The utility of MASS-FIX to detect and monitor monoclonal proteins in the clinic

P. Milani, D. L. Murray, D. R. Barnidge, M. C. Kohlhagen, J. R. Mills, G. Merlini, S. Dasari, A. Dispenzieri

Research output: Contribution to journalArticle

Abstract

The detection and quantification of monoclonal-proteins (M-proteins) are necessary for the diagnosis and evaluation of response in plasma cell dyscrasias. Immunoglobulin enrichment-coupled with matrix-assisted laser desorption ionization time-of-flight mass-spectrometry (MASS-FIX) is a simple and inexpensive method to identify M-proteins, but its clinical generalizability has not yet been elucidated. We compared MASS-FIX to protein electrophoresis (PEL), serum/urine immunofixation-electrophoresis (IFE), and quantitative serum free-light chain (FLC) for the identification of M-proteins in different clinical diagnoses. Paired serum and urine samples from 257 patients were tested. There were six patients for whom s-IFE and FLC ratio were positive and serum MASS-FIX was negative, but when serum and urine MASS-FIX results were combined, only one patient with light chain-MGUS was missed. Serum/urine-MASS-FIX detected M-proteins in 18 patients with negative serum/urine-PEL/IFE and serum-FLC, 10 of whom had multiple myeloma or AL amyloidosis, who were mistakenly thought to have complete hematologic response by serum/urine-PEL/IFE and serum-FLC. Nearly half of the AL amyloidosis patients had atypical spectra, which may prove to be a clue to the diagnosis and pathogenesis of the disease. In conclusion, MASS-FIX has a comparable sensitivity with PEL/IFE/FLC methods and can help inform the clinical diagnosis.
Original languageEnglish
Pages (from-to)772-779
Number of pages8
JournalAmerican Journal of Hematology
Volume92
Issue number8
DOIs
Publication statusPublished - Aug 1 2017

Keywords

  • Aged
  • Biomarkers
  • Diagnosis, Differential
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multiple Myeloma/blood/diagnosis
  • Myeloma Proteins
  • Prospective Studies
  • Sensitivity and Specificity
  • Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization/methods

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    Milani, P., Murray, D. L., Barnidge, D. R., Kohlhagen, M. C., Mills, J. R., Merlini, G., Dasari, S., & Dispenzieri, A. (2017). The utility of MASS-FIX to detect and monitor monoclonal proteins in the clinic. American Journal of Hematology, 92(8), 772-779. https://doi.org/10.1002/ajh.24772 [doi]