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The assessment of heavy/light chain pairs of immunoglobulin in patients with newly diagnosed Waldenström´s macroglobulinemia


Authors: T. Pika 1;  P. Lochman 2;  P. Kušnierová 3;  Z. Heřmanová 4;  J. Zapletalová 5;  P. Puščiznová 1;  J. Minařík 1;  V. Ščudla 1
Authors‘ workplace: Hemato-onkologická klinika, LF UP a FN Olomouc 1;  Oddělení klinické biochemie, FN Olomouc 2;  Oddělení klinické biochemie, Ústav laboratorní diagnostiky, FN Ostrava 3;  Ústav imunologie, LF UP a FN Olomouc 4;  Ústav lékařské biofyziky a statistiky, LF UP Olomouc 5
Published in: Klin. Biochem. Metab., 23 (44), 2015, No. 2, p. 42-47

Overview

Introduction:
Waldenström´s macroglobulinemia (WM) is a rare malignant B-lymphoproliferative disorder, characterized by bone marrow infiltration by tumor cells of lymphoplasmocytic lymphoma (LPL) with production of IgM monoclonal immunoglobulin (MIg). The newest test for MIg is the HevyLite system, based on the assessment using the pair of specific antibodies against junction epitopes between the domains of heavy and light chain (HLC) of the constant region of immunoglobulin chains.

Aim:
The aim of our paper was the comparison of detection methods for serum levels of MIg of IgM isotype in patients with newly diagnosed WM using conventional electrophoresis and with the use of the levels of heavy/light chain pairs of the immunoglobulin.

Patients and methods:
Our cohort consisted of 15 sera of WM patients with IgM kappa isotype. The samples were assessed using conventional gel and capillary electrophoresis. The assessment of MIg using gel electrophoresis was carried out using Sebia Hydrasys system, for capillary electrophoresis we used Sebia MiniCap system. For turbidimetry analysis of HLC pairs we used HevyLite Human Ig sets, IgM kappa kit for the use on the SPAplus with the use of turbidimetry SPAplus. For nephelometric analysis of HLC pairs we used nephelometer BN II and HevyLite IgMκ.

Results:
Within the comparison of the levels of MIg using gel (5 – 60 g/l) and capillary (7.5 – 62.5 g/l) electrophoresis we found strong correllation (r = 0.937, p < 0.0001) with median difference 13 %. Median total serum protein concentration was 95.3 g/l (73.4 – 131.6 g/l). Comparison of MIg detected using gel electrophoresis and IgMκ levels detected using SPAplus system (9-155 g/l) and BN II (9.3 – 262 g/l) we found positive correlations (r = 0.928, p < 0.0001), and (r = 0.803; p < 0.001) but with median difference 144 % and 156 % (ICC 0.213). Within the comparison of MIg levels defined by capillary electrophoresis and IgMκ detected by SPAplus system (9 – 155 g/l) and BN II (9.3 – 262 g/l) we found positive correlations (r = 0.959, p < 0.0001) and (r = 0.830; p < 0.001) with median difference 144 % and 133 % (ICC 0.225). The difference rate was increasing with MIg concentration.

Conclusions:
The results of our analysis confirm that the assessment of high IgM concentrations using HLC pairs is accompanied with significant overestimation of the values. Despite relatively strong correlations between conventional electrophoretic methods and HLC assessment, the results exceed not only MIg levels but even total protein levels. The assessment of HLC at this time cannot be reliably used for the diagnostics and monitoring of patients with active WM and high levels of MIg.

Keywords:
Waldenström`s macroglobulinemia, monoclonal immunoglobulin, electrophoresis, heavy/light chain immuno-globulin pairs.


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