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Chapter 11 : Strategy for Detecting and Following Monoclonal Gammopathies

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Abstract:

The preceding chapters in this section have dealt with several aspects of serum and urine protein analysis for immunoglobulins. Overwhelmingly, the single most important reason for performing these studies is to detect monoclonal gammopathies. This chapter briefly summarizes the various plasma cell proliferative diseases and then describes the use of the electrophoretic and nephelometric assays for the diagnosis, prognosis, and monitoring of monoclonal gammopathies. There are some general strategies for all laboratories as well as specific tests that are needed, depending on the disease presentation.

Citation: Katzmann J, Keren D. 2016. Strategy for Detecting and Following Monoclonal Gammopathies, p 112-124. In Detrick B, Schmitz J, Hamilton R (ed), Manual of Molecular and Clinical Laboratory Immunology, Eighth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818722.ch11
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Figures

Image of FIGURE 1
FIGURE 1

Normal serum protein electrophoresis (PEL) and immunofixation electrophoresis (IFE). The gel scan (electropherogram) is aligned above the PEL gel. Alb, albumin; ELP, electropherogram.

Citation: Katzmann J, Keren D. 2016. Strategy for Detecting and Following Monoclonal Gammopathies, p 112-124. In Detrick B, Schmitz J, Hamilton R (ed), Manual of Molecular and Clinical Laboratory Immunology, Eighth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818722.ch11
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Image of FIGURE 2
FIGURE 2

Monoclonal gammopathy serum protein electrophoresis (PEL) and immunofixation electrophoresis (IFE). The gel scan (electropherogram) is aligned above the PEL gel. The dashed lines on both sides of the M protein indicate the M-spike fraction.

Citation: Katzmann J, Keren D. 2016. Strategy for Detecting and Following Monoclonal Gammopathies, p 112-124. In Detrick B, Schmitz J, Hamilton R (ed), Manual of Molecular and Clinical Laboratory Immunology, Eighth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818722.ch11
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Image of FIGURE 3
FIGURE 3

Light-chain multiple myeloma serum (left) and urine (right) tested by PEL and IFE.

Citation: Katzmann J, Keren D. 2016. Strategy for Detecting and Following Monoclonal Gammopathies, p 112-124. In Detrick B, Schmitz J, Hamilton R (ed), Manual of Molecular and Clinical Laboratory Immunology, Eighth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818722.ch11
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Image of FIGURE 4
FIGURE 4

Primary amyloid tested by serum (left) and urine (right) PEL and IFE.

Citation: Katzmann J, Keren D. 2016. Strategy for Detecting and Following Monoclonal Gammopathies, p 112-124. In Detrick B, Schmitz J, Hamilton R (ed), Manual of Molecular and Clinical Laboratory Immunology, Eighth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818722.ch11
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Image of FIGURE 5
FIGURE 5

Large M protein with suppressed polyclonal immunoglobulins.

Citation: Katzmann J, Keren D. 2016. Strategy for Detecting and Following Monoclonal Gammopathies, p 112-124. In Detrick B, Schmitz J, Hamilton R (ed), Manual of Molecular and Clinical Laboratory Immunology, Eighth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818722.ch11
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Image of FIGURE 6
FIGURE 6

Small M protein within a background of polyclonal immunoglobulins.

Citation: Katzmann J, Keren D. 2016. Strategy for Detecting and Following Monoclonal Gammopathies, p 112-124. In Detrick B, Schmitz J, Hamilton R (ed), Manual of Molecular and Clinical Laboratory Immunology, Eighth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818722.ch11
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Image of FIGURE 7
FIGURE 7

(A) Use of ISE to estimate the area of small beta-migrating M proteins. Capillary electropherogram with beta region restriction and hypogammaglobulinemia. (B) Immunosubtraction demonstrating that anti-IgA and anti-L subtract the M protein in the mid-beta region. (C) Use ISE data to demarcate and measure the M protein concentration.

Citation: Katzmann J, Keren D. 2016. Strategy for Detecting and Following Monoclonal Gammopathies, p 112-124. In Detrick B, Schmitz J, Hamilton R (ed), Manual of Molecular and Clinical Laboratory Immunology, Eighth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818722.ch11
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References

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Tables

Generic image for table
TABLE 1

Monoclonal gammopathies from the Mayo Clinic, 1960 to 2008

Citation: Katzmann J, Keren D. 2016. Strategy for Detecting and Following Monoclonal Gammopathies, p 112-124. In Detrick B, Schmitz J, Hamilton R (ed), Manual of Molecular and Clinical Laboratory Immunology, Eighth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818722.ch11
Generic image for table
TABLE 2

Distribution of monoclonal proteins in patients with multiple myeloma and monoclonal gammopathies of undetermined significance

Citation: Katzmann J, Keren D. 2016. Strategy for Detecting and Following Monoclonal Gammopathies, p 112-124. In Detrick B, Schmitz J, Hamilton R (ed), Manual of Molecular and Clinical Laboratory Immunology, Eighth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818722.ch11
Generic image for table
TABLE 3

Diagnostic sensitivities of monoclonal gammopathy screening panels with combinations of serum PEL, serum IFE, serum FLC, and/or urine IFE-PEL

Citation: Katzmann J, Keren D. 2016. Strategy for Detecting and Following Monoclonal Gammopathies, p 112-124. In Detrick B, Schmitz J, Hamilton R (ed), Manual of Molecular and Clinical Laboratory Immunology, Eighth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818722.ch11
Generic image for table
TABLE 4

Response criteria for FLC determination

Citation: Katzmann J, Keren D. 2016. Strategy for Detecting and Following Monoclonal Gammopathies, p 112-124. In Detrick B, Schmitz J, Hamilton R (ed), Manual of Molecular and Clinical Laboratory Immunology, Eighth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818722.ch11
Generic image for table
TABLE 5

International Myeloma Working Group criteria for response to therapy

Citation: Katzmann J, Keren D. 2016. Strategy for Detecting and Following Monoclonal Gammopathies, p 112-124. In Detrick B, Schmitz J, Hamilton R (ed), Manual of Molecular and Clinical Laboratory Immunology, Eighth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818722.ch11

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