCLUSION Early reduction of FLC with IHD as an adjuvant treatment along with MM-targeted therapy may exert a positive impact on renal recovery.
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Affiliation(s)
| | - Alicia Senin
- Hospital Duran i Reynalds, ICO, Hospitalet, Spain
| | - Maria A Azancot
- Department of Nephrology, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Nestor Toapanta
- Department of Nephrology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Sheila Bermejo
- Department of Nephrology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Lucia Martin
- Department of Hematology, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Clara Cuellar
- Department of Hematology, Hospital 12 de Octubre, Madrid, Spain
| | | | - Eva Rodríguez
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Oriol Bestard
- Department of Nephrology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Maria Jose Soler
- Department of Nephrology, Hospital Vall d'Hebron, Barcelona, Spain
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14
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Gudowska-Sawczuk M, Mroczko B. Free Light Chains κ and λ as New Biomarkers of Selected Diseases. Int J Mol Sci 2023; 24:ijms24119531. [PMID: 37298479 DOI: 10.3390/ijms24119531] [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: 05/08/2023] [Revised: 05/24/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Diagnostic and prognostic markers are necessary to help in patient diagnosis and the prediction of future clinical events or disease progression. As promising biomarkers of selected diseases, the free light chains (FLCs) κ and λ were considered. Measurements of FLCs are currently used in routine diagnostics of, for example, multiple myeloma, and the usefulness of FLCs as biomarkers of monoclonal gammopathies is well understood. Therefore, this review focuses on the studies concerning FLCs as new potential biomarkers of other disorders in which an inflammatory background has been observed. We performed a bibliometric review of studies indexed in MEDLINE to assess the clinical significance of FLCs. Altered levels of FLCs were observed both in diseases strongly connected with inflammation such as viral infections, tick-borne diseases or rheumatic disorders, and disorders that are moderately associated with immune system reactions, e.g., multiple sclerosis, diabetes, cardiovascular disorders and cancers. Increased concentrations of FLCs appear to be a useful prognostic marker in patients with multiple sclerosis or tick-borne encephalitis. Intensive synthesis of FLCs may also reflect the production of specific antibodies against pathogens such as SARS-CoV-2. Moreover, abnormal FLC concentrations might predict the development of diabetic kidney disease in patients with type 2 diabetes. Markedly elevated levels are also associated with increased risk of hospitalization and death in patients with cardiovascular disorders. Additionally, FLCs have been found to be increased in rheumatic diseases and have been related to disease activity. Furthermore, it has been suggested that inhibition of FLCs would reduce the progression of tumorigenesis in breast cancer or colitis-associated colon carcinogenesis. In conclusion, abnormal levels of κ and λ FLCs, as well as the ratio of κ:λ, are usually the result of disturbances in the synthesis of immunoglobulins as an effect of overactive inflammatory reactions. Therefore, it seems that κ and λ FLCs may be significant diagnostic and prognostic biomarkers of selected diseases. Moreover, the inhibition of FLCs appears to be a promising therapeutical target for the treatment of various disorders where inflammation plays an important role in the development or progression of the disease.
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Affiliation(s)
- Monika Gudowska-Sawczuk
- Department of Biochemical Diagnostics, Medical University of Bialystok, Waszyngtona 15A St., 15-269 Bialystok, Poland
| | - Barbara Mroczko
- Department of Biochemical Diagnostics, Medical University of Bialystok, Waszyngtona 15A St., 15-269 Bialystok, Poland
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, Waszyngtona 15A St., 15-269 Bialystok, Poland
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15
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Gudowska-Sawczuk M, Kudelski J, Olkowicz M, Młynarczyk G, Chłosta P, Mroczko B. The Clinical Significance of Serum Free Light Chains in Bladder Cancer. J Clin Med 2023; 12:jcm12093294. [PMID: 37176734 PMCID: PMC10179731 DOI: 10.3390/jcm12093294] [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: 03/30/2023] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
This research aimed to assess the clinical usefulness of serum kappa (κ) and lambda (λ) free light chains (FLCs) in patients with bladder cancer (BC). One hundred samples were collected and analysed from healthy volunteers (C) and bladder cancer patients. Cancer patients were divided into two subgroups: low-grade (LG) and high-grade cancer (HG). Concentrations of FLCs, CEA, CA19-9, creatinine and urea were measured per manufacturers' guidelines. The concentrations of κ and λ FLCs and CEA were significantly higher in BC patients in comparison to the control group. Moreover, the concentrations of κ and λ FLCs and CEA were significantly higher in both low-grade as well as high-grade cancer in comparison to the controls. The levels of κ and λ FLCs differed between tumour grades, with patients presenting higher concentrations in high-grade compared to low-grade cancer. In the total study group, κFLC correlated with λFLC, the κ:λ ratio, CRP, CEA, CA19-9, creatinine and urea. There was also a correlation between λFLC and κFLC, CRP, CEA, creatinine and urea. The λFLC showed a higher ability (sensitivity and PPV) to detect bladder cancer in comparison to κFLC and CEA. In addition, λFLC had a higher ability to exclude BC (specificity and NPV) than κFLC and CEA. λFLC also showed the highest accuracy in the detection of bladder cancer. In conclusion, the revealed differences in the concentrations of both κ and λ FLCs suggest their potential participation in bladder cancer development. Increased concentrations of free light chains in bladder cancer patients and the association with the tumour grade suggest that κ and λ FLC measurements may be useful in the diagnosis and prognosis of bladder cancer. This is the first research that evaluates the concentration of FLCs in bladder cancer, so further studies are necessary to confirm their usefulness as tumour markers of this malignancy.
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Affiliation(s)
- Monika Gudowska-Sawczuk
- Department of Biochemical Diagnostics, Medical University of Bialystok, Waszyngtona 15A St., 15-269 Bialystok, Poland
| | - Jacek Kudelski
- Department of Urology, Medical University of Bialystok, M. Skłodowskiej-Curie 24A St., 15-276 Bialystok, Poland
| | - Michał Olkowicz
- Department of Urology, Medical University of Bialystok, M. Skłodowskiej-Curie 24A St., 15-276 Bialystok, Poland
| | - Grzegorz Młynarczyk
- Department of Urology, Medical University of Bialystok, M. Skłodowskiej-Curie 24A St., 15-276 Bialystok, Poland
| | - Piotr Chłosta
- Department of Urology, Jagiellonian University Medical College, Jakubowskiego 2 St., 30-688 Kraków, Poland
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20 St., 1090 Vienna, Austria
| | - Barbara Mroczko
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, Waszyngtona 15A St., 15-269 Bialystok, Poland
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16
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Krieter DH, Rüth M, Lemke HD, Wanner C. Clinical performance comparison of two medium cut-off dialyzers. Ther Apher Dial 2023; 27:284-292. [PMID: 36858049 DOI: 10.1111/1744-9987.13919] [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: 04/25/2022] [Revised: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Medium-cut-off (MCO) dialyzers may beneficially impact outcomes in patients on hemodialysis. METHODS In a randomized, controlled trial in maintenance hemodialysis patients, the new Nipro ELISIO-17HX MCO dialyzer was compared to the Baxter Theranova 400 filter regarding middle molecule removal. Furthermore, the suitability of two assays for free lambda-light chain (λFLC) detection (Freelite vs. N-Latex) was verified. RESULTS ELISIO-HX achieved slightly lower reduction ratios for β2 -microglobulin (71.8 ± 6.0 vs. 75.3 ± 5.8%; p = 0.001), myoglobin (54.7 ± 8.6 vs. 64.9 ± 8.7%; p < 0.001), and kappa-FLC (62.1 ± 8.8 vs. 56.3 ± 7.7%; p = 0.021). λFLC reduction ratios were more conclusive with the Freelite assay and not different between ELISIO-HX and Theranova (28.4 ± 3.9 vs. 38.7 ± 13.4%; p = 0.069). The albumin loss of Theranova was considerably higher (2.14 ± 0.45 vs. 0.77 ± 0.25 g; p = 0.001) and the Global Removal ScoreLoss alb largely inferior (30.6 ± 7.4 vs. 82.4 ± 29.2%/g; p = 0.006) to ELISIO-HX. CONCLUSIONS The new ELISIO-HX expands the choice of dialyzers for MCO hemodialysis.
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Affiliation(s)
- Detlef H Krieter
- Division of Nephrology, University Hospital Würzburg, Würzburg, Germany
| | | | | | - Christoph Wanner
- Division of Nephrology, University Hospital Würzburg, Würzburg, Germany
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17
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Goldis R, Kaplan B, Kukuy OL, Arad M, Magen H, Shavit-Stein E, Dori A, Livneh A. Diagnostic Challenges and Solutions in Systemic Amyloidosis. Int J Mol Sci 2023; 24. [PMID: 36902083 DOI: 10.3390/ijms24054655] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/10/2023] [Accepted: 02/25/2023] [Indexed: 03/04/2023] Open
Abstract
Amyloidosis refers to a clinically heterogeneous group of disorders characterized by the extracellular deposition of amyloid proteins in various tissues of the body. To date, 42 different amyloid proteins that originate from normal precursor proteins and are associated with distinct clinical forms of amyloidosis have been described. Identification of the amyloid type is essential in clinical practice, since prognosis and treatment regimens both vary according to the particular amyloid disease. However, typing of amyloid protein is often challenging, especially in the two most common forms of amyloidosis, i.e., the immunoglobulin light chain amyloidosis and transthyretin amyloidosis. Diagnostic methodology is based on tissue examinations as well as on noninvasive techniques including serological and imaging studies. Tissue examinations vary depending on the tissue preparation mode, i.e., whether it is fresh-frozen or fixed, and they can be carried out by ample methodologies including immunohistochemistry, immunofluorescence, immunoelectron microscopy, Western blotting, and proteomic analysis. In this review, we summarize current methodological approaches used for the diagnosis of amyloidosis and discusses their utility, advantages, and limitations. Special attention is paid to the simplicity of the procedures and their availability in clinical diagnostic laboratories. Finally, we describe new methods recently developed by our team to overcome limitations existing in the standard assays used in common practice.
