Yıl: 2023 Cilt: 56 Sayı: 1 Sayfa Aralığı: 33 - 45 Metin Dili: İngilizce DOI: 10.5505/aot.2023.32650 İndeks Tarihi: 31-05-2023

Simultaneous Evaluation of Serum Immunofixation Electrophoresis and Serum Free Light Chain Measurements Used in the Diagnosis of Monoclonal Gammopathy and Smoldering Multiple Myeloma of Uncertain Significance in the Presence of Risk Factors

Öz:
Introduction: This study aimed to investigate the effectiveness of using serum Free Light Chain (sFLC) together with traditional examination methods in diagnosing Monoclonal Gammopathy of Undetermined Significance (MGUS) and Smoldering Multiple Myeloma (SMM), especially in patients with Monoclonal Gammopathy (MG) without hypercalcemia, renal dysfunction, anemia, and bone lesions (CRAB) symptoms, by eliminating the need for bone marrow biopsy (BMb). Methods: A total of 160 patients over 50 years of age with an ESR of 50 mm/h and above were included in the study. Serum Immunofixation Electrophoresis (sIFE) and sFLC levels of these patients were studied simultaneously. Sensitivity and specificity of the sIFE and sFLC for diagnosis of MGUS were estimated by ROC analysis. Results: MG was detected in 36 (22.5%) patients with sIFE and in 30 (18.7%) patients with sFLC of 160 patients included in the study.There were a total of 44 patients with MG detected by sIFE alone, sFLC alone, and both sIFE and sFLC. BMb were performed on 42 patients with MG who approved the BMb procedure. These patients were diagnosed MGUS, SMM and MM by using test results, BMb results, and clinical and laboratory data. The sensitivity of sIFE in the detection of MG was 82.5% and the specificity was 99.2% (p<0.001). sFLC had a sensitivity of 72.5% and a specificity of 99.2% (p<0.001). When sIFE and sFLC were performed simultaneously, the sensitivity was 100% and the specificity was 98.3% (p<0.001). Discussion and Conclusion: Simultaneous monitoring of sIFE and sFLC, which is both non-invasive and with the opportunity to achieve results in less time without BMb, may be sufficient and reliable in the diagnosis and follow-up of MGUS in the detection of MGs and especially in asymptomatic patients
Anahtar Kelime:

Risk Faktörleri Varlığında Önemi Belirsiz Monoklonal Gammopati ve Smoldering Multiple Myeloma Tanısında Kullanılan Serum İmmünfiksasyon Elektroforezi ve Serum Serbest Hafif Zincir Ölçümlerinin Eş Zamanlı Değerlendirilmesi

Öz:
Giriş ve Amaç: Bu çalışmada, özellikle hiperkalsemi, böbrek fonksiyon bozukluğu, anemi ve kemik lezyonları (CRAB) semptomları olmayan Monoklonal Gammopatili (MG) hastalarda, Önemi Belirsiz Monoklonal Gammopati (MGUS) ve Smoldering Multipl Miyelom (SMM) tanısında, serum Serbest Hafif Zincirinin (sFLC) geleneksel tetkik yöntemleri ile birlikte kullanımının kemik iliği biyopsisi (Kİb) ihtiyacını ortadan kaldırarak etkinliğinin araştırılması amaçladık. Yöntem ve Gereçler: Çalışmaya ESR 50 mm/h ve üzerinde olan, 50 yaş üstü 160 hasta alındı. Bu hastaların serum İmmünfiksasyon Elektroforezi (sIFE) ve sFLC düzeyleri eş zamanlı çalışıldı. MGUS tanısı için sIFE ve sFLC'nin duyarlılığı ve özgüllüğü ROC analizi ile tahmin edildi. Bulgular: Çalışmaya alınan160 hastanın yapılan sIFE ile 36(%22,5) hastada ve sFLC ile de 30 (%18,7) hastada MG tespit edilmiştir. Yalnızca sIFE, yalnızca sFLC ve hem sIFE hem de sFLC tarafından saptanan MG'li toplam 44 hasta vardı. MG tespit edilen ve kemik iliği biyopsi (Kİb) işlemine onay veren 42 hastaya Kİb yapılmıştır. Bu hastalara; test sonuçları, Kİb sonuçları, klinik ve laboratuar verileri de kullanılarak MGUS, SMM ve MM tanısı konulmuştur. sİFE’nin MG tespitinde sensitivitesi %82.5, spesifitesi %99.2 (p<0.001) olarak saptanmıştır. sFLC’nin sesensitivitesi %72.5, spesifitesi %99.2 (p<0.001) olarak saptanmıştır. sİFE ve sFLC eş zamanlı yapıldığında ise sensitivitesi %100, spesifitesi %98.3 (p<0.001) olarak saptanmıştır. Tartışma ve Sonuç: MG’lerin tespitinde ve özellikle asemptomatik hastalarda Kİb yapmadan hem noninvaziv hem de daha kısa sürede sonuç alma fırsatı ile sIFE ve sFLC’nin eşzamanlı bakılması MGUS tanısı koymada ve takip etmede yeterli ve güvenilir olabilir.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer. 2013; 49(6): 1374-403.
