一种用于区分多发性骨髓瘤患者免疫固定电泳中残留依鲁替尼与单克隆副蛋白的简单方法。

A simple method to distinguish residual elotuzumab from monoclonal paraprotein in immunofixation assays for multiple myeloma patients.

机构信息

Department of Immunology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.

Department of Hematology, Chugoku Central Hospital, Fukuyama, Japan.

出版信息

Int J Hematol. 2021 Apr;113(4):473-479. doi: 10.1007/s12185-021-03088-9. Epub 2021 Jan 28.

Abstract

Negative immunofixation electrophoresis (IFE) of serum and/or urine is a diagnostic marker for determining a complete response (CR) after immunotherapy for multiple myeloma (MM). However, residual therapeutic antibodies such as elotuzumab (IgG-κ), can compromise IFE evaluation when the affected immunoglobulins belong to the same IgG-κ subclass. We thus sought to develop a simple and rapid method to treat patient serum before IFE to distinguish the residual elotuzumab. Serum samples from patients receiving elotuzumab were treated with a predetermined amount of soluble signaling lymphocyte activation molecule F7 (SLAMF7) protein and then subjected to conventional IFE testing. We tested our method in samples from 12 patients. The IgG-κ band in IFE disappeared or shifted after elotuzumab treatment in four patients with no bone marrow minimal residual disease and normalized free light chain, whereas seven patients with any sign of residual MM showed a remaining IgG-κ band after treatment. One-hour incubation of samples with 6-9 molar excess soluble SLAMF7 before IFE was sufficient to distinguish residual elotuzumab in 11 of 12 samples. This simple method does not require special reagents, can be performed in most clinical laboratories, and enables differentiation between patients with a CR and those requiring further treatment.

摘要

血清和/或尿液的阴性免疫固定电泳(IFE)是确定多发性骨髓瘤(MM)免疫治疗后完全缓解(CR)的诊断标志物。然而,当受影响的免疫球蛋白属于同一 IgG-κ 亚类时,残留的治疗性抗体(如埃罗妥珠单抗[IgG-κ])会影响 IFE 评估。因此,我们试图开发一种简单快速的方法,在进行 IFE 之前处理患者的血清,以区分残留的埃罗妥珠单抗。用预定量的可溶性信号淋巴细胞激活分子 F7(SLAMF7)蛋白处理接受埃罗妥珠单抗治疗的患者的血清样本,然后进行常规 IFE 检测。我们在 12 名患者的样本中测试了我们的方法。在无骨髓微小残留病且游离轻链正常的 4 名患者中,IFE 中的 IgG-κ 带在埃罗妥珠单抗治疗后消失或转移,而 7 名有任何残留 MM 迹象的患者在治疗后仍显示 IgG-κ 带。在进行 IFE 之前,将样本用 6-9 摩尔过量的可溶性 SLAMF7 孵育 1 小时,足以区分 12 个样本中的 11 个残留的埃罗妥珠单抗。这种简单的方法不需要特殊试剂,可以在大多数临床实验室进行,并能够区分 CR 患者和需要进一步治疗的患者。

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