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18
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Volovik Y, Nimri-Ammouri S, Adler T, Barak M, Henig C. Is this a true lambda free light chain? Clin Chem Lab Med 2023; 61:e36-e37. [PMID: 36351252 DOI: 10.1515/cclm-2022-0974] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/02/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Yael Volovik
- Central Laboratory of Haifa and Western Galilee, Clalit Health Services, Nesher, Israel
| | - Suheir Nimri-Ammouri
- Central Laboratory of Haifa and Western Galilee, Clalit Health Services, Nesher, Israel
| | - Tanya Adler
- Central Laboratory of Haifa and Western Galilee, Clalit Health Services, Nesher, Israel
| | - Mira Barak
- Medical Laboratory Sciences, Zefat Academic College and Central Laboratory of Haifa and Western Galilee, Clalit Health Services, Nesher, Israel
| | - Clara Henig
- Central Laboratory of Haifa and Western Galilee, Clalit Health Services, Nesher, Israel
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19
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Wang J, Sheng L, Lai Y, Ouyang G, Xu Z. Effects of physical activity on clinical and inflammatory markers in diagnosing multiple myeloma patients. Front Physiol 2023; 13:1094470. [PMID: 36685193 PMCID: PMC9846549 DOI: 10.3389/fphys.2022.1094470] [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: 11/10/2022] [Accepted: 12/02/2022] [Indexed: 01/06/2023] Open
Abstract
Multiple myeloma (MM) is the second most common hematological disorder. Although several drugs have been developed to treat MM, their efficacy is uncertain. In addition, how normal physical activities can decrease inflammatory responses and clinical biomarkers in MM patients needs to be better defined. Therefore, this study evaluated possible clinical and inflammatory markers to determine the early diagnosis of MM during physical activity. This study selected 30 MM patients with normal or no physical activity with ages of >50 years. This study did not require any specific exercise protocols other than noting patients' daily life activities and considering them as physical activity for 17 days. Then, blood samples were collected to assess clinical and inflammatory markers. Regarding clinical markers, daily life activities in MM patients decreased their LDH, calcium, and β2-microglobulin levels significantly compared to other clinical biomarkers such as creatine and total protein. Further, this study observed no significant differences between daily life activities of MM patients and normal MM patients regarding levels of immunoglobulins except IgM. Furthermore, IL-6 level was significantly increased with the daily life activities of MM patients, suggesting the role of physical activities in increasing anti-inflammatory response along with altering the biochemical profiles including LDH, calcium and β2-microglobulin in MM patients.
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20
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Muacevic A, Adler JR, Sidhu AS, Chang J, Lui F. Isolated Hypoglossal Nerve Palsy Secondary to Oligosecretory Multiple Myeloma. Cureus 2023; 15:e33361. [PMID: 36751257 PMCID: PMC9897323 DOI: 10.7759/cureus.33361] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
Isolated hypoglossal nerve (CN XII) palsy is rare. Neurological complications of multiple myeloma (MM) are quite common, most often due to hyperviscosity and paraprotein-related neuropathy. Direct compression of CN XII can be caused by plasmacytoma, yet direct invasion by MM is extremely rare. We are reporting a very unusual case of a 45-year-old man who presented with an isolated right CN XII palsy. The cause revealed by MRI is stenosis of the hypoglossal canal resulting from lytic bony erosion. Despite negative serum and urine protein electrophoresis tests, the final diagnosis of oligosecretory MM was confirmed by serum-free light chain test and bone marrow biopsy. The causes and diagnosis of isolated XII nerve palsy and oligosecretory MM are discussed.
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21
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Behrens J, Gaskin G, Iggo N, Barratt J, Tighe J, Soutar R, Cook G, Drake M, Morris C, Drayson M. What can we do about patients presenting with myeloma and severe renal failure? Observations from the UK MERIT plasma exchange trial. EJHaem 2022; 4:246-250. [PMID: 36819186 PMCID: PMC9928667 DOI: 10.1002/jha2.620] [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] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022]
Abstract
Myeloma patients presenting with renal failure continue to have a poor prognosis despite significant advances in anti-myeloma therapy. MERIT was a randomised clinical trial (RCT), set up to evaluate if mechanical reduction of elevated free light chain levels (FLC) would result in clinical benefit. Completion of the planned seven plasma exchanges (PEs) in the first 14 days failed to show, for the exchange group, a greater reduction in FLC or any improvement in dialysis independence at 100 days or subsequently. To improve prognosis for these patients requires earlier diagnosis and prompt anti-myeloma therapy with effectiveness guided by frequent FLC monitoring.
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Affiliation(s)
| | - Gill Gaskin
- Department of Renal MedicineHammersmith HospitalLondonUK
| | - Neil Iggo
- Sussex Kidney UnitBrighton and Sussex University Hospitals NHS TrustBrightonUK
| | - Jonathan Barratt
- Department of Cardiovascular SciencesJohn Walls Renal Unit, Leicester General HospitalLeicesterUK
| | - Jane Tighe
- Department of HaematologyAberdeen Royal InfirmaryForesterhillUK
| | - Richard Soutar
- Department of HaematologyGlasgow Royal Infirmary GlasgowGlasgowUK
| | - Gordon Cook
- Leeds Cancer CentreSt. James University HospitalLeedsUK
| | - Mary Drake
- Haematology DepartmentBelfast City HospitalBelfastUK
| | - Curly Morris
- Centre for Cancer Research and Cell BiologyQueens UniversityBelfastUK
| | - Mark Drayson
- Clinical Immunology ServiceUniversity of BirminghamBirminghamUK
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22
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Lacquaniti A, Campo S, Falliti G, Caruso D, Gargano R, Giunta E, Monardo P. Free Light Chains, High Mobility Group Box 1, and Mortality in Hemodialysis Patients. J Clin Med 2022; 11:jcm11236904. [PMID: 36498479 PMCID: PMC9739300 DOI: 10.3390/jcm11236904] [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: 10/18/2022] [Revised: 11/15/2022] [Accepted: 11/19/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Uremic toxins are associated with immune dysfunction and inflammation. The inadequate removal by hemodialysis (HD) of serum free light chains (FLCs) determines their accumulation. This study evaluated FLCs in HD patients, analyzing their relations with other biomarkers, such as serum high mobility group box 1 (HMGB1). Methods: FLC and HMGB1 were evaluated in a cohort of 119 HD patients. κFLC and λFLC were summated to give a combined (c) FLC concentration. Patients were followed prospectively until the end of the observation period of four years, or until the endpoint: the patient’s death. Results: cFLC values in HD patients were 244.4 (197.9−273.5) mg/L. We detected a significant reduction in CD8+ cells and a decreased CD4+/CD8+ ratio. HMGB1 levels were 94.5 (55−302) pg/mL. After multivariate analysis, cFLCs correlated with β2-microglobulin and the CD4+/CD8+ ratio. Subjects with cFLC values above 263 mg/L and with sHMGB1 values < 80 pg/mL experienced a significantly faster evolution to the endpoint (mean follow-up time to progression of 27.5 and 28.5 months, respectively; p < 0.001). After an adjusted multivariate Cox analysis, cFLCs were associated with 11% increased risk of death, whereas low sHMGB1 increased this risk by 5%. Conclusions: cFLCs and HMGB1 reflect the inflammation and immune dysfunction in HD patients representing two strong and independent risk markers of mortality.
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Affiliation(s)
| | - Susanna Campo
- Nephrology and Dialysis Unit, Papardo Hospital, 98158 Messina, Italy
| | | | - Daniele Caruso
- Clinical Pathology Unit, Papardo Hospital, 98158 Messina, Italy
| | - Romana Gargano
- Department of Economics, University of Messina, 98122 Messina, Italy
| | - Elena Giunta
- Microbiology and Virology Unit, Papardo Hospital, 98158 Messina, Italy
| | - Paolo Monardo
- Nephrology and Dialysis Unit, Papardo Hospital, 98158 Messina, Italy
- Correspondence: ; Tel.: +39-090-3996062; Fax: +39-090-3992337
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23
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Konen FF, Seeliger T, Schwenkenbecher P, Gingele S, Jendretzky KF, Sühs KW, Ernst D, Witte T, Skripuletz T. Saliva Free Light Chains in Patients with Neuro-Sjögren. Biomedicines 2022; 10:biomedicines10102470. [PMID: 36289732 PMCID: PMC9599066 DOI: 10.3390/biomedicines10102470] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Sjögren’s syndrome (SS) is an autoimmune disease characterized by sicca symptoms and various extra-glandular manifestations. The diagnosis of SS requires sicca symptoms, anti-SSA(Ro)-antibody positivity, and/or pathological focus scores on a minor salivary gland biopsy. Previous studies have investigated different biomarkers in order to avoid invasive diagnostic procedures. It was found that kappa and lambda free light chains (KFLC and LFLC) in saliva are specific for SS. Methods: FLC concentrations in saliva and serum were determined in 130 patients—50 with SS and neurological involvement (Neuro-Sjögren) and 80 neurological controls. The EULAR SS disease activity index and patient reported index (ESSPRI) were determined in patients with SS. Results: Patients with SS revealed increased pain and decreased saliva production according to the ESSPRI and Saxon test, respectively, with increasing FLC concentrations in the saliva. No significant differences in serum and salivary protein concentrations were observed between patients with SS and controls. Conclusion: KFLC and LFLC concentrations in saliva are not suitable to distinguish patients with Neuro-Sjögren and neurological control subjects, thus a diagnostic biopsy is still required. The association of salivary KFLC and LFLC concentrations with saliva production and ESSPRI pain score suggests a complex relationship between dryness and pain in patients with SS.
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Affiliation(s)
- Franz Felix Konen
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Tabea Seeliger
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Philipp Schwenkenbecher
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Stefan Gingele
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | | | - Kurt-Wolfram Sühs
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Diana Ernst
- Department of Immunology & Rheumatology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Torsten Witte
- Department of Immunology & Rheumatology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Thomas Skripuletz
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
- Correspondence: ; Tel.: +49-511-532-3120
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24
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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25
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Donati G, Zappulo F, Maietti E, Scrivo A, Gasperoni L, Zamagni E, Tacchetti P, Pantani L, Baraldi O, Comai G, Cappuccilli M, Cavo M, La Manna G. Early Light Chains Removal and Albumin Levels with a Double Filter-Based Extracorporeal Treatment for Acute Myeloma Kidney. Toxins (Basel) 2022; 14:toxins14060391. [PMID: 35737052 PMCID: PMC9229388 DOI: 10.3390/toxins14060391] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/27/2022] [Accepted: 06/02/2022] [Indexed: 11/16/2022] Open
Abstract
Renal impairment in Multiple Myeloma (MM) represents one of the most important factors that influences patient survival. In fact, before the introduction of modern chemotherapy, less than 25% of patients with acute kidney injury (AKI) and MM who required dialysis recovered sufficient renal function to become independent from dialysis, with a median overall survival of less than 1 year. There are many other factors involved in determining patient survival. In this study we aimed to investigate the role of double filter-based extracorporeal treatment for removal of serum free light chains (sFLC) in acute myeloma kidney (AKI for MM) and to evaluate patient overall survival. All patients received Bortezomib-based chemotherapy and extracorporeal treatment for sFLC removal. For each session 2 dialyzers of the same kind were used. The dialytic dose was not related to the degree of renal function but to the removal of sFLC. The factors that have been found to be significantly associated with lower mortality were reduction of sFLC at day 12 and day 30, >50% reduction of sFLC at day 30, number of sessions and independence from dialysis. Among baseline characteristics, albumin level was statistically associated with the patients’ outcome. Our analysis highlights the importance of the early treatment for removal of sFLC in AKI for MM. These results indicate that the early removal of sFLC can improve patient’s outcome.
