The importance of selected laboratory parameters for the diagnostics, stratification and monitoring of AL amyloidosis patients


Authors: T. Pika 1;  P. Lochman 2;  P. Flodr 3;  J. Minařík 1;  P. Látalová 3;  J. Bačovský 1;  V. Ščudla 1
Authors‘ workplace: III. interní klinika – nefrologická, revmatologická, endokrinologická, LF UP a FN Olomouc 1;  Oddělení klinické biochemie, FN Olomouc 2;  Ústav klinické a molekulární patologie, LF UP a FN Olomouc 3
Published in: Klin. Biochem. Metab., 21 (42), 2013, No. 2, p. 79-82

Overview

Objective:
The objective of this report is to point out the clinical importance of select biological indicators applied to diagnostics and monitoring of AL amyloidosis patients. In addition to the usual parameters such as urine analysis or the monoclonal immunoglobulin level assay, the benefits of free light immunoglobulin chains serum level assay and its application to treatment response evaluation are pointed out, as well as the benefits of heart indicator assays (troponins and natriuretic peptides) for the stratification of AL amyloidosis patients. A brief introduction of this rare diagnosis is also included in the report.

Key words:
AL amyloidosis, free light immunoglobulin chains, troponins, natriuretic peptides.


Sources

1. Ščudla, V., Pika, T. Současné možnosti diagnostiky a léčby systémové AL-amyloidózy. Vnitř. Lék., 2009; 55: p. 77-87.

2. Sipe, J. D., Benson, M. D., Buxbaum, J. N. et al. Amy-loid fibril protein nomenclature: 2010 recommendations from the nomenclature committe of International Society of Amyloidosis. Amyloid, 2010, 17: p. 101-104.

3. Bird, J., Cavenagh, J., Hawkins, P. et al. Guidelines on the diagnosis and management of AL amyloidosis. Brit. J. Hematol., 2004, 125, p. 681-700.

4. Gertz, M. A. Immunoglobulin light chain amyloidosis: 2011 update on diagnosis, risk-stratification, and mana-gement. Am. J. Hematol., 2011, 86, p. 181-186.

5. Sanchorawala, V., Blanchard, E., Seldin, D. C., O´Hara, C., Skinner, M., Wright, D. G. AL amyloidosis associated with B-cell lymphoproliferative disorders: frequency and treatment outcomes. Am. J. Hematol., 2006, 81, p. 692-695.

6. Merlini, G., Bellotti, V. Molecular mechanisms of amyloidosis. N. Engl. J. Med., 2003, 349, p. 583-596.

7. Merlini, G., Seldin, D. C., Gertz, M. A. Amyloidosis: pathogenesis and new therapeutic options. J. Clin. Oncol., 2011, 29, s.1924-1933.

8. Gertz, M. A., Lacy, M. Q., Dispenzieri, A. et al. Auto-logous stem cell transplant for immunoglobulin light chain amyloidosis: a status report. Leuk. Lymph., 2010, 51, p. 2181-2187.

9. Dispenzieri, A., Kyle, R. A., Lacy, M. Q. et al. Superior survival in primary systemic amyloidosis patients undergoing peripherial blood stem cell transplantation: a case control study. Blood, 2004, 103, p. 3960-3963.

10. Sanchorawala, V., Skinner, M, Quillen, K., Finn, K. T., Doros, G., Seldin, D. C. Long-term outcome of patients with AL amyloidosis treated with high-dose melphalan and stem-cell transplantation. Blood, 2007, 110, p. 3561-3563.

11. Sanchorawala, V., Wright, D. G., Seldin, D. C. et al. Low-dose continuous oral melphalan for the treatment of primary systemic (AL) amyloidosis. Brit. J. Hematol., 2002, 117, p. 886-889.

12. Palladini, G., Anesi, E., Perfetti, V. et al. A modified high-dose dexamethasone regimen for primary systemic (AL) amyloidosis. Brit. J. Hematol., 2001, 113, p. 1044-1046.

13. Wechalekar, A. D., Hawkins, P. N., Gillmore, J. D. Perspectives in treatment of AL amyloidosis. Brit. J. Hematol., 2007, 140, p. 365-377.

14. Kastritis, E., Anagnostopoulos, A., Roussou, M. et al. Treatment of light chain (AL) amyloidosis with the combination of bortezomib and dexamethasone. Haematologica, 2007, 92, p. 1351-1358.

15. Adam, Z., Pour, L. Krejčí, M. et al. Léčba AL-amyloidózy – výsledky jednoho pracoviště a přehled publikovaných zkušeností s novými léky (bortezomibem, thalidomidem a lenalidomidem) u AL-amyloidózy. Vnitř. Lék., 2010, 56, p. 190-209.

16. Katzmann, J. A., Kyle, R. A., Benson, J. et al. Screening panels for detection of monoclonal gammopathies. Clin. Chem., 2009, 55, p. 1517-22.

