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Articoli con TAG: mieloma multiplo

Confronto tra un metodo nefelometrico ed un metodo turbidimetrico per la determinazione delle catene leggere libere sieriche: punti di forza e criticità
Comparison between a turbidimetric and a nephelometric method for the measurement of serum free light chains: strengths and weaknesses
<p>Background: monoclonal gammopathies include a broad spectrum of pathologies, and free light chains (FLC) measurement is recommended by guidelines for the diagnosis, follow up and prognosis of plasma cell dyscrasia. The aim of the study is to compare the measurement of FLC performed with two different analytical platforms, a nephelometer and a turbidimeter, in order to assess the analytical and diagnostic agreement.<br />Methods: 87 consecutive samples received by the laboratory with a request of FLC measurement were analyzed on nephelometer Immage 800 (Beckman Coulter, USA) and turbidimeter Optilite (The Binding Site, UK), using the same antibodies (Freelite, The Binding Site, UK).<br />Results: by applying the Passing-Bablok regression and the Bland-Altman analysis, a proportional and constant systematic error but non-significant bias for FLC ratio (rFLC) has been observed. By applying the Weighted Cohen&rsquo;s Kappa (WK) test to the rFLC values, an excellent diagnostic agreement between the two instruments has been shown, considering both the normal range (0.26 &ndash; 1.65) (WK=0.87) and the diagnostic range for multiple myeloma (&lt;0.01 or &gt;100) (WK=0.84).<br />Conclusions: Although there are statistical differences between the measurements performed by the two instruments, these do not affect the diagnostic agreement, that is excellent. Nevertheless, the turbidimeter is provided with a software that can automatically detect the antigen excess; by diluting further the samples automatically, it performs fewer dilutions than the nephelometer and provides a wider range of measurement, especially for low concentrations. These characteristics assist the operator both during the analysis and the validation phases of the results, saving time and resources. On the basis of the results of the study, it can be concluded that the turbidimeter shows better performances compared to the nephelometer.</p>
Biochimica Clinica ; 44(2) 149-156
Contributi Scientifici - Scientific Papers
Espressione e valore prognostico del ciclo cellulare e delle aneuploidie nel mieloma multiplo e nella gammopatia monoclonale di significato indeterminato
Expression and prognostic value of cell cycle and aneuploidy in multiple myeloma (MM) and monoclonal gammopathy of undetermined significance (MGUS)
<p>In this study, we used multiparameter flow cytometry (MFC) to investigate old and new plasma cell (PC) markers, such as the extrusion pumps of drugs, cluster of differentiation 243 (CD243) and citochemokine receptors (CD197, CD191, CD192, CD196, CD183, CD184, CD126) involved in cellular interactions, locomotion, adhesion and invasion. We studied the different expression of PC in 55 samples of bone marrow of patients affected by MM and MGUS, using MFC and immunomagnetic sorting. The incidence and prognostic significance of the analysis of the cell cycle and aneuploidy were evaluated in order to support the efficacy of MFC. By analysing the immunophenotypic receptor molecules expression and extrusion pumps, we found that CD243, CD192, CD183, CD191 and CD196 showed increased expression in cases of MM, whereas an increased expression of CD197, CD184 and CD126 emerged in MGUS samples. In comparing neoplastic and normal PC in MM samples, we found an increased expression of all receptors on the surface of neoplastic PC. Cell cycle and aneuploidy analysis of all samples showed a pseudodiploid condition with a more difficult prognosis, even considering the old age of patients.</p>
Biochimica Clinica ; 41(3) 228-234
Contributi scientifici - Scientific papers
La spettrometria di massa nella diagnosi e nel monitoraggio delle gammopatie monoclonali
Mass spectrometry in diagnosis and monitoring of monoclonal gammopathies
<p>The identification ofmonoclonal components requires the use of protein electrophoresis, immunofixation electrophoresis of serum andurine and serum free light chain measurement. The combination of these three tests grants the highest diagnosticperformance in different clinical settings. In clinical practice, the monoclonal protein (M-protein) is detected in apatients&rsquo; serum or urine by the appearance of a distinct protein band migrating within regions typically occupied byimmunoglobulins. Immunofixation or immunotyping then provides evidence that the identified protein band is anintact immunoglobulin or an immunoglobulin light chain. Taking into consideration that each M-protein is composedby a sequence of amino acids pre-defined by somatic recombination unique to each clonal plasma cell, the molecularmass of the M-protein can act as a surrogate marker of the protein composition. The Mayo Clinic researchersestablished mass spectrometry-based methods to assign molecular mass to the monoclonal immunoglobulin lightchain and used this to detect the presence of M-proteins. The first method proposed is based on the enrichment ofserum for immunoglobulins, followed by reduction to separate light chains from heavy chains, followed by microflowLC-ESI-Q-TOF mass spectrometry. The second method is based on the enrichment of nanobodies and thesubsequent analysis on a matrix-assisted laser desorption mass spectrometer (MALDI). Both methods demonstrateda comparable diagnostic sensitivity to the standard procedures and could be considered as a possible futuresubstitution of immunofixation.</p>
