Martin William, Abraham Roshini, Shanafelt Tait, Clark Raynell J, Bone Nancy, Geyer Susan M, Katzmann Jerry A, Bradwell Arthur, Kay Neil E, Witzig Thomas E
Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Transl Res. 2007 Apr;149(4):231-5. doi: 10.1016/j.trsl.2006.11.001.
New nephelometric immunoassays specific for free immunoglobulin light chains (FLCs) improve detection of monoclonal proteins (M-protein). Initial studies with FLC have focused on multiple myeloma and amyloidosis. The goal of this study was to evaluate the frequency of monoclonal serum FLC in patients with other B-cell malignancies. Frozen sera from 226 patients with non-Hodgkin lymphoma (NHL) or chronic lymphocytic leukemia (CLL) were tested for M-protein by the serum FLC assay and compared with standard protein electrophoresis (PEL) and immunofixation (IF). Overall, 24% (54/226) of samples had a detectable M-protein with 63% of these (34/54) FLC-positive. In 35% (19/54), the M-protein was only detectable by FLC analysis. Of the 208 NHL patients, 22% (46/208) had a detectable M-protein. Also, 13% (27/208) were positive for FLC and 16% (33/208) had a detectable M-protein by PEL/IF. Twenty-eighty percent (13/46) of NHL patients with M-proteins were detectable only by FLC analysis. Within NHL, the highest incidences of FLC presence were in patients with mantle cell (36%) and small lymphocytic (24%). Among CLL patients, 44% had an M-protein with 39% detected by FLC and 11% detected by PEL/IF. Notably, in 6 of 8 CLL patients, the M-protein was only detectable by the FLC method. Serum FLC can be detected in a substantial fraction of patients with NHL/CLL, and the FLC technique improves detection of M-proteins when combined with standard PEL/IF. Future studies are warranted to elucidate the role of serum FLC as biomarkers of disease, for monitoring of minimal residual disease, and as a prognostic factor for response and survival.
针对游离免疫球蛋白轻链（FLC）的新型散射比浊免疫测定法提高了单克隆蛋白（M蛋白）的检测率。FLC的初步研究主要集中在多发性骨髓瘤和淀粉样变性病。本研究的目的是评估其他B细胞恶性肿瘤患者血清单克隆FLC的频率。采用血清FLC测定法对226例非霍奇金淋巴瘤（NHL）或慢性淋巴细胞白血病（CLL）患者的冻存血清进行M蛋白检测，并与标准蛋白电泳（PEL）和免疫固定法（IF）进行比较。总体而言，24%（54/226）的样本可检测到M蛋白，其中63%（34/54）为FLC阳性。在35%（19/54）的样本中，M蛋白仅通过FLC分析才能检测到。在208例NHL患者中，22%（46/208）可检测到M蛋白。此外，13%（27/208）的患者FLC呈阳性，16%（33/208）的患者通过PEL/IF检测到M蛋白。NHL患者中M蛋白仅通过FLC分析才能检测到的比例为28%（13/46）。在NHL患者中，FLC阳性率最高的是套细胞淋巴瘤患者（36%）和小淋巴细胞淋巴瘤患者（24%）。在CLL患者中，44%的患者存在M蛋白，其中39%通过FLC检测到，11%通过PEL/IF检测到。值得注意的是，在8例CLL患者中有6例，M蛋白仅通过FLC方法才能检测到。在相当一部分NHL/CLL患者中可检测到血清FLC，并且FLC技术与标准PEL/IF联合使用时可提高M蛋白的检测率。有必要进行进一步研究以阐明血清FLC作为疾病生物标志物的作用、监测微小残留病以及作为反应和生存的预后因素。
