Polyclonal free light chain of Ig may interfere with interpretation of monoclonal free light chain κ/λ ratio

Annals of Clinical and Laboratory Science

Volumn 40, Issue 4, 2010, Pages 348-353

  Levinson, Stanley S ^a,b  

^a University of Louisville School of Medicine   (United States)

^b VETERANS AFFAIRS MEDICAL CENTER   (United States)

Author keywords

Bence Jones protein; Free light chains; Monoclonal gammopathy; Polyclonal masking

Indexed keywords

BENCE JONES PROTEIN; CREATININE; IMMUNOGLOBULIN KAPPA CHAIN; IMMUNOGLOBULIN LAMBDA CHAIN; PARAPROTEIN;

AGED; ARTICLE; CASE REPORT; CREATININE BLOOD LEVEL; HUMAN; IMMUNOGLOBULIN BLOOD LEVEL; MALE; MULTIPLE MYELOMA; PRIORITY JOURNAL; PROTEIN ELECTROPHORESIS; PROTEIN URINE LEVEL; UREA NITROGEN BLOOD LEVEL; URINE IMMUNOFIXATION ELECTROPHORESIS; WALDENSTROEM MACROGLOBULINEMIA;

AGED; AGED, 80 AND OVER; BENCE JONES PROTEIN; ELECTROPHORESIS; FATAL OUTCOME; HUMANS; IMMUNOGLOBULIN KAPPA-CHAINS; IMMUNOGLOBULIN LAMBDA-CHAINS; MALE; MULTIPLE MYELOMA;

EID: 77958077224     PISSN: 00917370     EISSN: 15508080     Source Type: Journal    
DOI: None     Document Type: Article

References (26)