17. Abraham, R. S., Katzmann, J. A., Clark, R. J., Bradwell, A. R., Kyle, R. A., Gertz, M. A. Quantitative analysis of serum free light chains. A new marker for the diagnostic evaluation of primary systemic amyloidosis. Am. J. Clin. Pathol., 2003, 119, p. 274-8.

18. Palladini, G., Russo, P., Bosoni, T. et al. Identification of amyloidogenic light chains requires the combination of serum-free light chain assay with immunofixation of serum and urine. Clin. Chem., 2009, 55, p. 499-504.

19. Akar, H., Seldin, D. C., Magnani, B. et al. Quantitative serum free light chain assay in the diagnostic evaluation of AL amyloidosis. Amyloid, 2005, 12, p. 210-215.

20. Dispenzieri, A., Kyle, R. A, Merlini, G. et al. International Myeloma Working Group guidelines for serum-free light chain analysis in multiple myeloma and related disorders. Leukemia, 2009, 23, p. 215-224.

21. Gertz, M. A., Comenzo, R., Falk, R. H. et al. Definition of organ involvement and treatment response in immunoglobulin light chain amyloidosis (AL): a consensus opinion from the 10th International Symposium on Amyloid and Amyloidosis. Am. J. Hematol., 2005, 79, p. 319-328.

22. Gertz, M. A., Merlini, G. Definition of organ inolvement and response to treatment in AL amyloidosis: an upda-ted consensus opinion. Amyloid, 2010, 17, p. 48-49.

23. Kumar, S., Dispenzieri, A., Lacy, M. Q. et al. Chan-ges in serum-free light chain rather than intact monoclonal immunoglobulin levels predicts outcome following therapy in primary amyloidosis. Am. J. Hematol., 2011, 86, p. 251-255.

24. Dispenzieri, A., Lacy, M. Q., Katzmann, J. A. et al. Absolute values of immunoglobulin free light chains are prognostic in patients with primary systemic amyloidosis undergoing peripherial blood stem cell transplantation. Blood, 2006, 107, p. 3378-3383.

25. Kumar, S. K., Dispenzieri, A., Katzmann, J. A. et al. Serum immunoglobulin free light-chain measurement in primary amyloidosis: prognostic value and correlations with clinical features. Blood, 2010, 116, p. 5126-5129.

26. Dispenzieri, A., Kyle, R. A., Gertz, M. A. et al. Survival in patients with primary systemic amyloidosis and raised serum cardiac troponins. Lancet, 2003, 361, p. 1787-1789.

27. Kristen, A. V., Giannitsis, E., Lehrke, S. et al. Assessment of disease severity and outcome in patients with systemic light-chain amyloidosis by the high-sensitivity troponin T assay. Blood, 2010, 116, p. 2455-2461.

28. Palladini, G., Barassi, A., Klersy, C. et al. The combination of high-sensitivity cardiac trponin T (hs-cTnT) at presentation and changes in N-terminal natriuretic peptide type B (NT-proBNP) after chemotherapy best predicts survival in AL amyloidosis. Blood, 2010, 116, p. 3426-3430.

29. Dispenzieri, A., Gertz, M. A., Kyle, R. A. et al. Serum cardiac troponins and N-terminal pro-brain natriuretic peptide: a staging system for primary systemic amyloidosis. J. Clin. Oncol., 2004, 22, p. 3751-3757.

30. Dispenzieri, A., Gertz, M. A., Kyle, R. A. et al. Prognostication of survival using cardiac troponins and N-terminal pro-brain natriuretic peptide in patients with primary systemic amyloidosis undergoing peripherial blood stem cell transplantation. Blood, 2004, 104, p. 1881-1887.

31. Kumar, S., Dispenzieri, A., Lacy, M. Q. et al. Revised prognostic staging system for light chain amyloidosis incorporating cardiac biomarkers and serum free light chain measurements. J. Clin. Oncol., 2012, 30, p. 989-995.

32. Weber, M., Hamm, C. Role of B-type natriuretic peptide (BNP) and NT-proBNP in clinical routine. Heart, 2006, 92, p. 843-849.

33. Palladini, G., Campana, C., Klersy, C. et al. Serum N-terminal Pro-brain natriuretic peptide is a sensitive marker of myocardial dysfunction in AL amyloidosis. Circulation, 2003, 107, p. 2440-2445.

34. Dispenzieri, A., Dingli, D., Kumar, S. K. et al. Discordance between serum cardiac biomarker and immunoglobulin-free light-cahin response in patients with immunoglobulin light-chain amyloidosis treated with immune modulatory drugs. Am. J. Hematol., 2010, 85, p. 757-759.

35. Tapan, U., Seldin, D. C., Finn, K. T. et al. Increases in B-type natriuretic peptide (BNP) during treatment with lenalidomide in AL amyloidosis. Blood, 2010, 116, p. 5071-5072.

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