Biochimica Clinica ; 43(3) 256-263
Rassegne - Reviews
Gammopatie monoclonali: quadri clinici principali e ruolo del laboratorio
Monoclonal gammopathies: main clinical pictures and role of the clinical laboratory
<p>The finding of a monoclonal gammopathy both by chance and upon clinical suspicion is becoming more and more frequent and requires in-depth clinical, laboratory and instrumental analyses in order to establish the underlying disease, if any. In the last two decades the improvement of the diagnostic tools has led to the identification and precise definition of several clinical entities pathogenetically linked to the monoclonal gammopathy, thus shrinking the field of the &quot;monoclonal gammopathy of undetermined significance&quot;. Such a striking improvement relies on the increasing sensitivity and accuracy of old analyses and availability of new ones (such as the serum Free Light Chain assay). Currently, data from the clinical biochemistry laboratory provide important clues to the diagnosis and prognosis, and are also crucial for monitoring the therapy. These new achievements, along with the availability of new therapeutic options, allowed a significant, sometimes dramatic improvement of the prognosis of many of the gammopathy-related diseases. In this review the main clinical pictures are described along with the contribution of the clinical biochemistry laboratory to the definition of the diagnosis, the risk profile and the monitoring of the specific diseases.</p>
Biochimica Clinica ; 43(4) 366-383
Rassegne - Reviews
Gammopatie monoclonali di significato clinico
Monoclonal gammopathies of clinical significance.
<p>This Opinion is aimed to comment and emphazise the main points raised in a seminal paper published in 2018 in Blood. The paper deals with a number of severe diseases caused by small lymphoid/plasma cell clones. These clones affect different organs by means of the biological properties of the clonal cells themselves and/or of their secretion products such as monoclonal immunoglobulins, cytokines and other molecules. More importantly, the paper also deals with the pathogenetic mechanisms involved in the organ damage and sheds light on most of them. The present comment aims to bring attention to these diseases, but it does not encompass the whole matter. We suggest that the readers involved in this matter refer to the paper in its original version.</p>
Biochimica Clinica ; 43(4) 421-423
Opinioni - Opinions
Mieloma multiplo: da plasmocitoma a coinvolgimento multiorgano
Multiple myeloma: from plasmacytoma to multi-organic involvement
<p>Solitary plasmacytoma is a rare form of plasma cell dyscrasia characterized by localized proliferation of neoplastic monoclonal plasmacells. The lesion can originate in bone or in soft tissue, with no or minimal evidence of bone marrow plasmacytosis (&lt;10%) and absence of end-organ damage signs such as hypercalcaemia, renal insufficiency, anaemia, or bone lesions (CRAB). We present a case of solitary bone plasmacytoma (SPB) that rapidly evolved to multiple myeloma (MM). A partial response was obtained within few months of chemotherapy but then the disease rapidly progressed with involvement of liver, kidneys and lungs. Salvage therapy (bendamustine-bortezomib-dexamethasone, 1 cycle) had no effect and the patient died shortly after. Biochemical work up plays a central role in the follow up of MM patients, as recommended by international guidelines. In some cases the disease is so aggressive that early diagnosis and treatment fail to improve the outcome.</p>
Biochimica Clinica ; 44(2) E14-E17
Casi Clinici - Case Report
Utilità dell’esame citologico del liquido cerebrospinale
Clinical utility of cerebrospinal fluid cytological examination
<p>Cerebrospinal fluid (CSF) of a 64 year old malepatient was sent from the hematology unit to laboratory for cell count and morphology and chemical-physicalexamination. CSF was clear, colourless and with increased total protein concentration. Cell count was first performedin Burker camera with a result of 40/&mu;L; some of the cells showed an abnormal morphology. Our laboratory workflowincludes the CSF examination utilizing an automatic cell counter: it showed a few white blood cells (3/&mu;L), but a highnumber of total cells (64/&mu;L). The morphological evaluation, with cytocentrifugation and May-Grunwald Giemsa stain,identified the elements as mature plasma cells; the result was then confirmed by immunophenotyping.<br />These findings suggest a neurological localization of a multiple myeloma (MM). Actually, the patient had beendiagnosed as IgA lambda MM, with bone involvement that caused progressive loss of walk. Positron EmissionTomography revealed hyperdense areas, but it wasn&rsquo;t able to distinguish between lymphoproliferative disease andthrombotic phlogosis. In spite of the therapy, patient neurological conditions worsened till irreversible coma. He dieda few days later.</p>
Biochimica Clinica ; 43(2) e17-e19
Casi Clinici - Case Report