  • 2. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015; 136(5): E359-86.
  • 3. Weiss BM, Abadie J, Verma P, Howard RS, Kuehl WM. A monoclonal gammopathy precedes multiple myeloma in most patients. Blood. 2009; 113(22): 5418-22.
  • 4. Landgren O, Kyle RA, Pfeiffer RM, et al. Monoclonal gammopathy of undetermined significance (MGUS) consistently precedes multiple myeloma: a prospective study. Blood. 2009; 113(22): 5412-7.
  • 5. Kyle RA, Larson DR, Therneau TM, et al. Long-Term Follow-up of Monoclonal Gammopathy of Undetermined Significance. N Engl J Med. 2018; 378(3): 241-9.
  • 6. Kyle RA, Therneau TM, Rajkumar SV, et al. Prevalence of monoclonal gammopathy of undetermined significance. N Engl J Med. 2006; 354(13): 1362-9.
  • 7. Go RS, Swanson KM, Sangaralingham LR, Habermann EB, Shah ND. Clinical prevalence (diagnosed cases) of monoclonal gammopathy of undetermined significance in the US: estimating the burden on health care. Leukemia. 2016; 30(6): 1443-6.
  • 8. Sigurdardottir EE, Turesson I, Lund SH, et al. The Role of Diagnosis and Clinical Follow-up of Monoclonal Gammopathy of Undetermined Significance on Survival in Multiple Myeloma. JAMA Oncol. 2015; 1(2): 168-74.
  • 9. Kyle RA, Therneau TM, Rajkumar SV, et al. A long-term study of prognosis in monoclonal gammopathy of undetermined significance. N Engl J Med. 2002; 346(8): 564-9.
  • 10. Rajkumar SV, Landgren O, Mateos MV. Smoldering multiple myeloma. Blood. 2015; 125(20): 3069-75.
  • 11. Dispenzieri A, Katzmann JA, Kyle RA, et al. Prevalence and risk of progression of light-chain monoclonal gammopathy of undetermined significance: a retrospective population-based cohort study. Lancet. 2010; 375(9727): 1721-8.
  • 12. Kyle RA. Sequence of testing for monoclonal gammopathies. Arch Pathol Lab Med. 1999; 123(2): 114-8.
  • 13. Katzmann JA, Kyle RA, Benson J, et al. Screening panels for detection of monoclonal gammopathies. Clin Chem. 2009; 55(8): 1517-22.
  • 14. Murray DL, Ryu E, Snyder MR, Katzmann JA. Quantitation of serum monoclonal proteins: relationship between agarose gel electrophoresis and immunonephelometry. Clin Chem. 2009; 55(8): 1523-9.
  • 15. Bradwell AR, Carr-Smith HD, Mead GP, et al. Highly sensitive, automated immunoassay for immunoglobulin free light chains in serum and urine. Clin Chem. 2001; 47(4): 673-80.
  • 16. Dispenzieri A, Kyle R, Merlini G, et al. International Myeloma Working Group guidelines for serum-free light chain analysis in multiple myeloma and related disorders. Leukemia. 2009; 23(2): 215-24.
