Laboratory Characterizations on 2007 Cases of Monoclonal Gammopathies in East China

Wang, Hao; Gao, Chunfang; Xu, Lei; Yang, Zaixing; Zhao, Wei; Xiantao, Kong

doi:10.1038/cmi.2008.36

Cited by 15 publications

(22 citation statements)

References 28 publications

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“…Thus, in high concentration, slow ␥-migrating IgG monoclonal proteins decrease the anion gap. Similarly, approximately one-half of IgA paraproteins are anionic and migrate to the alpha or beta regions (16). Our observation of an abnormal gap in one-quarter of IgG gammopathies and one-third of IgA gammopathies is consistent with the migratory pattern of monoclonal proteins.…”

Section: Discussionsupporting

confidence: 82%

“…Most IgG monoclonal proteins are cationic, migrating to the gamma region of the electrophoretic gel (Figure 4). The gamma region is classically divided into slow (highly cationic), medium, and fast domains (16). Approximately one-third of IgG monoclonal proteins migrate to the slow gamma region (16).…”

Section: Discussionmentioning

confidence: 99%

“…The gamma region is classically divided into slow (highly cationic), medium, and fast domains (16). Approximately one-third of IgG monoclonal proteins migrate to the slow gamma region (16). Thus, in high concentration, slow ␥-migrating IgG monoclonal proteins decrease the anion gap.…”

Section: Discussionmentioning

confidence: 99%

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The Anion Gap and Routine Serum Protein Measurements in Monoclonal Gammopathies

Hoeven¹,

Joseph²,

Gaughan³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives An abnormal anion gap and an increased total protein and globulin are clues to the diagnosis of monoclonal gammopathy. We explored the utility of these markers in IgG, IgA, IgM, and free light chain monoclonal gammopathies.Design, Setting, Participants, & Measurements The anion gap, Na ϩ -(Cl -ϩ HCO 3 -), corrected for hypoalbuminemia, was calculated in patients with monoclonal gammopathies. Exclusion criteria were serum calcium Ͼ10.5 mg/dl and/or creatinine Ͼ2 mg/dl.Results Among 287 patients, 242 remained after applying exclusion criteria (109 IgG, 64 IgA, 21 IgM, and 48 light chain); 36% of 242 patients required correction for hypoalbuminemia. The anion gap was decreased (Ͻ10) in 22% of IgG and increased (Ͼ15) in 31% of IgA monoclonal gammopathies. IgM did not affect the gap. In light chain gammopathies, the anion gap showed no consistent trend (15% increased, 17% decreased). Mean clonal IgG, IgA, and IgM concentrations were 10-fold higher than mean clonal free light chain concentrations in the respective monoclonal gammopathies (P Ͻ 0.001). These paraprotein level disparities were reflected in significantly increased mean serum total protein and globulin concentrations in IgG, IgA, and IgM versus free light chain monoclonal gammopathies, where mean total protein and globulin levels were within normal limits (P Ͻ 0.001). ConclusionsThe anion gap was significantly altered in IgG and IgA monoclonal gammopathies, but it was not a sensitive tool for suspecting the diagnosis. In light chain monoclonal gammopathies, the anion gap, total protein, and globulin did not provide reliable diagnostic clues.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

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The Anion Gap and Routine Serum Protein Measurements in Monoclonal Gammopathies

Hoeven¹,

Joseph²,

Gaughan³

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…In case of high MIg, serum levels of polyclonal IgG are low as FcRn receptors are fully saturated; this phenomenon, however, is also contributed to by suppression of normal plasma cells leading to reduced production of normal IgG Ig (ref. 32 ). Given the fact that both the polyclonal and monoclonal fractions of IgG are similarly affected, the HLC-r values are not substantially influenced by these changes and express the degree of tumor production more accurately than MIg concentrations measured with SPE (ref.…”

Section: Discussionmentioning

confidence: 99%

Relationship of differences in immunoglobulin heavy/light chain pairs (Hevylite<sup>TM</sup>), selected laboratory parameters and stratification systems in different immunochemical types of multiple myeloma

