The utility of MASS-FIX to detect and monitor monoclonal proteins in the clinic
The utility of MASS-FIX to detect and monitor monoclonal proteins in the clinic
复制标题
DOI：
10.1002/ajh.24772
复制
发表时间：
2017-08-01
影响因子：
12.8
通讯作者：
Dispenzieri, Angela
中科院分区：
文献类型：
--
作者：
Milani, Paolo;Murray, David L.;Dispenzieri, Angela
单克隆蛋白（M 蛋白）的检测和定量对于浆细胞恶液质反应的诊断和评估是必要的。免疫球蛋白富集结合基质辅助激光解吸电离飞行时间质谱（MASS-FIX）是一种简单且廉价的鉴定 M 蛋白的方法，但其临床普遍性尚未阐明。我们将 MASS-FIX 与蛋白质电泳 (PEL)、血清/尿液免疫固定电泳 (IFE) 和定量血清游离轻链 (FLC) 进行比较，以鉴定不同临床诊断中的 M 蛋白。对 257 名患者的配对血清和尿液样本进行了测试。有 6 名患者的 s-IFE 和 FLC 比值呈阳性，而血清 MASS-FIX 呈阴性，但当合并血清和尿液 MASS-FIX 结果时，仅遗漏了 1 名轻链-MGUS 患者。血清/尿液-MASS-FIX在18例血清/尿液-PEL/IFE和血清-FLC阴性的患者中检测到M蛋白，其中10例患有多发性骨髓瘤或AL淀粉样变性，血清/尿液-PEL/IFE和血清-FLC被错误地认为具有完全血液学缓解。近一半的 AL 淀粉样变性患者具有非典型谱，这可能被证明是该疾病的诊断和发病机制的线索。总之，MASS-FIX 与 PEL/IFE/FLC 方法具有相当的灵敏度，可以帮助临床诊断。
The detection and quantification of monoclonal-proteins (M-proteins) are necessary for the diagnosis and evaluation of response in plasma cell dyscrasias. Immunoglobulin enrichment-coupled with matrix-assisted laser desorption ionization time-of-flight mass-spectrometry (MASS-FIX) is a simple and inexpensive method to identify M-proteins, but its clinical generalizability has not yet been elucidated. We compared MASS-FIX to protein electrophoresis (PEL), serum/urine immunofixation-electrophoresis (IFE), and quantitative serum free-light chain (FLC) for the identification of M-proteins in different clinical diagnoses. Paired serum and urine samples from 257 patients were tested. There were six patients for whom s-IFE and FLC ratio were positive and serum MASS-FIX was negative, but when serum and urine MASS-FIX results were combined, only one patient with light chain-MGUS was missed. Serum/urine-MASS-FIX detected M-proteins in 18 patients with negative serum/urine-PEL/IFE and serum-FLC, 10 of whom had multiple myeloma or AL amyloidosis, who were mistakenly thought to have complete hematologic response by serum/urine-PEL/IFE and serum-FLC. Nearly half of the AL amyloidosis patients had atypical spectra, which may prove to be a clue to the diagnosis and pathogenesis of the disease. In conclusion, MASS-FIX has a comparable sensitivity with PEL/IFE/FLC methods and can help inform the clinical diagnosis.