1. Levinson SS, Keren DF. Free light chains of immunoglobulins: clinical laboratory analysis. Clin Chem 1994; 40:1869-1878.
2. Keren DF, Alexanian R, Goeken JA, Gorevic PD, Kyle RA, Tomar RH. Guidelines for clinical and laboratory evaluation of patients with monoclonal gammopathies. Arch Pathol Lab Med 1999;123:106-107. (Pubitemid 29093593)
3. Dispenzieri A, Kyle R, Merlini G, Miguel JS, Ludwig H, Hajek R, Palumbo A, Jagannath S, Blade J, Lonial S, Dimopoulos M, Comenzo R, Einsele H, Barlogie B, Anderson K, Gertz M, Harousseau JL, Attal M, Tosi P, Sonneveld P, Boccadoro M, Morgan G, Richardson P, Sezer O, Mateos MV, Cavo M, Joshua D, Turesson I, Chen W, Shimizu K, Powles R, Rajkumar SV, Durie BG. International Myeloma Working Group guidelines for serum-free light chain analysis in multiple myeloma and related disorders. Leukemia 2009;23:215-224.
4. Drayson M, Tang LX, Drew R, Mead GP, Carr-Smith H, Bradwell AR. Serum free light-chain measurements for identifying and monitoring patients with nonsecretory multiple myeloma. Blood 2001;97:2900-2902.
5. Katzmann JA, Clark RJ, Abraham RS, Bryant S, Lymp JF, Bradwell AR, Kyle RA.. Serum reference intervals and diagnostic ranges for free kappa and free lambda immunoglobulin light chains: relative sensitivity for detection of monoclonal light chains. Clin Chem 2002; 48:1437-1444.
6. Hill PG, Forsyth JM, Rai B, Mayne S. Serum free light chains: an alternative to the urine Bence Jones proteins screening test for monoclonal gammopathies. Clin Chem 2006;52:1743-1748.
7. Abadie JM, van Hoeven KH, Wells JM. Are renal reference intervals required when screening for plasma cell disorders with serum free light chains and serum protein electrophoresis? Am J Clin Pathol 2009;131:166-171.
8. Piehler AP, Gulbrandsen N, Kierulf P, Urdal P. Quantitation of serum free light chains in combination with protein electrophoresis and clinical information for diagnosing multiple myeloma in a general hospital population. Clin Chem 2008;54:1823-1830.
9. Beetham R, Wassell J, Wallage MJ, Whiteway AJ, James JA. Can serum free light chains replace urine electrophoresis in the detection of monoclonal gammopathies? Ann Clin Biochem 2007;44:516-522.
10. Palladini G, Russo P, Bosoni T, Verga L, Sarais G, Lavatelli F, Nuvolone M, Obici L, Casarini S, Donadei S, Albertini R, Righetti G, Marini M, Graziani MS, Melzi D'Eril GV, Moratti R, Merlini G. Identification of amyloidogenic light chains requires the combination of serum-free light chain assay with immunofixation of serum and urine. Clin Chem 2009;55:499-504.
11. Shaheen SP, Levinson SS. Serum free light chain analysis may miss monoclonal light chains that urine immunofixation electrophoreses would detect. Clin Chim Acta 2009;406:162-166.
12. Tate JR, Gill D, Cobcroft R, Hickman PE. Practical considerations for the measurement of free light chains in serum. Clin Chem 2003;49:1252-1257. (Pubitemid 36900609)
13. Levinson SS. An algorithmic approach using kappa/lambda ratios to improve the diagnostic accuracy of urine protein electrophoresis and to reduce the volume required for immunoelectrophoresis. Clin Chim Acta 1997;262:121-130.
14. Katzmann JA, Dispenzieri A, Kyle RA, Snyder MR, Plevak MF, Larson DR, Abraham RS, Lust JA, Melton LJ 3rd, Rajkumar SV. Elimination of the need for urine studies in the screening algorithm for monoclonal gammopathies by using serum immunofixation and free light chain assays. Mayo Clin Proc 2006;81:1575-1578.
15. Siegel DS, McBride L, Bilotti E, Lendvai N, Gonsky J. Inaccuracies in 24-hour urine testing for monoclonal gammopathies. Serum free light chain analysis provides a more accurate measure of light chain burden than urine protein electrophoresis. Labmedicine 2009; 40:341-344.
16. Katzmann JA, Abraham RS, Dispenzieri A, Lust JA, Kyle RA. Diagnostic performance of quantitative kappa and lambda free light chain assays in clinical practice. Clin Chem 2005;51:878-881.
17. Katzmann JA, Kyle RA, Benson J, Larson DR, Snyder MR, Lust JA, Rajkumar SV, Dispenzieri A. Screening panels for detection of monoclonal gammopathies. Clin Chem 2009;55:1517-1522.
18. Sølling K. Free light chains of immunoglobulins: studies of radioimmunoassay of normal values, polymerism, mechanisms of renal handling and clinical significance. Scan J Clin Lab Invest 1981;41(Suppl 157):15-83.
19. Peterson PA, Berggard I. Urinary immunoglobulin components in normal tubular and glomerular proteinuria: quantities and characteristics of free light chains, IgG, IgA, and Fcg fragment. J Eur Clin Invest 1971; 1:255-264.
20. Keren DF, Warren JS, Lowe JB. Strategy to diagnose monoclonal gammopathies in serum: high-resolution electrophoresis, immunofixation, and kappa/lambda quantification. Clin Chem 1988;34:2196-2201.
21. Whicher JT, Wallage M, Fifield R. Use of immunoglobulin heavy- and light-chain measurements compared with existing techniques as a means of typing monoclonal immunoglobulins. Clin Chem 1987;33:1771-1773.
22. Nowrousian MR, Brandhorst D, Sammet C, Kellert M, Daniels R, Schuett P, Poser M, Mueller S, Ebeling P, Welt A, Bradwell AR, Buttkereit U, Opalka B, Flasshove M, Moritz T, Seeber S. Serum free light chain analysis and urine immunofixation electrophoresis in patients with multiple myeloma. Clin Cancer Res 2005;11:8706-8714.
23. Kyle RA, Remstein ED, Therneau TM, Dispenzieri A, Kurtin PJ, Hodnefield JM, Larson DR, Plevak MF, Jelinek DF, Fonseca R, Melton LJ 3rd, Rajkumar SV. Clinical course and prognosis of smoldering (asymptomatic) multiple myeloma. NEJM 2007;356:2582-2590.
24. Falk RH, Comenzo RL, Skinner M. The systemic amyloidoses. NEJM 1997;337:898-909.
25. Lachmann HJ, Booth DR, Booth SE, Bybee A, Gilbertson JA, Gillmore JD, Pepys MB, Hawkins PN. Misdiagnosis of hereditary amyloidosis as AL (primary) amyloidosis. NEJM 2002;346:1786-1791.
26. Merlini G. Serum-free light chain analysis: works in progress. Clin Chem Lab Med 2009;47:1021-1022.