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Affiliation(s)
- Gabriele Donati
- Nephrology, Dialysis and Renal Transplantation Unit, Azienda Ospedaliero-Universitaria di Modena, Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, 41124 Modena, Italy;
| | - Fulvia Zappulo
- Nephrology Dialysis and Renal Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (F.Z.); (A.S.); (L.G.); (O.B.); (G.C.); (M.C.)
| | - Elisa Maietti
- Department of Biomedical and Neuromotor Sciences-DIBINEM, University of Bologna, 40138 Bologna, Italy;
| | - Anna Scrivo
- Nephrology Dialysis and Renal Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (F.Z.); (A.S.); (L.G.); (O.B.); (G.C.); (M.C.)
| | - Lorenzo Gasperoni
- Nephrology Dialysis and Renal Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (F.Z.); (A.S.); (L.G.); (O.B.); (G.C.); (M.C.)
| | - Elena Zamagni
- Hematology and Oncology Unit “Lorenzo & Ariosto Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (E.Z.); (P.T.); (L.P.); (M.C.)
| | - Paola Tacchetti
- Hematology and Oncology Unit “Lorenzo & Ariosto Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (E.Z.); (P.T.); (L.P.); (M.C.)
| | - Lucia Pantani
- Hematology and Oncology Unit “Lorenzo & Ariosto Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (E.Z.); (P.T.); (L.P.); (M.C.)
| | - Olga Baraldi
- Nephrology Dialysis and Renal Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (F.Z.); (A.S.); (L.G.); (O.B.); (G.C.); (M.C.)
| | - Giorgia Comai
- Nephrology Dialysis and Renal Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (F.Z.); (A.S.); (L.G.); (O.B.); (G.C.); (M.C.)
| | - Maria Cappuccilli
- Nephrology Dialysis and Renal Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (F.Z.); (A.S.); (L.G.); (O.B.); (G.C.); (M.C.)
| | - Michele Cavo
- Hematology and Oncology Unit “Lorenzo & Ariosto Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (E.Z.); (P.T.); (L.P.); (M.C.)
| | - Gaetano La Manna
- Nephrology Dialysis and Renal Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (F.Z.); (A.S.); (L.G.); (O.B.); (G.C.); (M.C.)
- Correspondence:
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26
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Ganelin-Cohen E, Tartakovsky E, Klepfish E, Golderman S, Rozenberg A, Kaplan B. Personalized Disease Monitoring in Pediatric Onset Multiple Sclerosis Using the Saliva Free Light Chain Test. Front Immunol 2022; 13:821499. [PMID: 35450065 PMCID: PMC9016751 DOI: 10.3389/fimmu.2022.821499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/11/2022] [Indexed: 12/15/2022] Open
Abstract
Background Development of new safe methods of monitoring disease activity in the pediatric onset multiple sclerosis (POMS) is a challenging task, especially when trying to refrain from frequent MRI usage. In our recent study, the saliva immunoglobulin free light chains (FLC) were suggested as biomarkers to discriminate between remission and active MS in adults. Objectives To assess utility of saliva FLC measurements for monitoring disease activity in POMS. Methods We used semiquantitative Western blot analysis to detect immunoreactive FLC monomers and dimers and to calculate the intensity of their bands. Statistical tests included Firth logistic regression analysis suitable for small sample sizes, and Spearman's non-parametric correlation. Results In naive POMS patients, the saliva levels of FLC in relapse were significantly higher than those in remission. Significant correlation was found between FLC levels (monomers, dimers or both) and the load of enhanced lesions in MRI scans. FLC levels may be reduced under treatment, especially as result of corticosteroids therapy. Follow-up of individual patients showed the correspondence of changes in the FLC levels to MRI findings. Conclusions Our results show the potential of the non-invasive saliva FLC test, as a new tool for monitoring the disease activity in POMS.
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Affiliation(s)
- Esther Ganelin-Cohen
- Institute of Pediatric Neurology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - Sizilia Golderman
- Heller Institute of Medical Research, Sheba Medical Center, Ramat Gan, Israel
| | - Ayal Rozenberg
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Batia Kaplan
- Heller Institute of Medical Research, Sheba Medical Center, Ramat Gan, Israel
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27
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Willrich MAV. Commentary on Significance of Monoclonal Band in Cerebral Spinal Fluid. Clin Chem 2022; 68:281. [PMID: 35104858 DOI: 10.1093/clinchem/hvab255] [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: 08/03/2021] [Accepted: 08/10/2021] [Indexed: 11/14/2022]
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28
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Augustijn D, Jacobs JFM, Russcher H. Method comparison of three serum free light chain assays on the Roche Cobas 6000 c501 chemistry analyzer. Clin Chem Lab Med 2021; 60:379-385. [PMID: 34969184 DOI: 10.1515/cclm-2021-1029] [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: 09/21/2021] [Accepted: 12/13/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Free light chains (FLC) are important in the diagnosis, prognosis and monitoring of therapy response of patients with monoclonal gammopathies. In this study, we performed a method comparison of three FLC assays on the Cobas 6000 c501 chemistry analyzer of Roche Diagnostics. METHODS Samples of 119 patients with various monoclonal gammopathies and 26 control patients were measured with the Freelite (The Binding Site), Diazyme (Diazyme Laboratories) and KLoneus (Trimero Diagnostics) FLC assays. A method comparison was performed and reference intervals of the three assays were validated. RESULTS The analysis of the Bland-Altman agreement showed bias between the three FLC assays, ranging from -62.7 to 5.1% for κFLC and between -29.2 to 80.5% for λFLC. The Freelite and Diazyme assays have the highest agreement. The concordance of the FLC-ratio ranges from 41 to 75%, with the highest concordance between the Freelite and KLoneus assays. The FLC-ratio in 25 sera from healthy controls were within the reference ranges of the Freelite and KLoneus assays. The FLC-ratio was elevated in all 25 samples tested with the Diazyme assay. CONCLUSIONS The agreement for the free light chains is highest between the Freelite and the Diazyme assay and fair for the KLoneus assay. However, concordance of the FLC-ratio is highest when the Freelite and KLoneus assays were compared. Our data suggest that concordance for the Diazyme assay could be improved by recalibration. Because of absolute differences between the three methods in individual patients, none of the three FLC assays can be used interchangeably.
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Affiliation(s)
- Dieuwertje Augustijn
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Joannes F M Jacobs
- Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henk Russcher
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Woziwodzka K, Małyszko J, Koc-Żórawska E, Żórawski M, Dumnicka P, Jurczyszyn A, Batko K, Mazur P, Banaszkiewicz M, Krzanowski M, Gołasa P, Małyszko JA, Drożdż R, Krzanowska K. Renal Impairment Detectors: IGFBP-7 and NGAL as Tubular Injury Markers in Multiple Myeloma Patients. Medicina (Kaunas) 2021; 57:1348. [PMID: 34946293 PMCID: PMC8703512 DOI: 10.3390/medicina57121348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/03/2021] [Accepted: 12/08/2021] [Indexed: 02/07/2023]
Abstract
Background and Objectives: Urine insulin-like growth factor-binding protein 7 (IGFBP-7), tissue inhibitor of matrix metalloproteinase 2 (TIMP-2), and neutrophil gelatinase-associated lipocalin (NGAL) monomer are novel tubular kidney injury biomarkers. In multiple myeloma (MM), immunoglobulin free light chains (FLCs) play an integral role in renal impairment. This study aimed to investigate the correlation between new biomarkers and acclaimed parameters of renal failure, MM stage, and prognosis. Materials and Methods: The examined parameters included: urinary and serum cystatin-C, IGFBP-7, and TIMP-2, and urinary NGAL monomer in 124 enrolled patients. Results: Urinary and serum IGFBP-7 and urinary NGAL were higher among patients with an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2, and positively correlated with urine light chains. Serum and urine IGFBP-7 and urine NGAL were greater among patients with a higher disease stage. In the whole study group, urinary concentrations of the studied markers were positively correlated with each other. In multiple linear regression, urinary IGFBP-7 and NGAL were associated with lower eGFR, independently of other urinary markers. Conclusions: Urinary IGFBP-7 and NGAL monomer may be useful markers of tubular renal damage in patients with MM. Biomarker-based diagnostics may contribute to earlier treatment that may improve renal outcomes and life expectancy in MM.
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Affiliation(s)
- Karolina Woziwodzka
- Department of Nephrology, Jagiellonian University Medical College, 30-688 Kraków, Poland; (K.W.); (K.B.); (M.B.); (M.K.); (P.G.)
| | - Jolanta Małyszko
- Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Ewa Koc-Żórawska
- Second Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, 15-276 Bialystok, Poland;
| | - Marcin Żórawski
- Department of Clinical Medicine, Medical University of Bialystok, 15-254 Bialystok, Poland;
| | - Paulina Dumnicka
- Department of Medical Diagnostics, Jagiellonian University Medical College, 30-688 Kraków, Poland; (P.D.); (P.M.); (R.D.)
| | - Artur Jurczyszyn
- Departament of Hematology, Jagiellonian University Medical College, Kopernika 17, 30-501 Kraków, Poland;
| | - Krzysztof Batko
- Department of Nephrology, Jagiellonian University Medical College, 30-688 Kraków, Poland; (K.W.); (K.B.); (M.B.); (M.K.); (P.G.)
| | - Paulina Mazur
- Department of Medical Diagnostics, Jagiellonian University Medical College, 30-688 Kraków, Poland; (P.D.); (P.M.); (R.D.)
| | - Małgorzata Banaszkiewicz
- Department of Nephrology, Jagiellonian University Medical College, 30-688 Kraków, Poland; (K.W.); (K.B.); (M.B.); (M.K.); (P.G.)
| | - Marcin Krzanowski
- Department of Nephrology, Jagiellonian University Medical College, 30-688 Kraków, Poland; (K.W.); (K.B.); (M.B.); (M.K.); (P.G.)
| | - Paulina Gołasa
- Department of Nephrology, Jagiellonian University Medical College, 30-688 Kraków, Poland; (K.W.); (K.B.); (M.B.); (M.K.); (P.G.)
| | - Jacek A. Małyszko
- First Department of Nephrology and Transplantology with Dialysis Unit, Medical University of Bialystok, 15-540 Bialystok, Poland;
| | - Ryszard Drożdż
- Department of Medical Diagnostics, Jagiellonian University Medical College, 30-688 Kraków, Poland; (P.D.); (P.M.); (R.D.)
| | - Katarzyna Krzanowska
- Department of Nephrology, Jagiellonian University Medical College, 30-688 Kraków, Poland; (K.W.); (K.B.); (M.B.); (M.K.); (P.G.)
