Keywords
monoclonal gammopathies
oligoclonal bands
interference by daratumumab
How to Cite
Abstract
The presence in serum or at least in urine of a monoclonal component (MC) or its light chain subunits, as a product of clonal proliferation of B lymphocytes or plasma cells, characterizes a large group of monoclonal gammopathies (MG). The main application of immunofixation (IFx) is the immunological identification of MC in serum and urine to establish their diagnosis. In addition, this result has prognostic value for some of the MG. IFx also makes it possible to establish the various degrees of response to treatment achieved by patients, and to determine the reappearance of MC, marking the relapse of the disease.
IFx consists of precipitating the protein of interest in the gel by adding monospecific antiserum at the end of the electrophoretic fractionation of the serum or urine samples, seeded on agarose or gelatinized cellulose acetate support. Subsequent washes must be exhaustive to avoid nonspecific visualization. Finally, it is revealed with Coomassie Brilliant Blue R 250 or ultrasensitive colloidal silver or gold stain.
The appearance of oligoclonal bands in serum during the follow-up of patients with multiple myeloma (MM), after autologous stem cell transplantation (ASCT), generated difficulty in evaluating the original MC. Its appearance, certified by IFx, was associated with the occurrence of fewer adverse effects to the applied therapy, and longer overall disease-free survival in patients.
More recently, therapeutic monoclonal antibodies for the treatment of MM also complicate the evaluation of its MC. They appear in the proteinogram (PROT) at therapeutic doses and of type IgG-kappa by IFx.
Such interference may falsely indicate a poor response to therapy, especially in those cases where the original MC is of the same immunological type and has the same electrophoretic mobility as the therapeutic antibody.
In the follow-up of patients with COVID-19 disease, the appearance of homogeneous bands in the PROT could be observed, interfering in the evaluation of their MC for those patients with a previous diagnosis of MG.
For all the above, it is advisable to follow up patients in the same clinical analysis laboratory, given the need to add to the correct technical processing of the IFx, the knowledge of the analytical and clinical history data. This favors the proper interpretation and writing of the report, while it allows us to discern in which of the various situations mentioned above our patients are included.
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