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单克隆抗体治疗多发性骨髓瘤及外周血中M峰假阳性的困境

Treatment of multiple myeloma with monoclonal antibodies and the dilemma of false positive M-spikes in peripheral blood.

作者信息

Murata Kazunori, McCash Samuel I, Carroll Brittany, Lesokhin Alexander M, Hassoun Hani, Lendvai Nikoletta, Korde Neha S, Mailankody Sham, Landau Heather J, Koehne Guenther, Chung David J, Giralt Sergio A, Ramanathan Lakshmi V, Landgren Ola

机构信息

Clinical Chemistry Service, Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10065, United States.

Clinical Chemistry Service, Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10065, United States.

出版信息

Clin Biochem. 2018 Jan;51:66-71. doi: 10.1016/j.clinbiochem.2016.09.015. Epub 2016 Sep 21.


DOI:10.1016/j.clinbiochem.2016.09.015
PMID:27664535
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5360528/
Abstract

OBJECTIVES: To characterize the effect of three humanized IgG κ monoclonal antibodies (daratumumab, isatuximab, and elotuzumab) on the interpretation of results generated by protein electrophoresis, immunofixation, free light chain, and heavy/light chain assays performed on human serum. METHODS: Healthy volunteer serum and serum from multiple myeloma patients were supplemented with clinically relevant concentrations of each of the three monoclonal antibodies. These specimens then underwent analysis via serum protein electrophoresis, immunofixation, serum free light chain quantification, heavy/light chain quantification, total IgG, and total protein. In addition, serum specimens from patients who had undergone treatment with elotuzumab for multiple myeloma underwent similar analysis. RESULTS: Addition of the study drugs to serum from both the healthy donor as well as multiple myeloma patients resulted in a visible and quantifiable M-protein on SPEP and a visible IgGκ band by IFE. Increases were also noted in total IgG, IgGκ, and IgGκ/IgGλ-ratios. Analysis of serum from multiple myeloma patients receiving study drug showed similar findings with an additional IgGκ band and quantifiable M-protein with similar migration patterns in specimens drawn after administration. CONCLUSION: The treatment of multiple myeloma patients with monoclonal antibodies results in a visible and quantifiable M-protein that has the potential to falsely indicate poor response to therapy.

摘要

目的:表征三种人源化IgGκ单克隆抗体(达雷妥尤单抗、isatuximab和埃罗妥珠单抗)对人血清蛋白电泳、免疫固定、游离轻链以及重/轻链检测结果解读的影响。 方法:向健康志愿者血清和多发性骨髓瘤患者血清中添加临床相关浓度的三种单克隆抗体中的每一种。然后对这些标本进行血清蛋白电泳、免疫固定、血清游离轻链定量、重/轻链定量、总IgG和总蛋白分析。此外,对接受埃罗妥珠单抗治疗多发性骨髓瘤的患者的血清标本进行类似分析。 结果:向健康供体血清以及多发性骨髓瘤患者血清中添加研究药物后,在血清蛋白电泳上出现了可见且可定量的M蛋白,免疫固定电泳显示出可见的IgGκ条带。总IgG、IgGκ和IgGκ/IgGλ比值也有所增加。对接受研究药物治疗的多发性骨髓瘤患者血清的分析显示出类似结果,给药后采集的标本中出现额外的IgGκ条带和具有相似迁移模式的可定量M蛋白。 结论:用单克隆抗体治疗多发性骨髓瘤患者会导致出现可见且可定量的M蛋白,这有可能错误地表明对治疗反应不佳。

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Treatment of multiple myeloma with monoclonal antibodies and the dilemma of false positive M-spikes in peripheral blood.

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[7]
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[9]
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[10]
[Application of Hydrashift 2/4 daratumumab assay in eliminating interference of daratumumab on serum immunofixation electrophoresis].

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本文引用的文献

[1]
Monoclonal antibody therapeutics as potential interferences on protein electrophoresis and immunofixation.

Clin Chem Lab Med. 2016-6-1

[2]
Interference of daratumumab in monitoring multiple myeloma patients using serum immunofixation electrophoresis can be abrogated using the daratumumab IFE reflex assay (DIRA).

Clin Chem Lab Med. 2016-6-1

[3]
Clarification of the definition of complete response in multiple myeloma.

Leukemia. 2015-12

[4]
Targeting CD38 with Daratumumab Monotherapy in Multiple Myeloma.

N Engl J Med. 2015-8-26

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Upregulation of CD38 expression on multiple myeloma cells by all-trans retinoic acid improves the efficacy of daratumumab.

Leukemia. 2015-5-15

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Detecting monoclonal immunoglobulins in human serum using mass spectrometry.

Methods. 2015-6-15

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SAR650984, a novel humanized CD38-targeting antibody, demonstrates potent antitumor activity in models of multiple myeloma and other CD38+ hematologic malignancies.

Clin Cancer Res. 2014-7-1

[8]
Interference of therapeutic monoclonal immunoglobulins in the investigation of M-proteins.

Clin Chem Lab Med. 2014-11

[9]
Monitoring M-proteins in patients with multiple myeloma using heavy-chain variable region clonotypic peptides and LC-MS/MS.

J Proteome Res. 2014-4-4

[10]
Using mass spectrometry to monitor monoclonal immunoglobulins in patients with a monoclonal gammopathy.

J Proteome Res. 2014-2-11

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