scholarly journals A Novel Risk-Model to Predict Time to First Treatment (TTT) in Chronic Lymphocytic Leukemia Based on Heavy+Light Chain Immunoparesis and Serum Free Light Chain Analysis: Results from the Israeli CLL Study Group

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 1849-1849
Author(s):  
Tamar Tadmor ◽  
Andrei Braester ◽  
Najib Dally ◽  
Ariel Aviv ◽  
Yair Herishanu ◽  
...  
Keyword(s):  
Binding Site ◽  
Light Chain ◽  
Research Funding ◽  
Reference Range ◽  
Lymphocytic Leukemia ◽  
Light Chains ◽  
Normal Reference Range ◽  
Site Group ◽  
Normal Reference ◽  
Time To First Treatment

Abstract Introduction: Chronic Lymphocytic Leukemia (CLL) is frequently accompanied by immune dysregulation. Hypogammaglobulinemia is one of the most important immune defects encountered, and all three classes of immunoglobulins (IgG, A and M) can be involved. Recently, novel heavy+light chain (HLC) immunoassays have become available that quantify the light chain types of each immunoglobulin class (e.g. IgGk and IgGl). These assays are measured in pairs and provide information on the isotype produced by a tumour (the "involved" HLC), the non-clonal ("uninvolved") HLC, and the ratio (e.g. IgGk/IgGl) - which indicates monoclonality. HLC assays have been shown to improve monitoring of plasma cell dyscrasias, but their role in CLL is yet to be studied. Methods This is a multi-center study performed in collaboration with the Israeli CLL Study Group and involved 10 medical centers. The cohort included 122 patients with CLL and 26 healthy controls. Baseline was defined as the time the blood sample was taken. Serum samples were analyzed for levels of IgG subclasses (IgG1, IgG2, IgG3, IgG4), heavy+light chains (HLC) (IgGκ, IgGλ, IgAκ, IgAλ, IgMκ or IgMλ) and free light chains (sFLC). HLC-pair suppression was defined as an abnormal HLC ratio and uninvolved HLC levels below the normal reference range (i.e. in g/L: IgGκ<3.84; IgGλ<1.91; IgAκ<0.57; IgAλ<0.44; IgMκ<0.19; IgMλ<0.12). HLC immunoparesis was defined as HLC isotype levels below the normal reference range, regardless of HLC ratio (i.e. HLC immunoparesis of at least 1 isotype indicates at least one of IgGκ, IgGλ, IgAκ, IgAλ, IgMκ or IgMλ below the normal reference range). Severe HLC-pair suppression or severe HLC immunoparesis was defined as a concentration of the uninvolved HLC or any HLC isotype that is suppressed by >50% below the normal reference range. The association of variables with time to first treatment (TTT) was performed with Cox proportional hazard model. Results Current analysis was performed on 105 CLL patients who had complete data available; median age was 68 years, 64% were males and Binet stage A, B, C, were 80%, 18.1% and 1.9% respectively. Median time from diagnosis to baseline measurements was 27 months (range 0-328 months). An abnormal sFLC ratio was identified in 70% (73/105) patients and summated k and λ concentrations (SFLC) were ≥70 mg/L in 18% of cases. An abnormal HLC ratio was present in 32% (34/105) patients, and 21% had HLC pair suppression of any 1 HLC isotype. HLC immunoparesis of 1, ≥2 and ≥3 isotypes was observed in 74 (70%), 58 (55%) and 36 (34%) of patients, respectively, with severe HLC immunoparesis identified in 40 patients (38%). Patients with IgG2 suppression were more frequently hospitalized due to infection with an Odds Ratio of 3.826 (p=0.031). In multivariate analysis, SFLC ≥70 mg/L and severe HLC immunoparesis were independently associated with TTT (HR 15.3, p<0.001; HR 80, p<0.001 respectively). Using these 2 variables, a risk-stratification model was constructed that separated CLL patients into 3 risk groups (with 0, 1 or 2 risk factors) with significantly different TTT (p<0.001, Figure 1). Patients with both risk factors (SFLC ≥70 mg/L and severe HLC immunoparesis) had the shortest TTT. Conclusions The findings presented here demonstrate that there is considerable potential for the use of HLC and FLC immunoassays to provide prognostic information in CLL. Figure 1. Figure 1. Disclosures Tadmor: PFIEZER: Consultancy; JNJ: Consultancy; ABBVIE: Consultancy; NOVARTIS: Consultancy; ROCHE: Research Funding. Aviv:ABBVIE: Consultancy; ROCHE: Research Funding. Herishanu:ROCHE: Research Funding; JNJ: Consultancy; ABBVIE: Consultancy. Shvidel:ROCHE: Consultancy, Research Funding; ABBVIE: Consultancy, Research Funding; JNJ: Consultancy. Rahimi-Levene:ABBVIE: Consultancy. Ruchlemer:ABBVIE: Consultancy; JNJ: Consultancy. Fogl:The Binding Site Group Ltd: Employment. Polliack:ROCHE: Research Funding; ABBVIE: Consultancy. Magal:The Binding Site: Employment. Townsend:The Binding Site Group Ltd: Employment.