  • 17. Rajkumar SV, Harousseau JL, Durie B, et al. Consensus recommendations for the uniform reporting of clinical trials: report of the International Myeloma Workshop Consensus Panel 1. Blood. 2011; 117(18): 4691-5.
  • 18. Rajkumar SV, Dimopoulos MA, Palumbo A, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014;15(12):e538-48.
  • 19. Snozek CL, Katzmann JA, Kyle RA, et al. Prognostic value of the serum free light chain ratio in newly diagnosed myeloma: proposed incorporation into the international staging system. Leukemia. 2008; 22(10): 1933-7.
  • 20. Gertz MA. Utility of the immunoglobulin free light chain assay for plasma cell disorders 2015. Leuk Lymphoma. 2015; 56(10): 2757-8.
  • 21. Lakshman A, Rajkumar SV, Buadi FK, et al. Risk stratification of smoldering multiple myeloma incorporating revised IMWG diagnostic criteria. Blood Cancer J. 2018; 8(6): 59.
  • 22. Sørrig R, Klausen TW, Salomo M, et al. Smoldering multiple myeloma risk factors for progression: a Danish population-based cohort study. Eur J Haematol. 2016; 97(3): 303-9.
  • 23. Pérez-Persona E, Mateo G, García-Sanz R, et al. Risk of progression in smouldering myeloma and monoclonal gammopathies of unknown significance: comparative analysis of the evolution of monoclonal component and multiparameter flow cytometry of bone marrow plasma cells. Br J Haematol. 2010; 148(1): 110-4.
  • 24. Rajkumar SV, Kyle RA, Therneau TM, et al. Serum free light chain ratio is an independent risk factor for progression in monoclonal gammopathy of undetermined significance. Blood. 2005; 106(3): 812-7.
  • 25. Willrich MA, Katzmann JA. Laboratory testing requirements for diagnosis and follow-up of multiple myeloma and related plasma cell dyscrasias. Clin Chem Lab Med. 2016; 54(6): 907-19.
  • 26. Bhole MV, Sadler R, Ramasamy K. Serum-free light-chain assay: clinical utility and limitations. Ann Clin Biochem. 2014; 51(Pt 5): 528-42.
  • 27. Katzmann JA, Clark R, Kyle RA, et al. Suppression of uninvolved immunoglobulins defined by heavy/light chain pair suppression is a risk factor for progression of MGUS. Leukemia. 2013; 27(1): 208-12.
  • 28. Shaheen SP, Levinson SS. Serum free light chain analysis may miss monoclonal light chains that urine immunofixation electrophoreses would detect. Clin Chim Acta. 2009; 406(1-2): 162-6.
  • 29. Katzmann JA, Dispenzieri A, Kyle RA, et al. Elimination of the need for urine studies in the screening algorithm for monoclonal gammopathies by using serum immunofixation and free light chain assays. Mayo Clin Proc. 2006; 81(12): 1575-8.
  • 30. Rajkumar SV, Kyle RA, Therneau TM, et al. Presence of monoclonal free light chains in the serum predicts risk of progression in monoclonal gammopathy of undetermined significance. Br J Haematol. 2004; 127(3): 308-10.
  • 31. Gagliardi A, Carbone C, Russo A, et al. Combined use of free light chain and heavy/light chain ratios allow diagnosis and monitoring of patients with monoclonal gammopathies: Experience of a single institute, with three exemplar case reports. Oncol Lett. 2016; 12(4): 2363-70.
  • 32. Wood PB, McElroy YG, Stone MJ. Comparison of serum immunofixation electrophoresis and free light chain assays in the detection of monoclonal gammopathies. Clin Lymphoma Myeloma Leuk. 2010; 10(4): 278-80.
  • 33. Jaskowski TD, Litwin CM, Hill HR. Detection of kappa and lambda light chain monoclonal proteins in human serum: automated immunoassay versus immunofixation electro-phoresis. Clin Vaccine Immunol. 2006; 13(2): 277-80.
  • 34. Sabatino R, Perrone A, Cuomo M, et al. Analytical Criticalities Associated to Different Immunological Methods for Serum Free Light Chain Detection in Plasma Cell Dyscrasias: A Description of Particular Clinical Cases. Int J Mol Sci. 2017; 18(4).
