>Revista de Hematología
>Year 2016, Issue 2
Pizarro R, Samanez C, Cartolin M, Delgado F
Impact of serum free light chain measurements in diagnosis of monoclonal gammopathies, experience in Peru
Rev Hematol Mex 2016; 17 (2)
PDF: 345.68 Kb.
Background: Monoclonal free light chains (FLCs) are important
disease biomarkers in patients with plasma cell-proliferative disorders.
The increasing scientific evidence that supports clonal diversity and
evolution in multiple myeloma highlights the importance of using appropriate
laboratory algorithms that could be able to measure intact
immunoglobulins or monoclonal free light chains, both at diagnosis
and during the follow up of the response to treatment. Particularly
in this area, a focus has been set on the utility of serum FLC (sFLC)
assays to replace urine electrophoresis for monoclonal FLC measurement.
Due to the limited sensitivity and practical disadvantages of
urine analysis, the serum-based algorithm of SPE and sFLC has been
adopted by many laboratories around the world as a first line screen
in patients with suspected monoclonal gammopathies. The advantages
are many and the clinical validation has shown to add value to this
scheme that has an increasing acceptance in daily laboratory routine
worldwide. In this study we evaluate a local population of patients
from our institution with plasma cell dyscrasia and we compare different
screening algorithms with the aim to simplify and improve the
sensitivity of our initial diagnosis scheme for these pathologies, mainly
for multiple myeloma patients.
Objetive: To assess the impact of diagnostic sensitivity of the incorporation
of serum free light chain to the original algorithm used
in our patients with proliferative disorders of cells B in our institution.
Material and Method: A prospective study was done including
102 patients with diagnosis of monoclonal gammopathy, confirmed
by bone marrow biopsy. This cohort was conformed by 92 patients
from National Institute of Neoplastic Diseases, Lima, Peru, diagnosed
with multiple myeloma, 54 (59%) had IgG production, 23 patients
(25%) IgA production and two patients (2%) IgD production as main
Results: Out of 92 patients diagnosed with multiple myeloma, 12
patients (13% of the total) had exclusive production of light chain
(light chains multiple myeloma; six patients κ y six patients λ) and a
patient was found with undetectable production of monoclonal protein,
so, he was classified a priori as non secretor multipel myeloma,
1%, added then to the group of light chains multiple myeloma due to
his protein production; 14% of the total of patients. Electrophoresis
of urine proteins and immunofixation were very unefficient, because
only evidenced correct results in 39 (42%) patients of the 92 analyzed.
Conclusion: the incorporation of immunoassay of serum light
chains to the diagnostic algorithm of the institution allowed to detect
two aditional patients, comparing the results with electrophoresis of
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>Revista de Hematología
>Year 2016, Issue 2