scholarly journals Comparison of IgA Heavy/Light Chain Immunoassays with Capillary Zone Electrophoresis and Total Immunoglobulin Measurements

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5692-5692
Author(s):  
Lidia Gartcheva ◽  
Violeta Petkova ◽  
Keranka Dimitrova ◽  
Veronika Petkova ◽  
Penka Ganeva ◽  
...  
Keyword(s):  
Capillary Zone Electrophoresis ◽  
Light Chain ◽  
Research Funding ◽  
Reference Range ◽  
Residual Disease ◽  
Normal Reference Range ◽  
Normal Reference ◽  
Normal Ranges ◽  
Zone Electrophoresis ◽  
Capillary Zone

Abstract Introduction: Capillary zone electrophoresis (CZE) and measurement of total immunoglobulins (total Ig) are standard techniques for the identification and quantification of monoclonal immunoglobulins (M-Ig). Heavy/light chain (HLC) pair analysis allows discrimination between Igκ and Igλ and as a result allows measurement of both the monoclonal involved and polyclonal uninvolved HLC pair. We compared measurement of M-Ig by CZE and total Ig to HLC levels. Methods: 93 samples from 8 patients with IgA intact immunoglobulin multiple myeloma (MM) were analysed. M-Ig was measured using CZE Sebia Capillarys 2 system, total IgA (tIgA) and IgAκ and IgAλ HLC concentrations on a SPAPLUS analyser. IgA HLC levels were measured with Hevylite® and compared to published normal ranges (IgAκ (g/L): 0.57-2.08, IgAλ (g/L): 0.44-2.04, IgAκ/IgAλ: 0.78-1.94). Passing and Bablok fit analysis was used to determine correlation between the assays. Results: Measurement of the involved HLC pair (iHLC) (median: 12.45g/L; range: 0.64-44.71g/L) compared well with CZE (n=34; median: 11.04g/L; range: 1.24-37.71g/L.; y= 1.2x + -2.65, R2= 0.94). Measurement of iHLC (median: 0.88. range: 0.05-21.55g/L) also compared well with tIgA measurement (n=65 median=1.44g/L; range: 0.227-21.11g/L, y=0.85x + -0.26, R2=0.98). Percent changes in iHLC concentrations from baseline through treatment compared well with CZE (n=28; y=1.59x + 0.15 R2=0.93) and tIgA (n=57; y=1.06x + 0.01, R2=0.96). Of the 34 samples with quantifiable M-protein by CZE, 32(94%) had an abnormal HLC ratio. The two discrepant samples were follow up samples from the same patient, where HLC normalised alongside total IgA entering the normal reference range. In addition, all 15 samples (15/65; 23%) where tIgA concentration was above the normal reference range all had abnormal HLC ratios. M-Ig was not detected by CZE in 48/82 (57%) samples, 46/48 of the samples (96%) had a normalised HLC ratio. In 38/65 (58%) samples, tIgA concentrations were within the normal reference range, and 34 (90%) had a normalised HLC ratio. HLC ratio for all patient samples normalised in subsequent samples following treatment. Conclusion: The measurement of M-Ig is comparable between Hevylite® and both CZE and tIgA. The presented data indicate that Hevylite® is a more sensitive test for detecting residual disease and warrants prospective studies on larger cohorts of patients. Acknowledgments:This work was partially supported by the National Science Fund (D02-35/2009). Disclosures Guenova: Novartis Pharma Sevices Bulgaria: Consultancy, Research Funding, Speakers Bureau; Roche Bulgaria: Consultancy, Research Funding, Speakers Bureau; Amgen Bulgaria: Consultancy, Research Funding, Speakers Bureau; Sanofi-Aventis Bulgaria: Consultancy, Research Funding, Speakers Bureau.

