Immunoglobulin / free light chain ratio

Transcription

1 Immunoglobulin / free light chain ratio Kiyotaka FUJITA Katsunori TAKAHASHI Ikunosuke SAKURABAYASHI FLC IgG, IgA, IgM, IgD, IgE H 1 L H,,,, L 2 monoclonal immunoglobulinemia : M L L H 40 H L L free light chain : FLC FLC FLC L FLC Binding Site 1 M L FLC FLC 44,000 dimer 22,000 monomer tetramer FLC monoclonal polyclonal IFE IEP FLC FLC Bence Jones BJP M M FLC FLC FLC FLC FLC FLC Faculty of Health Science, Gunma Paz College (1-7-1 Tonyamachi, Takasaki-shi, Gunma) 2 Jichi Medical School ( Yakushiji, Shimotsuke-shi, Tochigi)

2 FLC FLC FLC -FLC FLC Binding Site FLC FREELITE TM L hidden surface polyclonal L hidden surface FLC hidden surface FLC 2 BJP 3 BJP FLC FLC FLC mg L FLC mg L M SPE mg L FREELITE TM FLC 5mg L IFE mg L M MGUS monoclonal gammopathy of undetermined significance M M IEP 100 SPE IEP 99 SPE IFE IEP FLC FLC FLC Nowrousian 6 BJP BJP intact immunoglibulin L FLC

3 FLC FLC FLC 7 FLC FLC 1.65 FLC 0.26 FLC H L 1 1 FLC X SPE IEP IFE 3 10 IFE M Drayson FLC 13 BJP 9 BJP FLC 7

4 BJP SPE BJP BJP IEP Abraham 10 FLC M FLC BJP FLC 10 30g day FLC FLC 11 AL FLC M 10 1 FLC IFE Bradwell 12 IFE M 86 AL FLC FLC AL MGUS M M 3g dl Kyle MGUS MGUS 1 14 MGUS MGUS FLC M IgG 21 IgA 6 IgD 3 FLC FLC 2 4 FLC Junghans 17 IgG- MM IgG FLC FLC IgG Mösbauer 18 FLC IFE M 128 IFE M 98 FLC M FLC FLC 75mg dl 2 3.5mg L 302mg dl LDH 190U L 19 FLC FLC 19 Dispenzrei 20 AL FLC 152mg L FLC 152mg L FLC Dingli

5 FLC 18 IgG- IFE M FLC BJP- IFE M FLC P FLC 20 AL FLC 152mg L FLC 152mg L 15 Rajkumar 15 MGUS MGUS FLC FLC FLC IFE IEP FLC M H H FLC IFE IEP M FLC 1 Dispenzieri A, Kyle RA, MerliniG, et al. International Myeloma Working Group guidelines for serum-free light chain analysis in multiple myeloma and related disordersinternational Myeloma Working Group guidelines.

6 Leukemia. 2 : , Bradwell AR, Carr-Smith HD, Mead GP, et al. Highlysensitive, automatedimmunoassay for immunoglobulin free light chains in serum and urine. Clin Chem. 4 : , Murata K, Clark RJ, Lockington KS,et al. Sharply increased serum free light-chain concentrations after treatment for multiple myeloma. Clin Chem. 1 : 16-18, Katzmann JA, Clark RJ, Abraham RS, et al. Serum reference intervals and diagnostic ranges for free kappa and free lambda immunoglobulin light chains : relative sensitivity for detection of monoclonal light chains. Clin Chem. 9 : , ,,... : , Nowrousian MR, Brandhorst D, Sammet C, et al. Serum free light chain analysis and urine immunofixation electrophoresis in patients with multiple myeloma. Clin Cancer Res. 24 : , Bradwell AR, Carr-Smith HD, Mead GP, et al. Serum test for assessment of patients with Bence Jones myeloma. Lancet : , Drayson M, Tang LX, Drew R, et al. Serum free lightchain measurements for identifying and monitoring patients with nonsecretory multiple myeloma. Blood. 9 : , Shimizu K, Nagura E, Takatsuki K ; Japan Myeloma Study Group. Management of patients with multiple myeloma in Japan: data of 1,383 patients from 16 hospitals and 1 treatment group. Leuk Lymphoma. 12 : , Abraham RS, Clark RJ, Bryant SC, et al. Correlation of serum immunoglobulin free light chain quantification with urinary Bence Jones protein in light chain myeloma. Clin Chem. 4 : , Pratt G. The evolving use of serum free light chain assays in haematology. Br J Haematol. 4 : , Bradwell AR. Free Light Chain Normal Ranges and Reference Intervals. In : Bradwell AR, deitor. Serum Free Light Chain Analysis. 4th edition. The Binding Site Ltd , Kyle RA, Therneau TM, Rajkumar SV, et al. Prevalence of monoclonal gammopathy of undetermined significance. N Engl J Med. 13 : , Kyle RA, Rajkumar SV. Monoclonal gammopathy of undetermined significance. Br J Haematol. 6 : , Rajkumar SV, Kyle RA, Therneau TM, et al. Serum free light chain ratio is an independent risk factor for progression in monoclonal gammopathy of undetermined significance. Blood. 3 : , Wochner RD, Strober W, Waldmann TA. The role of the kidney in the catabolism of Bence Jones proteins and immunoglobulin fragments. J Exp Med. 2 : , Junghans RP, Anderson CL. The protection receptor for IgG catabolism is the beta2-microglobulin-containing neonatal intestinal transport receptor. Proc Natl Acad Sci U S A. 11 : , Mösbauer U, Ayuk F, Schieder H, et al. Monitoring serum free light chains in patients with multiple myeloma who achieved negative immunofixation after allogeneic stem cell transplantation. Haematologica. 2 : , van Rhee F, Bolejack V, Hollmig K, et al. High serum-free light chain levels and their rapid reduction in response to therapy define an aggressive multiple myeloma subtype with poor prognosis. Blood. 3 : , Dispenzieri A, Lacy MQ, Katzmann JA, et al. Absolutevalues of immunoglobulin free light chains are prognostic in patients with primary systemic amyloidosis undergoing peripheral blood stem cell transplantation. Blood. 8 : , Dingli D, Kyle RA, Rajkumar SV, et al. Immunoglobulin free light chains and solitary plasmacytoma of bone. Blood. 6 : , 2006.