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30
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Silva C, Costa A, Paiva D, Freitas S, Alves G, Cotter J. Light-Chain Multiple Myeloma: A Diagnostic Challenge. Cureus 2021; 13:e19131. [PMID: 34868770 PMCID: PMC8627691 DOI: 10.7759/cureus.19131] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 11/23/2022] Open
Abstract
Light-chain multiple myeloma (LCMM) is a less frequent type of multiple myeloma (MM), with a more aggressive course and poorer prognosis. It is characterized by the inability of the malignant plasma cells to produce heavy chains, resulting in the exclusive production of light chains. Therefore, no M-spike is visible in serum protein electrophoresis. We described the case of a 67-year-old female who presents to the emergency department with anemia, severe renal insufficiency, and multiple lytic bone lesions. After three days, the diagnosis of kappa light chain multiple myeloma was made in a patient with elevated serum and urinary kappa light chains and a bone marrow aspirate with 21.7% of atypical plasma cells. The rapid diagnosis allowed prompt referral to a specialized multiple myeloma center and early initiation of treatment.
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Affiliation(s)
- Cristina Silva
- Internal Medicine, Hospital Senhora da Oliveira, Guimarães, PRT
| | - Ana Costa
- Internal Medicine, Hospital Senhora da Oliveira, Guimarães, PRT
| | - David Paiva
- Internal Medicine, Hospital Senhora da Oliveira, Guimarães, PRT
| | - Sara Freitas
- Internal Medicine, Hospital Senhora da Oliveira, Guimarães, PRT
| | - Glória Alves
- Internal Medicine, Hospital Senhora da Oliveira, Guimarães, PRT
| | - Jorge Cotter
- Internal Medicine, Hospital Senhora da Oliveira, Guimarães, PRT
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31
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Basile U, Vergani E, Napodano C, Bruno C, Marino M, Oliva A, Gulli F, Mancini A. Evaluation of free light chains of immunoglobulins in normal and pathological seminal fluids: Preliminary data. Andrologia 2021; 54:e14317. [PMID: 34850444 DOI: 10.1111/and.14317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/28/2021] [Revised: 10/28/2021] [Accepted: 11/05/2021] [Indexed: 11/27/2022] Open
Abstract
Immunoglobulins free light chains (FLCs) are assayable in several biological fluids. Currently, there are no reports on FLCs in seminal plasma. The aims of our study were to investigate the presence and detectability of FLCs in seminal plasma and to evaluate the usefulness of this assay in the diagnostic approach to infertile patients. We enrolled 61 patients aged 18-50 years. Semen analysis was performed. They were divided into four groups: controls-normozoospermic, 10 patients, mean ± SEM age 35 ± 1.5 years; varicoceles (VAR), 18 patients aged 24.3 ± 0.96 years; inflammatory (INF) seminal fluids, 24 patients, aged 38.8 ± 2.2 years; and varicoceles and inflammatory (VAR/INF) seminal fluids, 9 patients, aged 29.5 ± 0.71 years. A trend towards higher λ FLCs levels was evidenced in the INF and VAR/INF groups. κ FLCs were higher in normozoospermic patients with lower levels in VAR, both isolated and associated with inflammatory parameters. This differential pattern of the two types of FLCs reached statistical significance when comparing κ/λ ratio, with significant lower levels in VAR vs controls. This is the first report of FLCs assay in seminal plasma. We can hypothesize that λ FLCs are increased in inflammatory processes, whether κ FLCs seem to be influenced by other molecular mechanisms related to varicocele.
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Affiliation(s)
- Umberto Basile
- Dipartimento di Scienze di laboratorio e Infettivologiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Edoardo Vergani
- Dipartimento di Medicina e Chirurgia Traslazionale, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Carmine Bruno
- Dipartimento di Medicina e Chirurgia Traslazionale, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mariapaola Marino
- Dipartimento di Medicina e Chirurgia Traslazionale, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Oliva
- Dipartimento di Medicina e Chirurgia Traslazionale, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Gulli
- Laboratorio di Patologia Clinica, Ospedale Madre Giuseppina Vannini, Rome, Italy
| | - Antonio Mancini
- Dipartimento di Medicina e Chirurgia Traslazionale, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Pocino K, Napodano C, Gragnani L, Ciasca G, Colantuono S, Marri S, Vantaggio L, Gulli F, Lorini S, Barini A, Stefanile A, Miele L, Casato M, Zignego AL, Rapaccini GL, Marino M, Visentini M, Basile U. Solving the mystery of HBV-related mixed cryoglobulinemia: potential biomarkers of disease progression. Rheumatology (Oxford) 2021; 60:4418-4427. [PMID: 33590837 PMCID: PMC7928620 DOI: 10.1093/rheumatology/keab157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/04/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The biomarkers of an immunological dysregulation due to a chronic HBV infection are indeed understudied. If untreated, this condition may evolve into liver impairment co-occurring with extrahepatic involvements. Here, we aim to identify a new panel of biomarkers [including immunoglobulin G (IgG) subclasses, RF, and Free Light Chains (FLCs)] that may be useful and reliable for clinical evaluation of HBV-related cryoglobulinemia. METHODS We retrospectively analysed clinical data from 44 HBV-positive patients. The patients were stratified (according to the presence/absence of mixed cryoglobulinemia) into two groups: 22 with cryoglobulins (CGs) and 22 without CGs. Samples from 20 healthy blood donors (HDs) were used as negative controls. Serum samples were tested for IgG subclasses, RF (-IgM, -IgG, and -IgA type), and FLCs. RESULTS We detected a strikingly different distribution of serum IgG subclasses between HDs and HBV-positive patients, together with different RF isotypes; in addition, FLCs were significantly increased in HBV-positive patients compared with HDs, while no significant difference was shown between HBV-positive patients with/without mixed cryoglobulinemia. CONCLUSION The immune-inflammatory response triggered by HBV may be monitored by a peculiar profile of biomarkers. Our results open a new perspective in the precision medicine era; in these challenging times, they could also be employed to monitor the clinical course of those COVID-19 patients who are at high risk of HBV reactivation due to liver impairment and/or immunosuppressive therapies.
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Affiliation(s)
- Krizia Pocino
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario ‘A. Gemelli’ I.R.C.C.S, Rome
| | - Cecilia Napodano
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario ‘A. Gemelli’ I.R.C.C.S, Rome
| | - Laura Gragnani
- Department of Experimental and Clinical Medicine, Interdepartmental Center for Systemic Manifestations of Hepatitis Viruses (MaSVE), University of Florence, Florence
| | - Gabriele Ciasca
- Istituto di Fisica, Università Cattolica del Sacro Cuore, Fondazione Policlinico A. Gemelli I.R.C.C.S, Roma
| | - Stefania Colantuono
- Department of Translational and Precision Medicine, Sapienza University of Rome
| | - Silvia Marri
- Department of Experimental and Clinical Medicine, Interdepartmental Center for Systemic Manifestations of Hepatitis Viruses (MaSVE), University of Florence, Florence
| | - Lorenzo Vantaggio
- Department of Translational and Precision Medicine, Sapienza University of Rome
| | - Francesca Gulli
- Dipartimento di Medicina di Laboratorio, Ospedale Madre Giuseppina Vannini
| | - Serena Lorini
- Department of Experimental and Clinical Medicine, Interdepartmental Center for Systemic Manifestations of Hepatitis Viruses (MaSVE), University of Florence, Florence
| | - Antonella Barini
- Area Diagnostica di Laboratorio, Fondazione Policlinico Universitario ‘A. Gemelli’, I.R.C.C.S, Rome, Italy
| | - Annunziata Stefanile
- Area Diagnostica di Laboratorio, Fondazione Policlinico Universitario ‘A. Gemelli’, I.R.C.C.S, Rome, Italy
| | - Luca Miele
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario ‘A. Gemelli’ I.R.C.C.S, Rome
| | - Milvia Casato
- Department of Translational and Precision Medicine, Sapienza University of Rome
| | - Anna Linda Zignego
- Department of Experimental and Clinical Medicine, Interdepartmental Center for Systemic Manifestations of Hepatitis Viruses (MaSVE), University of Florence, Florence
| | - Gian Ludovico Rapaccini
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario ‘A. Gemelli’ I.R.C.C.S, Rome
| | - Mariapaola Marino
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario ‘A. Gemelli’ I.R.C.C.S, Rome
| | - Marcella Visentini
- Department of Translational and Precision Medicine, Sapienza University of Rome
| | - Umberto Basile
- Area Diagnostica di Laboratorio, Fondazione Policlinico Universitario ‘A. Gemelli’, I.R.C.C.S, Rome, Italy
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Hudak M, Sardana R, Parwani AV, Mathewson RC, Gibson CG, Cohen PA, Lazarus JJ, Bruce JT, Son JH, Tynski Z. Light chain deposition disease presenting as an atrial mass: a case report and review of literature. Cardiovasc Pathol 2021; 55:107368. [PMID: 34324992 DOI: 10.1016/j.carpath.2021.107368] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022] Open
Abstract
Light chain deposition disease (LCDD) also known as nonamyloidotic immunoglobulin deposition disease is a rare systemic disorder due to the abnormal deposition of immunoglobulin in multiple organs caused by the clonal proliferation of B lymphocytes and plasma cells. Renal involvement is the most common with cardiac manifestations being the most common extra renal presentation of the disease. Renal involvement is not always associated with LCDD. Isolated cardiac involvement can manifest in a wide variety of ways: heart failure, cardiomyopathy, arrhythmias, angina, myocardial infarction, etc. We hereby present an unusual case of 59-year-old female who presented to clinic for routine follow up. A murmur on physical exam was evaluated with echocardiogram which led to the discovery of an incidental right atrial mass. Cardiac magnetic resonance imaging was completed 6 months later for follow up which showed increasing size of the mass. The mass was excised and found to be consistent with LCDD. To the best of our knowledge, this is the first reported case of LCDD manifesting as an atrial mass. Through this case report and review of literature we would like to generate awareness among our fellow pathologists and clinicians to maintain a high level of suspicion for LCDD as it can manifest in many unusual ways, with or without kidney involvement.