Evaluation of normal reference range for thyroid uptake of technetium-99 m in a single centre UK population

2017 ◽  
Author(s):  
Mavin Macauley ◽  
Mohamed Shagwi ◽  
Kim Howe ◽  
Andrew Curry ◽  
Elizabeth Howell ◽  
...  
Keyword(s):  
Reference Range ◽  
Single Centre ◽  
Normal Reference Range ◽  
Normal Reference ◽  
Thyroid Uptake

scholarly journals Monoclonal anti-light chain idiotype as a tumor-specific probe for human neoplastic B lymphocytes

Blood ◽  
1987 ◽  
Vol 69 (3) ◽  
pp. 919-923 ◽  
Author(s):  
M Wrightham ◽  
AL Tutt ◽  
MJ Glennie ◽  
TJ Hamblin ◽  
GT Stevenson ◽  
...  
Keyword(s):  
B Cell ◽  
Tumor Cells ◽  
B Lymphocytes ◽  
Light Chain ◽  
Normal Serum ◽  
Lymphocytic Leukemia ◽  
Light Chains ◽  
Specific Probe ◽  
Tonsillar Cells ◽  
Binding Curves

Abstract Tumor cells from patients with B cell neoplasms often secrete small amounts of free monoclonal light chains that can be found in the urine. Such tumor-derived light chains of the lambda type from a patient with typical chronic lymphocytic leukemia have been used to raise mouse monoclonal antibodies (MoAbs). A hybridoma-secreting antibody that recognized the idiotypic lambda chain but not normal lambda chains by a preliminary screen but which also reacted with idiotypic IgM from the patient's tumor cells was selected. This MoAb in fact recognized 1 in 20 X 10(3) molecules of pooled normal lambda chains, thus establishing its specificity for a private idiotypic determinant. It failed to give a detectable reaction with normal IgM, normal serum, or a panel of IgM paraproteins. The antibody bound to the patient's neoplastic B cells but not to normal tonsillar cells. The site of binding of the antibody to idiotypic IgM is clearly separate from that of another MoAb specific for idiotypic determinants on heavy plus light chains, since the two showed additive binding curves. The determinant also appeared to be less available in dimeric lambda chains than in monomeric lambda chains or in idiotypic IgM. Antibodies to idiotypic determinants on light chains show some technical advantages and should be useful for monitoring and possibly treating B cell tumors, either alone or together with the more conventional anti-idiotypic antibodies that usually recognize the heavy and light chain combination.

scholarly journals The Short Cosyntropin Test Revisited: New Normal Reference Range Using LC-MS/MS

2018 ◽  
Vol 103 (4) ◽  
pp. 1696-1703 ◽  
Author(s):  
Grethe Å Ueland ◽  
Paal Methlie ◽  
Marianne Øksnes ◽  
Hrafnkell B Thordarson ◽  
Jørn Sagen ◽  
...  
Keyword(s):  
Reference Range ◽  
Normal Reference Range ◽  
New Normal ◽  
Normal Reference

scholarly journals EP08.08: Ventricular occupying ratio at 18-30 weeks' gestation: normal reference range and ventriculomegaly

2018 ◽  
Vol 52 ◽  
pp. 224-224
Author(s):  
R.K. Pooh ◽  
T. Nakamura ◽  
M. Machida ◽  
K. Uenishi ◽  
K. Kusunoki ◽  
...  
Keyword(s):  
Reference Range ◽  
Normal Reference Range ◽  
Normal Reference

scholarly journals Monoclonal anti-light chain idiotype as a tumor-specific probe for human neoplastic B lymphocytes

