PDF(Pubmed)
Abstract：
Multiple myeloma (MM) is a disease, that at times poses diagnostic and monitoring challenges. Over the last decades laboratory methods have been expanded with serum free light chain (FLC) analysis. Alerted by two index cases with clinical impact due to failure of the FLC analysis to indicate a disease progression, we aimed to identify any clinical consequences due to known differences between FLC analysis methods. We applied two FLC analysis methods (Freelite Binding Site [FBS] and N-Latex Siemens [NLS]) on all patients with MM and monoclonal gammopathy of uncertain significance diagnosed/followed up at Södra Älvsborg Hematology Unit, from April to December 2022. From a total of 123 patients with malignant plasma cell disorder, we identified five cases (4.1%) where solely the FBS method, as opposed to NLS, urine and serum electrophoresis, could support diagnosis or detect progression. The consequences of this discrepancy included not only change of diagnosis or delayed therapy but also change of treatment. Our findings indicate that a stronger awareness of the potential weaknesses of different FLC methods is needed, which calls for a closer collaboration between clinical chemists and hematologists.
摘要：
多发性骨髓瘤（MM）是一种疾病，这有时会带来诊断和监测方面的挑战。在过去的几十年中，实验室方法已通过无血清轻链（FLC）分析进行了扩展。由于FLC分析未能指示疾病进展，两个具有临床影响的指标病例引起了警报，我们旨在确定由于FLC分析方法之间已知差异而导致的任何临床后果.我们应用了两种FLC分析方法（FreeliteBindingSite[FBS]和N-LatexSiemens[NLS]）对在Södravsborg血液科诊断/随访的所有MM和不确定意义的单克隆丙种球蛋白病患者，2022年4月至12月。从总共123例恶性浆细胞疾病患者中，我们确定了5例（4.1%），其中仅采用FBS方法，与NLS相反，尿液和血清电泳，可以支持诊断或检测进展。这种差异的后果不仅包括诊断或延迟治疗的改变，还包括治疗的改变。我们的研究结果表明，需要对不同FLC方法的潜在弱点有更强的认识，这需要临床化学家和血液学家之间更紧密的合作。
