Abstract
Plasma cell disorders (PCDs) are identified in the clinical lab by detecting the monoclonal immunoglobulin (M-protein) which they produce. Traditionally, serum protein electrophoresis methods have been utilized to detect and isotype M-proteins. Increasing demands to detect low-level disease and new therapeutic monoclonal immunoglobulin treatments have stretched the electrophoretic methods to their analytical limits. Newer techniques based on mass spectrometry (MS) are emerging which have improved clinical and analytical performance. MS is gaining traction into clinical laboratories, and has replaced immunofixation electrophoresis (IFE) in routine practice at one institution. The International Myeloma Working Group (IMWG) Mass Spectrometry Committee reviewed the literature in order to summarize current data and to make recommendations regarding the role of mass spectrometric methods in diagnosing and monitoring patients with myeloma and related disorders. Current literature demonstrates that immune-enrichment of immunoglobulins coupled to intact light chain MALDI-TOF MS has clinical characteristics equivalent in performance to IFE with added benefits of detecting additional risk factors for PCDs, differentiating M-protein from therapeutic antibodies, and is a suitable replacement for IFE for diagnosing and monitoring multiple myeloma and related PCDs. In this paper we discuss the IMWG recommendations for the use of MS in PCDs.
Highlights
Plasma cell disorders (PCDs) are a group of diseases characterized by clonal expansion of plasma cells[1]
Since the initial screen was performed by Serum protein electrophoresis (SPEP), the study assessed the ability of immunofixation electrophoresis (IFE), the intact light chains (LCs) MALDI-TOF method (Mass-Fix), as well as a more sensitive miRAMM method to detect the M-protein in the original sample
We recognize that using mass spectrometric methods in lieu of conventional IFE may lead to lower rates of complete response (CR), and cross-comparisons of CR rates in trials done in different time periods is not recommended
Summary
Plasma cell disorders (PCDs) are a group of diseases characterized by clonal expansion of plasma cells[1]. While most studies utilizing the clonotypic method detect the presence of the M-protein in samples from patients who are BM MRD-negative, the clinical implications of this will require more time to elucidate.
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