血清游离轻链连续检测并不比免疫固定电泳 M 蛋白检测更早地发现完整免疫球蛋白型骨髓瘤患者疾病状态的变化。
Serial serum free light chain measurements do not detect changes in disease status earlier than electrophoretic M-spike measurements in patients with intact immunoglobulin myeloma.
机构信息
Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115, United States.
出版信息
Clin Chim Acta. 2011 Mar 18;412(7-8):562-8. doi: 10.1016/j.cca.2010.12.002. Epub 2010 Dec 7.
BACKGROUND
Serum free light chains (SFLC) are used to manage patients with light chain or hyposecretory myeloma, and may also be useful in patients with intact immunoglobulin myeloma (IIMM), because their shorter half-life may enable earlier indication of relapse/response than electrophoretic M-spikes or heavy chain (IgGA) immunonephelometry.
METHODS
One thousand five SFLC, M-spike, and IgGA concentrations were compared at multiple time points during the treatment of 17 myeloma patients, followed over 7.7-63.4 months. Changes in these analytes were evaluated in context with changes in disease status and treatment.
RESULTS
14/17 (82%) patients showed synchrony between M-spike, IgGA, and SFLC measurements. SFLC changes preceded M-spike/IgGA in 1 patient, and lagged behind M-spike/IgGA in 2 patients. In eight patients, SFLC showed short-term fluctuations unaccompanied by changes in M-spike, IgGA, or clinical treatment.
CONCLUSIONS
In 16/17 intact immunoglobulin myeloma patients tested frequently over ~3 years, SFLC performed no better than M-spike and did not add value to conventional serum electrophoresis.
背景
血清游离轻链（SFLC）用于管理轻链或低分泌性骨髓瘤患者，也可能对完整免疫球蛋白骨髓瘤（IIMM）患者有用，因为它们的半衰期较短，可能比电泳 M 峰或重链（IgGA）免疫比浊法更早地提示复发/反应。
方法
在 17 例骨髓瘤患者的治疗过程中，在多个时间点比较了 1500 例 SFLC、M 峰和 IgGA 浓度，随访时间为 7.7-63.4 个月。在疾病状态和治疗变化的背景下评估这些分析物的变化。
结果
14/17（82%）患者的 M 峰、IgGA 和 SFLC 测量结果同步。1 例患者的 SFLC 变化先于 M 峰/IgGA，2 例患者的 SFLC 变化滞后于 M 峰/IgGA。在 8 例患者中，SFLC 出现短期波动，而 M 峰、IgGA 或临床治疗没有变化。
结论
在 16/17 例接受频繁测试的完整免疫球蛋白骨髓瘤患者中，SFLC 的表现并不优于 M 峰，也没有为常规血清电泳增加价值。
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