Blood ◽  
1987 ◽  
Vol 69 (3) ◽  
pp. 919-923
Author(s):  
M Wrightham ◽  
AL Tutt ◽  
MJ Glennie ◽  
TJ Hamblin ◽  
GT Stevenson ◽  
...  
Keyword(s):  
B Cell ◽  
Tumor Cells ◽  
B Lymphocytes ◽  
Light Chain ◽  
Normal Serum ◽  
Lymphocytic Leukemia ◽  
Light Chains ◽  
Specific Probe ◽  
Tonsillar Cells ◽  
Binding Curves

Tumor cells from patients with B cell neoplasms often secrete small amounts of free monoclonal light chains that can be found in the urine. Such tumor-derived light chains of the lambda type from a patient with typical chronic lymphocytic leukemia have been used to raise mouse monoclonal antibodies (MoAbs). A hybridoma-secreting antibody that recognized the idiotypic lambda chain but not normal lambda chains by a preliminary screen but which also reacted with idiotypic IgM from the patient's tumor cells was selected. This MoAb in fact recognized 1 in 20 X 10(3) molecules of pooled normal lambda chains, thus establishing its specificity for a private idiotypic determinant. It failed to give a detectable reaction with normal IgM, normal serum, or a panel of IgM paraproteins. The antibody bound to the patient's neoplastic B cells but not to normal tonsillar cells. The site of binding of the antibody to idiotypic IgM is clearly separate from that of another MoAb specific for idiotypic determinants on heavy plus light chains, since the two showed additive binding curves. The determinant also appeared to be less available in dimeric lambda chains than in monomeric lambda chains or in idiotypic IgM. Antibodies to idiotypic determinants on light chains show some technical advantages and should be useful for monitoring and possibly treating B cell tumors, either alone or together with the more conventional anti-idiotypic antibodies that usually recognize the heavy and light chain combination.

Assessing the haematology and serum chemistry of Uda rams fed different Kanwa based mineral licks

2021 ◽  
Vol 6 (6) ◽  
pp. 209-215
Author(s):  
A. Abdulkarim ◽  
◽  
K. M. Aljameel ◽  
Keyword(s):  
Reference Range ◽  
Health Hazard ◽  
Serum Biochemistry ◽  
Serum Chemistry ◽  
Normal Range ◽  
Blood Profile ◽  
Normal Reference Range ◽  
Normal Reference ◽  
Mineral Licks ◽  
Sheep Production

This study was conducted at the Department of Animal Science’s Teaching and Research farm of Usmanu Danfodiyo University, Sokoto to evaluate the effect of feeding different kanwa based mineral licks on blood profile of Uda rams. Blood of twenty (20) yearlings Uda rams aged by dentition were used to evaluate the effect of Kanwa¬-based mineral blocks. Four (4) animals were allotted to each treatment (Kanwa block) with each animal serving as a replicate. The Kanwa used were Kanwan Bai-Bai, Kanwan Kolo, Hogga, Balma and conventional mineral lick to represent treatment 1, 2, 3, 4 and 5 respectively. Data was collected at the end of the experiment. The result of haematological analysis showed significant (p<0.05) differences in all the parameters analysed except PCV, MCH, WBC and eosinophil; the result indicated that all the values where within the normal reference range except in MCHC where animals placed in T2 and T3 shows values slightly above the normal range. The result of serum biochemistry showed that all the values measured were within the normal reference range for sheep except the albumin of animals placed in T3 which had values slightly above the normal range. The serum mineral composition showed that Potassium levels were higher in T2 and lower in T4; however, there was no difference between animals placed in treatments 1, 2 and 3, so also between treatments 1, 3 and 4. The study concluded that Kanwa positively affected sheep production with no adverse effect on both haematological and serum chemistry, hence little health hazard is associated with feeding Kanwa-based blocks on growing Uda rams.