  • 35. Sidiqi MH, Aljama M, Kumar SK, et al. The role of bone marrow biopsy in patients with plasma cell disorders: should all patients with a monoclonal protein be biopsied? Blood Cancer J. 2020; 10(5): 52.
  • 36. Jenner E. Serum free light chains in clinical laboratory diagnostics. Clin Chim Acta. 2014; 427: 15-20.
  • 37. Katzmann JA, Clark RJ, Abraham RS, et al. Serum reference intervals and diagnostic ranges for free kappa and free lambda immunoglobulin light chains: relative sensitivity for detection of monoclonal light chains. Clin Chem. 2002; 48(9): 1437-44.
  • 38. Davids MS, Murali MR, Kuter DJ. Serum free light chain analysis. Am J Hematol. 2010; 85(10): 787-90.
  • 39. Beetham R, Wassell J, Wallage MJ, Whiteway AJ, James JA. Can serum free light chains replace urine electrophoresis in the detection of monoclonal gammopathies? Ann Clin Biochem. 2007; 44(Pt 6): 516-22.
  • 40. Hutchison CA, Plant T, Drayson M, et al. Serum free light chain measurement aids the diagnosis of myeloma in patients with severe renal failure. BMC Nephrol. 2008 ;9: 11.
  • 41. Abadie JM, van Hoeven KH, Wells JM. Are renal reference intervals required when screening for plasma cell disorders with serum free light chains and serum protein electro-phoresis? Am J Clin Pathol. 2009; 131(2): 166-71.
  • 42. Bridoux F, Leung N, Hutchison CA, et al. Diagnosis of monoclonal gammopathy of renal significance. Kidney Int. 2015; 87(4): 698-711.
  • 43. Levinson SS. Polyclonal free light chain of Ig may interfere with interpretation of monoclonal free light chain κ/λ ratio. Ann Clin Lab Sci. 2010; 40(4): 348-53.
  • 44. Larsen JT, Kumar SK, Dispenzieri A, Kyle RA, Katzmann JA, Rajkumar SV. Serum free light chain ratio as a biomarker for high-risk smoldering multiple myeloma. Leukemia. 2013; 27(4): 941-6.
  • 45. Xu B, Tang Y, Zhou J, Zhang P, Li H. Disease spectrum of abnormal serum free light chain ratio and its diagnostic significance. Oncotarget. 2017; 8(47): 82268-79.
APA öner i, Sackan F, ÜNAL A (2023). Simultaneous Evaluation of Serum Immunofixation Electrophoresis and Serum Free Light Chain Measurements Used in the Diagnosis of Monoclonal Gammopathy and Smoldering Multiple Myeloma of Uncertain Significance in the Presence of Risk Factors. , 33 - 45. 10.5505/aot.2023.32650
Chicago öner irem,Sackan Fatih,ÜNAL ALİ Simultaneous Evaluation of Serum Immunofixation Electrophoresis and Serum Free Light Chain Measurements Used in the Diagnosis of Monoclonal Gammopathy and Smoldering Multiple Myeloma of Uncertain Significance in the Presence of Risk Factors. (2023): 33 - 45. 10.5505/aot.2023.32650
MLA öner irem,Sackan Fatih,ÜNAL ALİ Simultaneous Evaluation of Serum Immunofixation Electrophoresis and Serum Free Light Chain Measurements Used in the Diagnosis of Monoclonal Gammopathy and Smoldering Multiple Myeloma of Uncertain Significance in the Presence of Risk Factors. , 2023, ss.33 - 45. 10.5505/aot.2023.32650
AMA öner i,Sackan F,ÜNAL A Simultaneous Evaluation of Serum Immunofixation Electrophoresis and Serum Free Light Chain Measurements Used in the Diagnosis of Monoclonal Gammopathy and Smoldering Multiple Myeloma of Uncertain Significance in the Presence of Risk Factors. . 2023; 33 - 45. 10.5505/aot.2023.32650