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Affiliation(s)
- Madeline Hudak
- Department of Internal Medicine, Fairfield Medical Center, Lancaster, Ohio
| | - Ruhani Sardana
- Department of Pathology, The Ohio State University Medical Center and Comprehensive Cancer Center, Columbus, Ohio
| | - Anil V Parwani
- Department of Pathology, The Ohio State University Medical Center and Comprehensive Cancer Center, Columbus, Ohio
| | | | | | - P Aryeh Cohen
- Department of Cardiothoracic Surgery, Fairfield Medical Center, Lancaster, Ohio
| | - John J Lazarus
- Department of Cardiology, Fairfield Medical Center, Lancaster, Ohio
| | - Jarrod T Bruce
- Department of Pulmonary Medicine, Fairfield Medical Center, Lancaster, Ohio
| | - Jae H Son
- Department of Internal Medicine, Fairfield Medical Center, Lancaster, Ohio
| | - Zofia Tynski
- Department of Pathology, Fairfield Medical Center, Lancaster, Ohio.
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Gudowska-Sawczuk M, Czupryna P, Moniuszko-Malinowska A, Pancewicz S, Mroczko B. Free Immunoglobulin Light Chains in Patients with Tick-Borne Encephalitis: Before and after Treatment. J Clin Med 2021; 10:2922. [PMID: 34209994 DOI: 10.3390/jcm10132922] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 05/26/2021] [Revised: 06/22/2021] [Accepted: 06/28/2021] [Indexed: 12/18/2022] Open
Abstract
Background: Tick-borne encephalitis (TBE) is inflammation of the central nervous system (CNS) caused by a viral infection which may be associated with increased synthesis of immunoglobulins. It can lead to inter alia, breakdown of the blood-brain barrier (BBB), or even death and, unfortunately, treatment is only symptomatic. Therefore, the aim of the present study was assessment of the concentrations of free light chains (FLC) kappa (κ) and lambda (λ in the cerebrospinal fluid (CSF) and serum of patients with TBE. Methods: A total of 58 cerebrospinal fluid and serum sample pairs were analyzed. Samples were collected from patients with TBE before and after treatment. FLC were measured using the turbidimetric method. The values of κIgG-index, λIgG-index, κFLC-index and λFLC-index were calculated using relevant formulas. Results: Pre-treatment serum λFLC concentrations were higher in comparison to post-treatment levels. Moreover, it was observed that CSF λFLC, TBEV IgM, TBEV IgG, and serum TBEV IgG, as well as the values of λFLC-index, κFLC-index, and λIgG-index were elevated after treatment. In the total study group, the concentrations of CSF κFLC and λFLC, and values of four indexes: κFLC-index, λFLC-index, κIgG-index, and λIgG-index correlated with each other and with CSF TBEV IgM and IgG antibodies. The CSF level of TBEV IgG was also associated with serum IgG TBEV and CSF IgM TBEV antibodies. Additionally, serum κFLC correlated with serum and CSF λFLC. Conclusion: This is the first study that demonstrates statistically significant differences in serum and CSF λFLC, as well as in the calculated values of three algorithms: λIgG-index, κFLC-index, and λIgG-index prior to and following treatment of TBE. Our findings may indicate that these differences reflect the intrathecal synthesis of immunoglobulins and increased permeability of BBB in patients with TBE. Moreover, it could provide the basis for developing new therapeutic strategies.
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Quinti I, Spadaro G, Jolles S, Condino-Neto A. Editorial: The Complexity of Primary Antibody Deficiencies. Front Immunol 2021; 12:635482. [PMID: 33968027 PMCID: PMC8097173 DOI: 10.3389/fimmu.2021.635482] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/12/2021] [Indexed: 12/04/2022] Open
Affiliation(s)
- Isabella Quinti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy
| | - Stephen Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, United Kingdom
| | - Antonio Condino-Neto
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
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Kwapisz D. Serum free light chains in solid organ transplant recipients. Clin Transplant 2021; 35:e14286. [PMID: 33715217 DOI: 10.1111/ctr.14286] [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: 12/02/2020] [Revised: 02/28/2021] [Accepted: 03/08/2021] [Indexed: 11/30/2022]
Abstract
Immunoglobulin is built by a pair of identical heavy and a pair of identical light chains. Light chains are produced in excess compared to heavy chains. Free light chains (FLCs) are those which are not combined with heavy chains. Currently, numerous assays are available for the measurement of serum FLCs (sFLCs). These assays cannot be used interchangeably, and renal function should be taken into account in interpreting test results. Levels of kappa and lambda sFLCs are usually used to diagnose and monitor plasma cell dyscrasias. However, the clinical relevance of sFLCs is being investigated in patients with a variety of diseases, including patients after transplantation. There are contradictory results regarding the usefulness of sFLCs in the prediction of post-transplant lymphoproliferative disorder (PTLD). However, it seems that sFLCs may be helpful in the prediction of early-onset PTLD. Some studies have shown that low levels of sFLCs are associated with a higher risk of infection in patients after transplantation. This review summarizes and highlights recent advances in the utility of sFLCs in the prediction of PTLD and infection, and inflammation assessment in patients after solid organ transplantation. Moreover, the influence of immunosuppressive treatment on sFLCs levels is described briefly.
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Affiliation(s)
- Dorota Kwapisz
- Department of Immunology, Transplantology and Internal Diseases, University Clinical Center of the Medical University of Warsaw, Warsaw, Poland
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37
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Kastritis E, Kostopoulos IV, Theodorakakou F, Fotiou D, Gavriatopoulou M, Migkou M, Tselegkidi MI, Roussou M, Papathoma A, Eleutherakis-Papaioakovou E, Dialoupi I, Kanellias N, Ntalianis A, Rousakis P, Trougakos IP, Tsitsilonis O, Gakiopoulou C, Terpos E, Dimopoulos MA. Next generation flow cytometry for MRD detection in patients with AL amyloidosis. Amyloid 2021; 28:19-23. [PMID: 32783569 DOI: 10.1080/13506129.2020.1802713] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 01/08/2023]
Abstract
The treatment of AL amyloidosis aims to eradicate the plasma cell clone and eliminate toxic free light chain production. Only in a minority of patients the plasma cell clone is completely eradicated; residual light chain production may still exist while clonal relapse may occur. We used sensitive next-generation flow cytometry (NGF) to detect minimal residual disease (MRD) in AL amyloidosis patients at complete haematologic response. MRD evaluation was feasible in 51 of 52 (98%) tested patients and at a median sensitivity of 2.3 × 10-6 MRD was undetectable in 23 (45%). An organ response occurred in 86% of MRDneg vs 77% in MRDpos; renal response in 15/17(88%) of MRDneg vs in 14/16(87.5%) of MRDpos and cardiac response in 10/10(100%) of MRDneg vs 11/15(73%) of MRDpos patients. After a median follow-up of 24 months post MRD testing, no MRDneg patient had a haematologic relapse vs 6/28(21%) MRDpos (p = .029). Pooling haematologic and organ progressions, 9 (32%) MRDpos patients had disease progression vs only 1 (4%) MRDneg patient (p = .026). In conclusion, MRD detection using NGF has profound clinical implications, so that AL patients with undetectable MRD have a very high probability of organ response and a very low probability of haematologic relapse.
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Affiliation(s)
- Esftathios Kastritis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis V Kostopoulos
- Department of Biology, School of Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Foteini Theodorakakou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Despina Fotiou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Magdalini Migkou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Irini Tselegkidi
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Roussou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Ioanna Dialoupi
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kanellias
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Argyrios Ntalianis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Pantelis Rousakis
- Department of Biology, School of Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis P Trougakos
- Department of Biology, School of Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Ourania Tsitsilonis
- Department of Biology, School of Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Charikleia Gakiopoulou
- 1st Department of Pathology, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Kastritis E, Fotiou D, Theodorakakou F, Dialoupi I, Migkou M, Roussou M, Karatrasoglou EA, Tselegkidi MI, Ntalianis A, Kanellias N, Eleutherakis-Papaiakovou E, Ntanasis-Stathopoulos I, Gakiopoulou C, Papanikolaou A, Papathoma A, Spyropoulou-Vlachou M, Psimenou E, Stamatelopoulos K, Gavriatopoulou M, Terpos E, Dimopoulos MA. Timing and impact of a deep response in the outcome of patients with systemic light chain (AL) amyloidosis. Amyloid 2021; 28:3-11. [PMID: 32713209 DOI: 10.1080/13506129.2020.1798224] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 12/11/2022]
Abstract
A rapid and deep haematologic response is fundamental in order to improve outcomes of patients with AL amyloidosis. We evaluated the impact of timing and depth of haematologic response at early time points (at 1 and 3 months from the start of therapy) in 227 consecutive previously untreated AL patients, who received bortezomib-based primary therapy. After 1 month of therapy, 30.5% had ≥VGPR, 28% PR and 36% no response (NR), with 11% having iFLC <20 mg/L and 15% dFLC <10 mg/L. Deep haematologic response at 1 month (either ≥VGPR or iFLC <20 mg/L or dFLC <10 mg/L), was associated with a high organ response rate. The survival of patients with ≥VGPR was significantly better than those with PR and NR at 1-month landmark (p < .001) but this benefit was mainly driven by those with iFLC <20 mg/L. The depth of haematologic response at 1 month was significant across all Mayo stages. At 3 months, 46% of the patients had not significantly improved the depth of their response but even patients that improved their response from an iFLC ≥20 mg/L at 1 month to iFLC <20 mg/L at 3 months still had inferior outcome to those with an early deep response. Thus, in patients with AL amyloidosis, a very rapid and deep response is crucial, especially for those at high risk, targeting very low FLC levels within the first month of therapy.
