Challenges With Serum Protein Electrophoresis in Assessing Progression and Clinical Response in Patients With Waldenström Macroglobulinemia |
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| Authors: | Sacha N Uljon Steven P Treon Christina K Tripsas Neal I Lindeman |
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| Institution: | 1. Department of Clinical Chemistry, Ghent University Hospital, Gent, Belgium;2. Department of Nephrology, Ghent University Hospital, Gent, Belgium;3. Department of Pediatric Nephrology, Ghent University Hospital, Gent, Belgium;1. Biology Department, Hôpital d''Instruction des Armées Percy, Percy Military Hospital, 101 Avenue Henri Barbusse, 92140 Clamart, France;2. Medicine Department, Hôpital d''Instruction des Armées Begin, Begin Military Hospital, 69 Avenue de Paris, 94160 Saint Mande, France;3. Ecole du Val-de-Grâce, 1 Place Alphonse Laveran, 72005 Paris, France |
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| Abstract: | Accurate determination of the immunoglobulin (Ig) M paraprotein concentration is crucial to evaluating response in patients with Waldenström macroglobulinemia (WM). In most clinical laboratories, M-spike quantitation is performed by serum protein electrophoresis, which is the same method used to quantitate IgG and IgA paraproteins in patients with multiple myeloma (MM). However, the migration pattern and propensity of IgM paraproteins to form higher-order complexes in serum makes laboratory evaluation of samples from patients with WM especially challenging. We review examples of patients whose IgM paraprotein is particularly ill-suited to M-spike quantitation by serum protein electrophoresis: a case of “sticky M,” a case of IgM multimers that cannot be resolved, and a case of an IgM in the β region. In these and similar cases, a method other than M-spike quantitation, such as IgM heavy chain nephelometry, should be considered in laboratory evaluation of paraprotein concentration. |
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