Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Clin Chem. 2020 Mar 1;66(3):421-433. doi: 10.1093/clinchem/hvz041.
Monoclonal gammopathies (MGs) are plasma cell disorders defined by the clonal expansion of plasma cells, resulting in the characteristic excretion of a monoclonal immunoglobulin (M-protein). M-protein detection and quantification are integral parts of the diagnosis and monitoring of MGs. Novel treatment modalities impose new challenges on the traditional electrophoretic and immunochemical methods that are routinely used for M-protein diagnostics, such as interferences from therapeutic monoclonal antibodies and the need for increased analytical sensitivity to measure minimal residual disease.
Mass spectrometry (MS) is ideally suited to accurate mass measurements or targeted measurement of unique clonotypic peptide fragments. Based on these features, MS-based methods allow for the analytically sensitive measurement of the patient-specific M-protein.
This review provides a comprehensive overview of the MS methods that have been developed recently to detect, characterize, and quantify M-proteins. The advantages and disadvantages of using these techniques in clinical practice and the impact they will have on the management of patients with MGs are discussed.
单克隆丙种球蛋白病（MGs）是浆细胞疾病，其特征是浆细胞克隆性扩张，导致单克隆免疫球蛋白（M 蛋白）的特征性排泄。M 蛋白的检测和定量是 MGs 诊断和监测的重要组成部分。新型治疗方法对传统的电泳和免疫化学方法提出了新的挑战，这些方法通常用于 M 蛋白诊断，例如治疗性单克隆抗体的干扰和需要提高分析灵敏度以测量微小残留病。
质谱（MS）非常适合于精确质量测量或针对独特的克隆型肽片段的靶向测量。基于这些特征，基于 MS 的方法允许对患者特异性 M 蛋白进行分析敏感的测量。
本文综述了最近开发的用于检测、表征和定量 M 蛋白的 MS 方法。讨论了在临床实践中使用这些技术的优缺点，以及它们对 MGs 患者管理的影响。
