对于完整免疫球蛋白多发性骨髓瘤患者的诊断及随访，重链/轻链特异性免疫球蛋白比率相较于血清蛋白电泳和免疫固定电泳并未提供更多信息。

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.

作者信息

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

机构信息

Laboratoire de génétique, CHU de Rennes, 35033 Rennes, France.

Laboratoire de biochimie et toxicologie médicale, CHU de Rennes, 35033 Rennes, France; Unité Inserm U991, université de Rennes 1, 35042 Rennes, France.

出版信息

Pathol Biol (Paris). 2015 Sep;63(4-5):215-21. doi: 10.1016/j.patbio.2015.06.001. Epub 2015 Aug 28.

DOI:10.1016/j.patbio.2015.06.001

PMID:26319969

Abstract

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 (R(2)=0.902 for IgA and R(2)=0.915 for IgG) and nephelometric quantification (R(2)=0.948 for IgA and R(2)=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 R(2) = 0.948 for IgA and R(2) = 0.920 for IgG.

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多发性骨髓瘤患者的诊断和随访。然而，这些方法存在诸多局限性，因此开发了一种散射比浊免疫分析法（Hevylite™）来特异性测定血清IgGκ、IgGλ、IgAκ和IgAλ浓度。

方法

在本研究中，我们评估了该检测方法与15例患者（12例IgG型和3例IgA型患者）的114份血清中的SPE和IFE之间的相关性，以及其对患者临床护理的影响，特别是对诊断、残留疾病评估和复发早期检测的影响。

结果

在纳入研究时及随访期间，我们发现单克隆免疫球蛋白浓度与用于评估单克隆和多克隆免疫球蛋白的SPE（IgA的R(2)=0.902，IgG的R(2)=0.915）和散射比浊定量法（IgA的R(2)=0.948，IgG的R(2)=0.920）之间具有良好的相关性。我们的结果表明，Hevylite™检测在检测残留疾病方面不如IFE敏感：5例获得非常好的部分缓解或完全缓解的患者，其Hevylite™比值恢复正常，而IFE仍为阳性。在15例患者中有3例，Hevylite™比值比SPE和IFE提前1至2个月检测到复发，但对于仅存在轻微生物学复发的患者，尚无治疗建议。

结论

我们的结果表明，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相比血清蛋白电泳和免疫固定电泳并未提供更多信息。我们还研究了Hevylite™测定的总免疫球蛋白浓度（Ig'κ + Ig'λ之和）与总IgG或IgA的散射比浊测量值之间的相关性。对于该相关性分析，对所有114份血清进行了分析。IgA的相关系数为R(2)=0.948，IgG的相关系数为R(2)=0.920。