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Affiliation(s)
- Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Despina Fotiou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Foteini Theodorakakou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Dialoupi
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Magdalini Migkou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Roussou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni A Karatrasoglou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Irini Tselegkidi
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Argyrios Ntalianis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kanellias
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Charikleia Gakiopoulou
- 1st Department of Pathology, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | - Erasmia Psimenou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
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Ferraro D, Bedin R, Natali P, Franciotta D, Smolik K, Santangelo M, Immovilli P, Camera V, Vitetta F, Gastaldi M, Trenti T, Meletti S, Sola P. Kappa Index Versus CSF Oligoclonal Bands in Predicting Multiple Sclerosis and Infectious/Inflammatory CNS Disorders. Diagnostics (Basel) 2020; 10:diagnostics10100856. [PMID: 33096861 PMCID: PMC7589948 DOI: 10.3390/diagnostics10100856] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/12/2020] [Accepted: 10/19/2020] [Indexed: 01/03/2023] Open
Abstract
Background: Cerebrospinal fluid (CSF) kappa free light chains (KFLC) are gaining increasing interest as markers of intrathecal immunoglobulin synthesis. The main aim of this study was to assess the diagnostic accuracy (AUC) of the kappa index (CSF/serum KFLC divided by the CSF/serum albumin ratio) compared to CSF oligoclonal IgG bands (OCB) in predicting Multiple Sclerosis (MS) or a central nervous system infectious/inflammatory disorder (CNSID). Methods: We enrolled patients who underwent a diagnostic spinal tap throughout two years. KFLC levels were determined using a Freelite assay (Binding Site) and the turbidimetric Optilite analyzer. Results: Of 540 included patients, 223 had a CNSID, and 84 had MS. The kappa index was more sensitive (0.89 versus 0.85) and less specific (0.84 versus 0.89), with the same AUC (0.87) as OCB for MS diagnosis (optimal cut-off: 6.2). Adding patients with a single CSF IgG band to the OCB-positive group slightly increased the AUC (0.88). Likewise, the kappa index (cut-off: 3.9) was more sensitive (0.67 versus 0.50) and less specific (0.81 versus 0.97), with the same AUC (0.74) as OCB, for a CNSID diagnosis. Conclusion: The kappa index and CSF OCB have comparable diagnostic accuracies for a MS or CNSID diagnosis and supply the clinician with useful, complementary information.
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Affiliation(s)
- Diana Ferraro
- Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy; (V.C.); (F.V.); (S.M.); (P.S.)
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, 41126 Modena, Italy; (R.B.); (K.S.)
- Correspondence: ; Tel.: +39-0593961678
| | - Roberta Bedin
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, 41126 Modena, Italy; (R.B.); (K.S.)
| | - Patrizia Natali
- Department of Laboratory Medicine, Azienda Ospedaliero-Universitaria and Azienda Unità Sanitaria Locale, Ospedale Civile, 41126 Modena, Italy; (P.N.); (T.T.)
| | - Diego Franciotta
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, 27100 Pavia, Italy; (D.F.); (M.G.)
| | - Krzysztof Smolik
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, 41126 Modena, Italy; (R.B.); (K.S.)
| | | | - Paolo Immovilli
- Neurology Unit, Ospedale G. da Saliceto, 29121 Piacenza, Italy;
| | - Valentina Camera
- Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy; (V.C.); (F.V.); (S.M.); (P.S.)
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, 41126 Modena, Italy; (R.B.); (K.S.)
| | - Francesca Vitetta
- Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy; (V.C.); (F.V.); (S.M.); (P.S.)
| | - Matteo Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, 27100 Pavia, Italy; (D.F.); (M.G.)
| | - Tommaso Trenti
- Department of Laboratory Medicine, Azienda Ospedaliero-Universitaria and Azienda Unità Sanitaria Locale, Ospedale Civile, 41126 Modena, Italy; (P.N.); (T.T.)
| | - Stefano Meletti
- Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy; (V.C.); (F.V.); (S.M.); (P.S.)
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, 41126 Modena, Italy; (R.B.); (K.S.)
| | - Patrizia Sola
- Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy; (V.C.); (F.V.); (S.M.); (P.S.)
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Gudowska-Sawczuk M, Tarasiuk J, Kułakowska A, Kochanowicz J, Mroczko B. Kappa Free Light Chains and IgG Combined in a Novel Algorithm for the Detection of Multiple Sclerosis. Brain Sci 2020; 10:E324. [PMID: 32471086 DOI: 10.3390/brainsci10060324] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 04/29/2020] [Revised: 05/20/2020] [Accepted: 05/24/2020] [Indexed: 01/09/2023] Open
Abstract
Background: It is well known that the cerebrospinal fluid (CSF) concentrations of free light chains (FLC) and immunoglobulin G (IgG) are elevated in multiple sclerosis patients (MS). Therefore, in this study we aimed to develop a model based on the concentrations of free light chains and IgG to predict multiple sclerosis. We tried to evaluate the diagnostic usefulness of the novel κIgG index and λIgG index, here presented for the first time, and compare them with the κFLC index and the λFLC index in multiple sclerosis patients. Methods: CSF and serum samples were obtained from 76 subjects who underwent lumbar puncture for diagnostic purposes and, as a result, were divided into two groups: patients with multiple sclerosis (n = 34) and patients with other neurological disorders (control group; n = 42). The samples were analyzed using turbidimetry and isoelectric focusing. The κIgG index, λIgG index, κFLC index, and λFLC index were calculated using specific formulas. Results: The concentrations of CSF κFLC, CSF λFLC, and serum κFLC and the values of κFLC index, λFLC index, and κIgG index were significantly higher in patients with multiple sclerosis compared to controls. CSF κFLC concentration and the values of κFLC index, λFLC index, and κIgG index differed in patients depending on their pattern type of oligoclonal bands. κFLC concentration was significantly higher in patients with pattern type 2 and type 3 in comparison to those with pattern type 1 and type 4. The κFLC index, λFLC index, and κIgG index were significantly higher in patients with pattern type 2 in comparison to those with pattern type 4. The κFLC index and κIgG index were significantly higher in patients with pattern type 2 in comparison to those with pattern type 1, and in patients with pattern type 3 compared to those with pattern type 4. The κIgG index was markedly elevated in patients with pattern type 3 compared to those with pattern type 1. In the total study group, κFLC, λFLC, κFLC index, λFLC index, κIgG index, and λIgG index correlated with each other. The κIgG index showed the highest diagnostic power (area under the curve, AUC) in the detection of multiple sclerosis. The κFLC index and κIgG index showed the highest diagnostic sensitivity, and the κIgG index presented the highest ability to exclude multiple sclerosis. Conclusion: This study provides novel information about the diagnostic significance of four markers combined in the κIgG index. More investigations in larger study groups are needed to confirm that the κIgG index can reflect the intrathecal synthesis of immunoglobulins and may improve the diagnosis of multiple sclerosis.
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Basile U, Gulli F, Napodano C, Pocino K, Basile V, Marrapodi R, Colantuono S, Todi L, Marino M, Rapaccini GL, Visentini M. Biomarkers of minimal residual disease in rituximab-treated patients with mixed cryoglobulinemia. Biotechnol Appl Biochem 2020; 68:319-329. [PMID: 32333692 DOI: 10.1002/bab.1929] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 12/30/2019] [Accepted: 04/12/2020] [Indexed: 12/13/2022]
Abstract
Hepatitis C virus (HCV) represents the major risk factor for mixed cryoglobulinemia (MC), a small-vessel vasculitis that may evolve into an overt B-cell non-Hodgkin's lymphoma. Here, we aimed to identify a biomarker signature for the early diagnosis of minimal residual disease (MRD). We assessed free light chains (FLCs), IgM k,and IgM λ heavy/light chain (HLC) pairs, and vascular endothelial growth factor (VEGF) in sera from 34 patients with MC vasculitis (32 HCV- and 2 HBV-related), treated with low-dose rituximab (RTX). FLCs and IgM HLCs were measured by turbidimetric assay; VEGF by an enzyme-linked immunosorbent assay. After RTX, the positive (complete + partial) clinical and laboratory responses were of 85.29% and 50%, respectively; in contrast, the mean levels of FLCs, IgM HLCs, and VEGF were substantially unaffected in most patients and still above the normal range. In those achieving a reduction of FLCs and IgM k and λ chains values within the range of normality, we found that post-treatment free λ chains and IgM k values correlated with clinical and laboratory response. Our results suggest that high levels of FLCs, IgM HLCs, and VEGF could represent the signature of "dormant" B cell clones' activity that could be very useful to identify MRD indicative of possible relapse or worsening outcome.
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Affiliation(s)
- Umberto Basile
- Area Diagnostica di Laboratorio, Fondazione Policlinico Universitario "A. Gemelli" - I.R.C.C.S, Rome, Italy
| | - Francesca Gulli
- Dipartimento di Medicina di Laboratorio, Ospedale Madre Giuseppina Vannini, Rome, Italy
| | - Cecilia Napodano
- Dipartimento di Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario "A. Gemelli" - I.R.C.C.S, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Krizia Pocino
- Dipartimento di Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario "A. Gemelli" - I.R.C.C.S, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valerio Basile
- Dipartimento di Medicina di Laboratorio, Università di Tor Vergata, Rome, Italy
| | - Ramona Marrapodi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Stefania Colantuono
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Laura Todi
- Istituto di Patologia generale, Dipartimento di Medicina e Chirurgia Traslazionale, Fondazione Policlinico Universitario "A. Gemelli" I.R.C.C.S, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mariapaola Marino
- Istituto di Patologia generale, Dipartimento di Medicina e Chirurgia Traslazionale, Fondazione Policlinico Universitario "A. Gemelli" I.R.C.C.S, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gian Ludovico Rapaccini
- Dipartimento di Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario "A. Gemelli" - I.R.C.C.S, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marcella Visentini
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
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Lalani A, Aziz K, Khan M, Zubair T, Ahmed SI. A Patient of Multiple Myeloma with Absent M-spike on Serum Protein Electrophoresis and Elevated Serum- Free Light Chains: A Case Report and Literature Review. Cureus 2019; 11:e5398. [PMID: 31620322 PMCID: PMC6793598 DOI: 10.7759/cureus.5398] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Multiple myeloma is a neoplasm described as an abnormal growth of plasma cells that outnumbers the other normal hematopoietic cells inside the bone marrow. Patients are diagnosed at a median age of 66-77 years with 37% of those with age less than 65. Unexplained bone pain (most commonly in back and ribs), pathologic fractures, fatigue, and weight loss are common initial symptoms at presentation. Here, we report a rare presentation of multiple myeloma with normal serum protein electrophoresis but elevated serum-free light chains. The absence of monoclonal gammopathy on protein electrophoresis or normal immunofixation does not negate the diagnosis of multiple myeloma. Therefore, all the sub types of multiple myeloma need to be comprehensively studied to aid in reaching an accurate diagnosis.
