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Journal of Medical Biochemistry

The Journal of Society of Medical Biochemists of Serbia

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Recommendations for use of Tumor Markers in Monoclonal Gammopathies

Marijana Dajak1

Clinical Center of Serbia, Institute of Medical Biochemistry, Belgrade1

This content is open access.

Citation Information: Journal of Medical Biochemistry. Volume 26, Issue 2, Pages 165–172, ISSN (Online) 1452-8266, ISSN (Print) 1452-8258, DOI: 10.2478/v10011-007-0020-x, April 2007

Publication History

Published Online:
2007-04-24

Preporuke za Primenu Tumorskih Markera Kod Monoklonskih Gamapatija

Monoklonske gamapatije čine grupu poremećaja koji se karakterišu klonskom proliferacijom plazma ćelija. M protein je tumorski marker specifičan za monoklonske gamapatije jer odražava klonsku produkciju imunoglobulina. Monoklonske gamapatije uključuju: multipli mijelom, Waldenström-ovu makroglobulinemiju (WM), nesekretorni mijelom, prikriveni (smoldering) multipli mijelom, monoklonsku gamapatiju od neodređenog značaja (MGUS, Monoclonal gammopathy of undetermined significance), primarnu sistemsku amiloidozu i bolest teških lanaca. Dijagnoza multiplog mijeloma je zasnovana na detekciji M proteina u serumu i/ili urinu, infiltraciji plazma ćelija u koštanoj srži i litičkim koštanim lezijama na radiografiji skeleta. Prema NACB (National Academy of Clinical Biochemistry) preporukama, tumorski markeri za dijagnozu, screening, identifikaciju klonaliteta, praćenje bolesti i prognostičku evaluaciju kod monoklonskih gamapatija su: elektroforeza proteina u serumu i/ili urinu, imunofiksacija u serumu i/ili urinu, slobodni laki lanci (SLL) u serumu i/ili urinu, viskoznost seruma i β2-mikroglobulin. Imunofiksacija se koristi za identifikaciju klonaliteta (tipa) M proteina primećenog na elektroforezi i kada postoji sumnja bez obzira na normalan proteinski elektroforetogram. Posebno je korisna za prepoznavanje i razlikovanje biklonskih ili triklonskih gamapatija. Viskoznost seruma trebalo bi određivati ako pacijent ima znake i simptome sindroma hiperviskoznosti. WM je najčeŠći uzrok hiperviskoznosti, ali se takođe može pojaviti i kod pacijenata sa velikim nivoima monoklonskog IgA ili IgG. Automatizovana imunoodređivanja SLL u serumu su osetljivija od tradicionalne elektroforetske metode i imunofiksacije za detekciju mijeloma monoklonskih lakih lanaca, nesekretornog mijeloma i AL amiloidoze. Osim toga, odnos SLL u serumu je nezavisan faktor rizika za nastanak maligne progresije kod pacijenata sa MGUS. Određivanje SLL u serumu i elektroforeze proteina seruma kao testova prve linije za razmatranje prisustva mogućih poremećaja B ćelija daje dodatnu dijagnostičku informaciju.

Recommendations for use of Tumor Markers in Monoclonal Gammopathies

Monoclonal gammopathies constitute a group of disorders characterized by the clonal proliferation of plasma cells. The M protein is a tumor marker specific for monoclonal gammopathies because it reflects the clonal production of immunoglobulin. The monoclonal gammopathies include: multiple myeloma, Waldenström macroglobulinemia (WM), nonsecretory myeloma, smoldering multiple myeloma, monoclonal gammopathy of undetermined significance (MGUS), primary systemic amyloidosis and heavychain diseases. The diagnosis of multiple myeloma is based on detection of M protein in serum and/or urine, infiltration of plasma cells in the bone marrow, and lytic bone lesions on radiography of the skeleton. According to NACB (National Academy of Clinical Biochemistry) recommendations, the tumor markers for diagnosis, screening, identification of clonality, follow up of disease and prognostic evaluation in monoclonal gammopathies are: serum and/or urine protein electrophoresis, serume and/or urine immunofixation, serum and/or urine free light chains (FLC), serum viscosity and β2-microglobulin. Immunofixation is used to identify the clonality (type) of M protein observed on electrophoresis and when suspicion persists despite a normal protein electrophoretogram. It is particularly useful for the recognition and distinction of biclonal or triclonal gammopathies. The viscosity of serum should be measured if the patient has sings or symptoms of hyperviscosity syndrome. WM is the most common cause of hyperviscosity, but it can also occur in patients with large levels of monoclonal IgA or IgG. Serum FLC automated immunoassays are more sensitive for the detection of monoclonal light-chain myeloma, nonsecretory myeloma and AL amyloidosis than traditional electophoretic and immunofixation methods. Furthermore, serum FLC ration is an independent risk factor for malignant progression in MGUS patients. The determination of serum FLC and serum electrophoresis as first-line tests for investigating possible B-cell disorders gains additional diagnostic information.

Keywords: monoclonal gammopathies; multiple myeloma; NACB (National Academy of Clinical Biochemistry) recommendations; immunotyping; free light chains; hyperviscosity; cryoglobulins

Keywords: monoklonske gamapatije; multipli mijelom; NACB (National Academy of Clinical Biochemistry) preporuke; imunotipizacija; slobodni laki lanci; hiperviskoznost; krioglobulini

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