Scudla¹,

Lochman²,

Pika³

et al. 2016

BIOMED PAP

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Background and Aims. Advances in the diagnosis and treatment of multiple myeloma (MM), place increasing demands on accurate stratification of patients as the starting point for optimal individualized therapy. The present study focused on assessing the association between HLC levels and the HLC-r to parameters of MM activity, prognosis and tumor mass volume.The objective was to assess the correlation of immunoglobulin (Ig), heavy/light chain (HLC) pairs (IgG-κ and-λ, IgA-κ and -λ HLC) and the ratio of monoclonal involved-HLC (i-HLC) to polyclonal uninvolved (u-HLC) Ig concentrations assessed by the Hevylite TM method with the free light chain κ/λ ratio (FLC-r), selected prognostic laboratory parameters i.e. Hb, platelets, albumin, β 2 -microglobulin (β 2 -M), Ca, lactate dehydrogenase (LDH), creatinine and the Durie-Salmon (D-S) and International Staging System (ISS), stages (1-3) for MM. Methods. Hevylite TM assays were done on the sera of 132 MM patients at the time of diagnosis (IgG 94, IgA 38). HLC-r was calculated in the case of i-HLC-κ from the i-HLC-κ/u-HLC-λ ratio and for i-HLC-λ from the i-HLC-λ/u-HLC-κ ratio. D-S and ISS stages were evenly distributed. Results. Md IgG-κ HLC-r was 64.8 (2.7-2222) and of IgG-λ HLC-r 49.6 (0.7-465.1), in the case of IgA-κ, Md HLC-r was 408.9 (3.4-3966) and for IgA-λ HLC-r the Md was 180.0 (0.1-3110). Normal levels of HLC pairs and HLC-r did not always rule out the diagnosis of MM. HLC-r correlated with FLC-r in IgG (r = 0.244, P = 0.018), but not in the IgA type. For IgG, HLC-r values were significantly different in patients with abnormal vs normal levels of Hb (P < 0.0001), albumin (P < 0.043), β 2 -M (P < 0.0001) and creatinine (P = 0.034) but not thrombocyte count, Ca or LDH. For the IgA isotype, we found a significant difference in HLC-r values only for thrombocyte count (P = 0.026) and β 2 -M (P = 0.016) but not for Hb, albumin, Ca, LDH or creatinine. For the IgG isotype there was a significant relationship of HLC-r index to stages 1-3 (P = 0.038) and substage A vs B (P = 0.048) according to D-S, and with high significance to stages 1-3 according to ISS (P = 0.005) and between stages 1 vs 3 (P = 0.001). For the IgA isotype, we found significant differences in HLC-r only between stages 1-3 (P = 0.025) according to D-S but not in the case of ISS. There were no significant correlations between i-HLC Ig levels and D-S or ISS stages in both IgG-κ and λ and IgA-κ and λ. Exceptions were significant differences for stages 1 vs 3 (P = 0.012) and 2 vs 3 (P = 0.017) for the IgG-λ isotype. There were no correlations of the HLC-r and u-HLC levels for either D-S or ISS stratifications in all HLC isotypes. Conclusion. We found a significant positive contribution of HLC-r using the i-HLC/u-HLC ratio even in the case of i-HLC-λ i.e. i-HLC-λ/u-HLC-κ. Variable results for the relationship of important laboratory parameters and D-S and ISS stratifications (stage 1-3) to HLC-r values in IgG and IgA isotypes make separate interpretation of the Hevylite TM method results necessary in clinic...

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“…Among the last group, 80% were IgA patients and 20% IgG patients, confirming that monoclonal IgA immunoglobulins frequently migrate in b region. 4,12,13 In contrast, HLC quantification was obtained for all patients and HLCr calculated. respond to treatments and only the IgAk/IgA ratio highlighted the suspect of therapy resistance (IgAk/ IgA ratio 2.38 (T55), 2.04 (T96)).…”

Section: Comparison Between Spe and Hlcmentioning

confidence: 99%

Comparison of Hevylite™ IgA and IgG assay with conventional techniques for the diagnosis and follow-up of plasma cell dyscrasia

et al. 2014

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Background: Heavy/light chain assay allows the characterization and quantification of immunoglobulin light chains bound to heavy chains for each Ig'k and Ig' immunoglobulin class, discriminating between the involved/uninvolved isotypes in plasma cell dyscrasia. The Ig'k/Ig' ratio (heavy/light chain ratio) enables to monitor the trend of monoclonal component during therapy and disease evolution. Objective: In this study, we evaluate the impact of the heavy/light chain assay in monitoring multiple myeloma patients in comparison with conventional techniques. Methods: Serum samples of 28 patients with IgG or IgA monoclonal component were collected for a mean of 109 days and analyzed. The heavy/light chain assay was compared with classical immunoglobulin quantification (Ig'Tot), serum immunofixation electrophoresis, serum protein electrophoresis, and serum-free light chains quantification. Serum samples from 30 healthy patients were used as control (polyclonal). Results: Heavy/light chain ratio and serum immunofixation electrophoresis were comparable in 86% of the cases, and free light chain ratio and heavy/light chain ratio in 71.8%. Heavy/light chain assay and Ig'Tot measurements showed a concentration-dependent agreement in monoclonal patients. The heavy/light chain assay was able to quantify the monoclonal component migrating in SPE b region: this occurred in 10% of our IgG and 50% of our IgA patients. Conclusions: The concordance scores indicate that heavy/light chain and Ig'Tot assays show differences at high monoclonal component values. The heavy/light chain ratio, serum immunofixation electrophoresis, and free light chain ratio showed partial concordance. Our study confirmed that, in the context of heavy/light chain assay, heavy/light chain Ig'k and Ig' absolute values and heavy/light chain ratio are both important tools to monitor the presence of monoclonal component that are difficult to be identified in SPE.

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Laboratory Characterizations on 2007 Cases of Monoclonal Gammopathies in East China

Cited by 15 publications

References 28 publications

The Anion Gap and Routine Serum Protein Measurements in Monoclonal Gammopathies

The Anion Gap and Routine Serum Protein Measurements in Monoclonal Gammopathies

Relationship of differences in immunoglobulin heavy/light chain pairs (Hevylite<sup>TM</sup>), selected laboratory parameters and stratification systems in different immunochemical types of multiple myeloma

Comparison of Hevylite™ IgA and IgG assay with conventional techniques for the diagnosis and follow-up of plasma cell dyscrasia

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