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Affiliation(s)
- Areej Lalani
- Internal Medicine, Dow Medical College and Civil Hospital Karachi, Dow University of Health Sciences, Karachi, PAK
| | - Kashif Aziz
- Neurology, Jersey Neurosciences, New Jersey, USA
| | - Mehreen Khan
- Internal Medicine, George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Tayyaba Zubair
- Internal Medicine, Desai Medical Center, Ellicott City, USA
| | - Syed Ijlal Ahmed
- Neurology, Liaquat National Hospital and Medical College, Karachi, PAK
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Tadmor T, Braester A, Najib D, Aviv A, Herishanu Y, Yuklea M, Shvidel L, Rahimi-Levene N, Ruchlemer R, Arad A, Fogl C, Henig C, Barak M, Magal L, Polliack A, Townsend K. A new risk model to predict time to first treatment in chronic lymphocytic leukemia based on heavy chain immunoparesis and summated free light chain. Eur J Haematol 2019; 103:335-341. [PMID: 31278876 DOI: 10.1111/ejh.13288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 04/23/2019] [Revised: 05/16/2019] [Accepted: 05/20/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Chronic lymphocytic leukemia (CLL) is frequently accompanied by immune dysregulation. AIMS In this multicenter prospective study, we investigated whether heavy + light chains (HLC: IgGκ, IgGλ, IgAκ, IgAκ, IgMκ, IgMλ) and IgG subclasses (IgG1, IgG2, IgG3, and IgG4) could be used as novel prognostic markers of immunoparesis in 105 treatment-naïve patients with CLL. RESULTS Heavy + light chains immunoparesis of ≥1, ≥2, and ≥3 isotypes was evident in 74 (70%), 58 (55%), and 36 (34%) patients, respectively. Severe HLC immunoparesis was identified in 40 (38%) patients. Of the IgG subclasses, IgG1 and IgG2 were most frequently suppressed, affecting 46 (44%) and 36 (34%) patients, respectively; 63 (60%) patients had low levels of at least one IgG subclass. In multivariate analysis, severe HLC immunoparesis (hazard ratio [HR]: 36.5; P = .010) and ΣFLC ≥ 70 mg/L (HR: 13.2; P = .004) were the only factors independently associated with time to first treatment (TTFT). A risk model including these variables identified patients with 0, 1, and 2 risk factors and significantly different TTFT (P < .001). Patients with two factors represented an ultra-high-risk group with a median TTFT of only 1.3 months. CONCLUSION The above findings demonstrate the potential for the use of HLC immunoparesis, together with sFLC measurements, as future prognostic biomarkers in CLL.
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Affiliation(s)
- Tamar Tadmor
- Bnai Zion Medical Center, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Andrei Braester
- Western Galilee Hospital, Nahariya, Israel.,Bar Ilan University, Ramat Gan, Israel
| | | | | | - Yair Herishanu
- Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.,Tel-Aviv University, Tel Aviv, Israel
| | | | | | | | | | - Ariela Arad
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Clara Henig
- Haifa and Western Galilee Laboratory, Nesher, Israel
| | - Mira Barak
- Haifa and Western Galilee Laboratory, Nesher, Israel
| | - Lee Magal
- Almog Diagnostic, Park Shoham, Israel
| | - Aaron Polliack
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Cocito F, Mangiacavalli S, Ferretti VV, Cartia CS, Ganzetti M, Benveuti P, Pompa A, Catalano M, Fugazza E, Landini B, Arcaini L, Corso A. Smoldering multiple myeloma: the role of different scoring systems in identifying high-risk patients in real-life practice. Leuk Lymphoma 2019; 60:2968-2974. [PMID: 31169049 DOI: 10.1080/10428194.2019.1620948] [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] [Indexed: 10/26/2022]
Abstract
We explore the predictive role of 2014-updated International Myeloma Working Group (IMWG) diagnostic criteria and of some of currently available risk models for progression to symptomatic myeloma when applied in our unselected population of 75 smoldering multiple myeloma (SMM) patients observed between 2000 and 2015. Risk scores including routinely used clinical parameters such as bone marrow plasmacell infiltration rate, immunoparesis, serum monoclonal component (sMC) value, and altered free light chain ratio (FLCr), were clinically useful to identify SMM patients at higher risk of progression. Time to myeloma progression in our ultra-high risk SMM according to IMWG diagnostic update criteria was very short (12.4 months). Our analysis identified as independent reliable predictors of progression altered FLCr as well as increasing plasma cell infiltration which are part of most commonly applied risk models. Waiting for new scoring systems, bone marrow evaluation and complete laboratory screening are still milestones for SMM management.
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Affiliation(s)
- Federica Cocito
- Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Virginia Valeria Ferretti
- Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,University of Pavia, Pavia, Italy
| | | | - Maya Ganzetti
- Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,University of Pavia, Pavia, Italy
| | - Pietro Benveuti
- Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,University of Pavia, Pavia, Italy
| | - Alessandra Pompa
- Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy
| | | | - Elena Fugazza
- Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Luca Arcaini
- Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,University of Pavia, Pavia, Italy
| | - Alessandro Corso
- Ospedale Nuovo di Legnano, Division of Hematology, Legnano, Italy
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Basile U, Napodano C, Pocino K, Gulli F, Santini SA, Todi L, Marino M, Rapaccini GL. Serological profile of asymptomatic HCV positive patients with low level of cryoglobulins. Biofactors 2019; 45:318-325. [PMID: 30561820 DOI: 10.1002/biof.1485] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/09/2018] [Accepted: 11/26/2018] [Indexed: 12/22/2022]
Abstract
Clinical spectrum of hepatitis C virus (HCV)-related cryoglobulinemia varies from an asymptomatic presentation to severe vasculitis and lymphoma. A recent study in HCV-negative patients suggests that low cryoglobulins (CGs) levels are responsible for severe renal and neurological complications. The aim of this study was to identify a panel of serological biomarkers associated with low levels of CGs in HCV-positive patients. We studied a population of 79 untreated patients with chronic HCV infection: 13 naïve patients without CGs; 28 patients with asymptomatic mixed cryoglobulinemia (MC) and low levels of CGs (16/28 with polyclonal type III and 12/28 with microheterogeneous type III CGs); 38 patients with symptomatic MC and high levels of type II CGs. Serum samples were collected and examined for rheumatoid factor (RF) IgG and IgM, free light chains (FLCs) and C3 and C4 complement components. We found that RF-IgG and IgM, free k chains and k+λ were increased while C4 component was reduced, both in symptomatic and asymptomatic patients. Our results suggest that, even in absence of MC symptoms, the low levels of CGs may represent a trigger of activation for immune system in course of HCV infection. The identification of a correlated biomarkers panel could improve the clinical management of these patients and pave the way for target treatment strategies. © 2018 BioFactors, 45(3):318-325, 2019.
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Affiliation(s)
- Umberto Basile
- Dipartimento di Diagnostica per Immagini e Medicina di laboratorio, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cecilia Napodano
- Dipartimento di Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Krizia Pocino
- Dipartimento di Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Gulli
- Dipartimento di Medicina di Laboratorio, Ospedale generale di zona Madre Giuseppina Vannini, Rome, Italy
| | - Stefano Angelo Santini
- Dipartimento di Diagnostica per Immagini e Medicina di laboratorio, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laura Todi
- Istituto di Patologia generale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Mariapaola Marino
- Istituto di Patologia generale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Gian Ludovico Rapaccini
- Dipartimento di Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
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Ganelin-Cohen E, Golderman S, Yeskaraev R, Rozenberg A, Livneh A, Kaplan B. Search for new biomarkers of pediatric multiple sclerosis: application of immunoglobulin free light chain analysis. Clin Chem Lab Med 2019; 56:1081-1089. [PMID: 29408796 DOI: 10.1515/cclm-2017-0911] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 10/09/2017] [Accepted: 12/18/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Identifying new biomarkers is needed to overcome the diagnostic difficulties of pediatric multiple sclerosis (MS). Recently, we developed a new technique including CSF analysis of free light chain (FLC) monomers and dimers, which can improve diagnosis of adult MS. The present study has been designed to evaluate the utility of our technique for MS diagnosis in children. METHODS Patients with MS (n=21) and non-MS demyelinating or inflammatory neurological disorders (n=35) participated in the study. MS diagnosis was based on clinical and magnetic resonance imaging (MRI) findings. Western blot analysis was applied to examine FLC in the patients' CSF and serum. FLC indices for FLC monomer and dimer levels and κ/λ ratios were estimated. The samples were also analyzed by oligoclonality test. RESULTS The study revealed abnormally elevated levels of κ-FLC monomers and dimers in the CSF of 10 MS patients ("κ-type MS"). Increased amounts of λ dimers were found in six MS cases ("λ-type MS"), while high levels of both κ and λ FLC ("mixed type MS") were documented in three MS cases. MRI and clinical assessment showed a more aggressive disease form for the "mixed" and "λ-type" cases. Our method demonstrated higher sensitivity (90.5%) and specificity (91.4%) for discrimination between MS and non-MS patients, as compared to oligoclonality test (81% and 65.7%, respectively). CONCLUSIONS The proposed method may significantly contribute to diagnosis and prognosis of pediatric MS.
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Affiliation(s)
- Esther Ganelin-Cohen
- Institute of Pediatric Neurology, Schneider Children's Medical Center, Petach Tikva 49202, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sizilia Golderman
- Heller Institute of Medical Research, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Regina Yeskaraev
- Department of Clinical Biochemistry, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Ayal Rozenberg
- Department of Neuroimmunology, Rambam Health Care Campus, Haifa, Israel
| | - Avi Livneh
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Heller Institute of Medical Research, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Batia Kaplan
- Heller Institute of Medical Research, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
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Yang Y, Han X, Zheng G, Cai Z. Comparison of two serum free light chain assays for the diagnosis of primary plasma cell malignant proliferative disease. Health Sci Rep 2019; 2:e113. [PMID: 31049418 PMCID: PMC6482328 DOI: 10.1002/hsr2.113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 12/01/2018] [Accepted: 12/25/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND AIMS The serum free light chain assay (sFLC) is well established for aiding in the diagnosis, prognosis, and monitoring of plasma cell proliferative disorders. There are currently two commercially available sFLC immunoassays, Freelite, based on polyclonal antibody technology, and N Latex FLC, based on monoclonal antibodies. This study aimed to compare the analytical and clinical performance of these two assays in a Chinese population. METHODS This study included 74 consecutive patients who were newly diagnosed with monoclonal gammopathies (MGs) including multiple myeloma (MM), AL amyloidosis, and light chain deposition disease (LCDD) between January 2014 and May 2015 at the First Affiliated Hospital of Zhejiang University. Alongside serum and urine electrophoresis analysis, the serum samples were retrospectively tested with both sFLC assays according to the manufacturers' instructions. RESULTS The two sFLC assays showed a moderate correlation for κFLC (Passing-Bablok slope = 0.645, coefficient of determination (R 2) = 0.83, and Spearman coefficient = 0.904). However, for λFLC, a poor correlation was found (Passing-Bablok slope = 0.690, R 2 = 0.39, and Spearman coefficient = 0.852). The concordance rate of κFLC, λFLC, and κ/λ FLC ratio were 83.78%, 75.68%, and 86.49%, respectively. The clinical sensitivity of the κ/λ ratios were 83.8% for the Freelite assay and 75.7% for the N Latex FLC assay. CONCLUSION Although the concordance and the clinical sensitivity of the two assays appeared comparable, a number of discrepancies were observed. There is a low correlation between the two assays in clinical practice, suggesting that the assays are not equivalent and, thus, current IMWG guidelines, based on Freelite, cannot be cross-applied to N Latex FLC.