Free Light Chains, Monoclonal Proteins, and Chronic Lymphocytic Leukemia.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4697-4697 ◽  
Author(s):  
Rosa Ruchlemer ◽  
Constantine Reinus ◽  
Esther Paz ◽  
Ahuva Cohen ◽  
Natalia Melnikov ◽  
...  
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Light Chain ◽  
Lymphocytic Leukemia ◽  
Light Chains ◽  
P Value ◽  
Advanced Stage ◽  
Free Light Chains ◽  
Monoclonal Protein ◽  
Low Levels ◽  
Monoclonal Proteins

Abstract Monoclonal proteins(MPs) can frequently be detected in the serum/urine of chronic lymphocytic leukemia(CLL) patients. Serum free light chains(FLC) assays can detect MPs in the absence of M bands on immunofixation(IMF).An abnormal FLC ratio indicates excess of one light chain type suggesting clonality.We evaluated fresh serum/urine samples from 34 CLL patients at various stages of disease by quantitative nephelometric assay,IMF and FLC assay.Median age was 66 yrs(43–87),M:F 1.9:1 and median time from diagnosis 41.5 mos(5–288). 45% had advanced stage and 39% prior treatment with 1–7 therapies.Only 2 patients had mild renal failure.Serum immunoglobulins were normal/low in 94% of patients:IgG (171–1580 mg/l, median 803 mg/l), IgA(<25–310 mg/l, median 88 mg/l),IgM(<18–290 mg/l, median 38 mg/l), irrespective of the presence of a monoclonal protein. 71% of patients had evidence of abnormal immunoglobulin synthesis: by IMF alone (8),IMF and FLC(10) or FLC alone(8).Abnormal FLC ratios were more frequently associated with advanced stage disease and increased κ chains(see table 1). Abnormal FLC ratios(< 0.26 or >1.65) were measured in 18(53%) patients, 8 of whom did not have MPs by IMF. Two advanced stage patients had abnormal FLC ratios due to very low levels of a single light chain, most probably reflecting secondary hypogammaglobulinemia due to CLL and/or chemotherapy.Abnormal FLC ratios reverted to normal after 1 course of chemotherapy(FC+/−R) in 3 patients despite persistence of minimal residual disease(MRD).FLC were of the same type as expressed on the surface of CLL cells, with discrepancies observed in 5 patients.BM biopsy staining for light chains revealed IgAκ MGUS in addition to λ chain restricted CLL in one patient, but was noncontributory in the other 4. Conclusions: Neither IMF nor the FLC assay alone could detect all MPs. Normal FLC ratios do not exclude the presence of MPs. The FLC ratio should be interpreted with caution in CLL patients with advanced disease and hypogammaglobulinemia. Monoclonal bands and abnormal FLC ratios can be detected despite normal or low levels of serum immunoglobulins in CLL patients. The significance of these monoclonal gammopathies in CLL is not clear and warrants further study in a larger group of patients. Discrepancies between surface immunoglobulins and serum/urine MPs might suggest the presence of an additional condition:ex. MGUS. FLC may not be a sensitive measure of MRD. Normal FLC ratio Abnormal FLC ratio P value *median No. patients 16(47%) 18(53%) M:F 1.3:1 3.5:1 NS Age* 62.5 yrs(49–73) 68 yrs(43–87) NS Time from CLL diagnosis* 25.3 mos(0–282) 59 mos(0–210) NS Adv stage(Rai III/IV-Binet C) 25% 66.7% 0.018 Untreated 62% 50% NS CLL:κ:λ restriction 7:8(0.88:1) 11:6(1.8:1) NS Monoclonal protein 8(50%) 10(56%) NS Increased freeκ no. 8 15 0.043 Freeκ level* 19.6(4.5–200) 39.2(2.9–386) 0.0064 Increased freeλ no 4 3 NS Free λ level* 19.3(12.4–146) 15.4(0.1–517) NS Serum β 2m* 3.1(1.8–6.7) 4.3(2.2–10.2) NS Zap70≥20 86% 36% 0.002 CD38≥30 44% 44% NS 17pdel/11qdel 40% 44% NS

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