Vancouver öner i,Sackan F,ÜNAL A Simultaneous Evaluation of Serum Immunofixation Electrophoresis and Serum Free Light Chain Measurements Used in the Diagnosis of Monoclonal Gammopathy and Smoldering Multiple Myeloma of Uncertain Significance in the Presence of Risk Factors. . 2023; 33 - 45. 10.5505/aot.2023.32650
IEEE öner i,Sackan F,ÜNAL A "Simultaneous Evaluation of Serum Immunofixation Electrophoresis and Serum Free Light Chain Measurements Used in the Diagnosis of Monoclonal Gammopathy and Smoldering Multiple Myeloma of Uncertain Significance in the Presence of Risk Factors." , ss.33 - 45, 2023. 10.5505/aot.2023.32650
ISNAD öner, irem vd. "Simultaneous Evaluation of Serum Immunofixation Electrophoresis and Serum Free Light Chain Measurements Used in the Diagnosis of Monoclonal Gammopathy and Smoldering Multiple Myeloma of Uncertain Significance in the Presence of Risk Factors". (2023), 33-45. https://doi.org/10.5505/aot.2023.32650
APA öner i, Sackan F, ÜNAL A (2023). Simultaneous Evaluation of Serum Immunofixation Electrophoresis and Serum Free Light Chain Measurements Used in the Diagnosis of Monoclonal Gammopathy and Smoldering Multiple Myeloma of Uncertain Significance in the Presence of Risk Factors. ACTA ONCOLOGICA TURCICA, 56(1), 33 - 45. 10.5505/aot.2023.32650
Chicago öner irem,Sackan Fatih,ÜNAL ALİ Simultaneous Evaluation of Serum Immunofixation Electrophoresis and Serum Free Light Chain Measurements Used in the Diagnosis of Monoclonal Gammopathy and Smoldering Multiple Myeloma of Uncertain Significance in the Presence of Risk Factors. ACTA ONCOLOGICA TURCICA 56, no.1 (2023): 33 - 45. 10.5505/aot.2023.32650
MLA öner irem,Sackan Fatih,ÜNAL ALİ Simultaneous Evaluation of Serum Immunofixation Electrophoresis and Serum Free Light Chain Measurements Used in the Diagnosis of Monoclonal Gammopathy and Smoldering Multiple Myeloma of Uncertain Significance in the Presence of Risk Factors. ACTA ONCOLOGICA TURCICA, vol.56, no.1, 2023, ss.33 - 45. 10.5505/aot.2023.32650
AMA öner i,Sackan F,ÜNAL A Simultaneous Evaluation of Serum Immunofixation Electrophoresis and Serum Free Light Chain Measurements Used in the Diagnosis of Monoclonal Gammopathy and Smoldering Multiple Myeloma of Uncertain Significance in the Presence of Risk Factors. ACTA ONCOLOGICA TURCICA. 2023; 56(1): 33 - 45. 10.5505/aot.2023.32650
Vancouver öner i,Sackan F,ÜNAL A Simultaneous Evaluation of Serum Immunofixation Electrophoresis and Serum Free Light Chain Measurements Used in the Diagnosis of Monoclonal Gammopathy and Smoldering Multiple Myeloma of Uncertain Significance in the Presence of Risk Factors. ACTA ONCOLOGICA TURCICA. 2023; 56(1): 33 - 45. 10.5505/aot.2023.32650
IEEE öner i,Sackan F,ÜNAL A "Simultaneous Evaluation of Serum Immunofixation Electrophoresis and Serum Free Light Chain Measurements Used in the Diagnosis of Monoclonal Gammopathy and Smoldering Multiple Myeloma of Uncertain Significance in the Presence of Risk Factors." ACTA ONCOLOGICA TURCICA, 56, ss.33 - 45, 2023. 10.5505/aot.2023.32650
ISNAD öner, irem vd. "Simultaneous Evaluation of Serum Immunofixation Electrophoresis and Serum Free Light Chain Measurements Used in the Diagnosis of Monoclonal Gammopathy and Smoldering Multiple Myeloma of Uncertain Significance in the Presence of Risk Factors". ACTA ONCOLOGICA TURCICA 56/1 (2023), 33-45. https://doi.org/10.5505/aot.2023.32650