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Affiliation(s)
- Yang Yang
- Bone Marrow Transplantation Center, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Xiaoyan Han
- Bone Marrow Transplantation Center, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Gaofeng Zheng
- Bone Marrow Transplantation Center, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Zhen Cai
- Bone Marrow Transplantation Center, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
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Lima J, Cambridge G, Vilas‐Boas A, Martins C, Borrego L, Leandro M. Serum markers of B-cell activation in pregnancy during late gestation, delivery, and the postpartum period. Am J Reprod Immunol 2019; 81:e13090. [PMID: 30624814 PMCID: PMC6590212 DOI: 10.1111/aji.13090] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/30/2018] [Accepted: 01/07/2019] [Indexed: 12/17/2022] Open
Abstract
PROBLEM B cells are vital for the normal evolution of pregnancy due to their humoral and possible regulatory activities. Our group and others have documented that circulating B-cell subsets undergo changes from normal late pregnancy to the postpartum period. However, the underlying mechanisms are poorly understood. Therefore, this study examined the degree of B-cell activation in normal pregnancy by analyzing the levels of serum markers in healthy pregnant women during the third trimester of pregnancy, the day of delivery, and the postpartum period. METHOD OF STUDY A prospective study including pregnant and non-pregnant women attending routine care was undertaken at a hospital clinic. Sociodemographic and clinical data were collected, along with peripheral blood samples. The serum levels of soluble CD23 (sCD23), B-cell-activating factor (BAFF), kappa (κ) and lambda (λ) free light chains (FLC), IgA, IgG, and IgM were quantified. RESULTS Our study included 43 third trimester pregnant and 35 non-pregnant women. In the pregnant women, the median levels of sCD23, BAFF, IgG, and κ FLC were significantly higher during the postpartum period than during the third trimester of pregnancy. Compared to the non-pregnant women, the third trimester pregnant women had higher median BAFF levels and lower sCD23, IgA, IgG, and FLC levels. CONCLUSION Changes in serum markers of B-cell kinetics that occur during pregnancy often persist into the postpartum period and affect the secretion of immunoglobulins from different classes. Further studies are needed to clarify the biological significance of our observations.
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Affiliation(s)
- Jorge Lima
- Department of Obstetrics and GynecologyCUF Descobertas HospitalLisbonPortugal
- Department of Immunology, Chronic Diseases Research Center (CEDOC), Faculty of Medical SciencesNOVA Medical SchoolLisbonPortugal
| | - Geraldine Cambridge
- Centre for Rheumatology and Bloomsbury Rheumatology Unit, Division of MedicineUniversity College LondonLondonUK
| | - Andreia Vilas‐Boas
- Centre for Rheumatology and Bloomsbury Rheumatology Unit, Division of MedicineUniversity College LondonLondonUK
| | - Catarina Martins
- Department of Immunology, Chronic Diseases Research Center (CEDOC), Faculty of Medical SciencesNOVA Medical SchoolLisbonPortugal
| | - Luís‐Miguel Borrego
- Department of Immunology, Chronic Diseases Research Center (CEDOC), Faculty of Medical SciencesNOVA Medical SchoolLisbonPortugal
- Department of ImmunoallergyCUF Descobertas HospitalLisbonPortugal
| | - Maria Leandro
- Centre for Rheumatology and Bloomsbury Rheumatology Unit, Division of MedicineUniversity College LondonLondonUK
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Donati G, Zappulo F, Croci Chiocchini AL, Comai G, Zamagni E, La Manna G. Early use of PEPA dialyzer for light chains removal and for the recovery from myeloma cast nephropathy: A case report. Hemodial Int 2019; 23:E97-E99. [PMID: 30791209 DOI: 10.1111/hdi.12733] [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: 10/04/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 11/30/2022]
Abstract
Chemotherapy and extracorporeal treatment reduce serum free light chains (FLCs) allowing the recovery of acute kidney injury (AKI) caused by myeloma cast nephropathy (MCN). We report the first case of recovery from AKI in a patient with MCN who underwent the removal of FLCs using the PEPA filter, with an undisclosed cut-off, combined with chemotherapy for multiple myeloma (MM).
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Affiliation(s)
- Gabriele Donati
- Nephrology Dialysis and Renal Transplantation Unit, L. & A. Seràgnoli, S.Orsola University Hospital, Bologna, Italy
| | - Fulvia Zappulo
- Nephrology Dialysis and Renal Transplantation Unit, L. & A. Seràgnoli, S.Orsola University Hospital, Bologna, Italy
| | - Anna Laura Croci Chiocchini
- Nephrology Dialysis and Renal Transplantation Unit, L. & A. Seràgnoli, S.Orsola University Hospital, Bologna, Italy
| | - Giorgia Comai
- Nephrology Dialysis and Renal Transplantation Unit, L. & A. Seràgnoli, S.Orsola University Hospital, Bologna, Italy
| | - Elena Zamagni
- Hematology and Oncology Unit, L. & A. Seràgnoli, S.Orsola University Hospital, Bologna, Italy
| | - Gaetano La Manna
- Nephrology Dialysis and Renal Transplantation Unit, L. & A. Seràgnoli, S.Orsola University Hospital, Bologna, Italy
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Kastritis E, Gavriatopoulou M, Roussou M, Bagratuni T, Migkou M, Fotiou D, Ziogas DC, Kanellias N, Eleutherakis-Papaiakovou E, Dialoupi I, Ntanasis-Stathopoulos I, Spyropoulou-Vlachou M, Psimenou E, Gakiopoulou H, Marinaki S, Papadopoulou E, Ntalianis A, Terpos E, Dimopoulos MA. Efficacy of lenalidomide as salvage therapy for patients with AL amyloidosis. Amyloid 2018; 25:234-241. [PMID: 30663408 DOI: 10.1080/13506129.2018.1540410] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 10/27/2022]
Abstract
We retrospectively evaluated 55 consecutive patients who received at least one dose of lenalidomide for relapsed/refractory AL amyloidosis. Their median age was 63 years; 72% had heart and 75% kidney involvement and 13% were on dialysis; while 20%, 46% and 34% had Mayo stage -1, -2 and -3 disease, respectively. Median time from start of primary therapy to lenalidomide was 15 months (range 2-100) and median number of prior therapies was 1 (range 1-4); 73% of the patients had prior bortezomib and 42% were bortezomib-refractory. On intent to treat, haematologic response rate was 51% (5.5% CRs, 20% VGPRs) and was 56% versus 40% for patients with and without prior bortezomib and 47% versus 62.5% for bortezomib refractory versus non-refractory patients (p = .351). Organ response was achieved by 16% of evaluable patients (22% renal, 7% liver and 3% cardiac); however, 10 (21%) patients progressed to dialysis. Median survival post lenalidomide was 25 months. Bortezomib-refractory patients had worse outcome (median survival of 10.5 versus 25 months for bortezomib-sensitive patients versus not reached for bortezomib-naive patients, p = .011). Median lenalidomide dose was 10 mg and no patient received the 25 mg dose; however, in 60% a dose reduction was required. Median duration of lenalidomide therapy was 7.2 months and 46% discontinued lenalidomide before completion of planned therapy, mainly due to toxicity (26%) or disease progression/no response (13%). We conclude that although lenalidomide is a major salvage option for patients with relapsed/refractory AL amyloidosis, its toxicity in patients with AL amyloidosis is significant and doses should be adjusted for optimal tolerability.
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Affiliation(s)
- Efstathios Kastritis
- a Department of Clinical Therapeutics , National and Kapodistrian University of Athens , Athens , Greece
| | - Maria Gavriatopoulou
- a Department of Clinical Therapeutics , National and Kapodistrian University of Athens , Athens , Greece
| | - Maria Roussou
- a Department of Clinical Therapeutics , National and Kapodistrian University of Athens , Athens , Greece
| | - Tina Bagratuni
- a Department of Clinical Therapeutics , National and Kapodistrian University of Athens , Athens , Greece
| | - Magdalini Migkou
- a Department of Clinical Therapeutics , National and Kapodistrian University of Athens , Athens , Greece
| | - Despina Fotiou
- a Department of Clinical Therapeutics , National and Kapodistrian University of Athens , Athens , Greece
| | - Dimitrios C Ziogas
- a Department of Clinical Therapeutics , National and Kapodistrian University of Athens , Athens , Greece
| | - Nikolaos Kanellias
- a Department of Clinical Therapeutics , National and Kapodistrian University of Athens , Athens , Greece
| | | | - Ioanna Dialoupi
- a Department of Clinical Therapeutics , National and Kapodistrian University of Athens , Athens , Greece
| | | | | | - Erasmia Psimenou
- a Department of Clinical Therapeutics , National and Kapodistrian University of Athens , Athens , Greece
| | - Harikleia Gakiopoulou
- c 1st Department of Pathology , National and Kapodistrian University of Athens , Athens , Greece
| | - Smaragdi Marinaki
- d Nephrology Unit , " Laikon" Hospital, National and Kapodistrian University of Athens , Athens , Greece
| | - Elektra Papadopoulou
- a Department of Clinical Therapeutics , National and Kapodistrian University of Athens , Athens , Greece
| | - Argyrios Ntalianis
- a Department of Clinical Therapeutics , National and Kapodistrian University of Athens , Athens , Greece
| | - Evangelos Terpos
- a Department of Clinical Therapeutics , National and Kapodistrian University of Athens , Athens , Greece
| | - Meletios A Dimopoulos
- a Department of Clinical Therapeutics , National and Kapodistrian University of Athens , Athens , Greece
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