对于完整免疫球蛋白多发性骨髓瘤患者的诊断和随访，重链/轻链特异性免疫球蛋白比值不能提供比血清蛋白电泳和免疫固定更多的信息

Pathologie-biologie Pub Date : 2015-09-01 DOI:10.1016/j.patbio.2015.06.001

M.-P. Beaumont-Epinette , C. Moreau , S. Besnard , F. Latute , N. Collet , M. Sebillot , B. Grosbois , C. Bendavid , L. Guenet , O. Decaux

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引用次数: 6

摘要

背景血清蛋白电泳(SPE)和免疫固定电泳(IFE)用于完整免疫球蛋白型多发性骨髓瘤的诊断和随访。然而，这些方法的众多局限性导致了浊度免疫测定法(Hevylite™)的发展，用于特异性测量血清IgGκ， IgGλ， igakk和igab浓度。方法本研究对15例患者114份血清(12例IgG, 3例IgA)的SPE和IFE进行相关性分析，分析其对患者临床护理的影响，特别是对诊断、残留疾病评估和早期发现复发的影响。结果通过sat检测和随访，我们发现单克隆免疫球蛋白浓度与SPE (IgA R2 = 0.902, IgG R2 = 0.915)和浊度定量(IgA R2 = 0.948, IgG R2 = 0.920)评价单克隆和多克隆免疫球蛋白具有良好的相关性。我们的研究结果表明，Hevylite™检测在检测残留疾病方面的敏感性低于IFE:获得非常好的部分缓解或完全缓解的5例患者Hevylite™比例正常化，而IFE仍为阳性。在15例患者中，Hevylite™比值比SPE和IFE早1 - 2个月检测到复发的患者有3例，但没有建议治疗只有轻微生物学复发的患者。结论重/轻链特异性免疫球蛋白比值对完整免疫球蛋白型多发性骨髓瘤患者的诊断和随访没有比血清蛋白电泳和免疫固定更重要的信息。我们还研究了Hevylite™测定的总免疫球蛋白浓度(Ig′κ + Ig′λ之和)与浊度法测定的总IgG或IgA的相关性。为了进行相关性分析，对所有114份血清进行了分析。IgA和IgG的相关系数分别为R2 = 0.948和R2 = 0.920。

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Heavy/light chain specific immunoglobulin ratios provides no additional information than serum proteins electrophoresis and immunofixation for the diagnosis and the follow-up of intact immunoglobulin multiple myeloma patients

Background

Serum protein electrophoresis (SPE) and immunofixation electrophoresis (IFE) are used for diagnosis and follow-up of patients with intact immunoglobulin multiple myeloma. However, the numerous limitations of these methods led to the development of a nephelometric immunoassay (Hevylite™) for the specific measurement of serum IgGκ, IgGλ, IgAκ and IgAλ concentrations.

Methods

In this study, we evaluated the correlation between this assay and SPE and IFE in 114 sera of 15 patients (12 IgG and 3 IgA patients) and its impact on the clinical care of patients, especially for diagnosis, for the evaluation of residual disease and for early detection of relapse.

Results

At inclusion and during follow-up, we found a good correlation between monoclonal immunoglobulin concentrations and SPE (R² = 0.902 for IgA and R² = 0.915 for IgG) and nephelometric quantification (R² = 0.948 for IgA and R² = 0.920 for IgG) for the evaluation of monoclonal and polyclonal immunoglobulins. Our results illustrate that the Hevylite™ test is less sensitive than the IFE for detection of residual disease: 5 patients who obtained very good partial response or complete response had normalization of the Hevylite™ ratio while IFE was still positive. A relapse had been detectable with the Hevylite™ ratio 1 to 2 months earlier than with SPE and IFE in 3 patients out of 15, but no recommendations for treating patients with only slight biological relapse are available.

Conclusion

Our results demonstrate that heavy/light chain specific immunoglobulin ratios provides no additional information than serum proteins electrophoresis and immunofixation for the diagnosis and the follow-up of intact immunoglobulin multiple myeloma patients. We also studied the correlation between the concentration of total immunoglobulin measured by Hevylite™ (sum of Ig’κ + Ig’λ) and nephelometric measurement of total IgG or IgA. For this correlation analysis, all 114 sera were analyzed. The correlation coefficient was R² = 0.948 for IgA and R² = 0.920 for IgG.

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