Breaking News
December 10, 2018 - A Tale of Two Labels
December 10, 2018 - Triple combination cancer immunotherapy improves outcomes in preclinical melanoma model
December 10, 2018 - A 14-year-old explains what it’s like to get a new heart
December 10, 2018 - Team Players Honored with 2018 Baton Awards
December 10, 2018 - Global report highlights how the changing world is affecting children’s physical activity levels
December 10, 2018 - Genes play a role in physical activity and sleep
December 10, 2018 - DDT in Alaskan fish shown to increase risk of cancer
December 10, 2018 - Laws to curb use of cell phones have greatly reduced fatalities for motorcyclists
December 10, 2018 - Argenx Provides Detailed Data from Phase 2 Clinical Trial of Efgartigimod in Immune Thrombocytopenia and Phase 1/2 Clinical Trial of Cusatuzumab in Acute Myeloid Leukemia
December 10, 2018 - University of Maryland doctors treat first breast cancer patients with GammaPod radiotherapy
December 10, 2018 - The heartbeat seat: Demoing new well-being technologies in a car
December 10, 2018 - Leading Cancer Researcher to Direct Herbert Irving Comprehensive Cancer Center
December 10, 2018 - Study compares pain-related diagnoses in First Nations and non-First Nations children, youth
December 10, 2018 - Scientists find answers to how cancer spreads
December 10, 2018 - Study explores why older people read more slowly
December 10, 2018 - Smart life-collar could save lives of young children
December 10, 2018 - Asbestos found in most NHS hospitals finds BBC inquiry
December 10, 2018 - Researchers use new technique to probe hydrogen bonds
December 10, 2018 - Music improves social communication in autistic children
December 10, 2018 - Some Brain Tumors May Respond to Immunotherapy, New Study Suggests
December 10, 2018 - Banning junk food ads to combat childhood obesity
December 10, 2018 - Skin Autofluorescence Predicts T2DM, Heart Disease, Mortality
December 10, 2018 - Largest autism sequencing study to date yields 102 genes associated with ASD
December 10, 2018 - Statins associated with low risk of side effects
December 10, 2018 - Episodic memory tests help in predicting brain atrophy and Alzheimer’s disease
December 10, 2018 - Study explores how schools address adolescent self-harming practices
December 10, 2018 - Pregnancy in adolescence linked to increased risks of complications in young mothers
December 10, 2018 - Risk Analysis publishes special issue on communicating about Zika virus
December 10, 2018 - Botox May Help Prevent Post-Op A-Fib
December 10, 2018 - African-American mothers rate boys higher for ADHD
December 10, 2018 - Graphic warning labels cancel out cigarettes’ appeal to young people
December 10, 2018 - Australian researchers to study gas inhalational anaesthetic and likelihood of cancer return
December 10, 2018 - Individual neurons located within the brain have implications for psychiatric diseases
December 10, 2018 - Researchers improve bariatric surgery scoring system to extend prediction time for diabetic remission
December 10, 2018 - HPV type 16 or 18 associated with cervical cancer risk in young women
December 10, 2018 - Cervical cancer risk is higher in women with positive HPV, but no cellular abnormalities
December 10, 2018 - Combo therapy not needed if low RA disease activity achieved
December 10, 2018 - Novel therapeutic targets based on biology of aging show promise for Alzheimer’s disease
December 10, 2018 - UC San Diego professor receives NCI Outstanding Investigator Award for cancer research
December 10, 2018 - Study evaluates placental mesenchymal stem cell sheets for myocardial repair and regeneration
December 10, 2018 - Blueprint Medicines Announces Updated Results from Ongoing EXPLORER Clinical Trial of Avapritinib Demonstrating Broad Clinical Activity and Significant Symptom Reductions in Patients with Systemic Mastocytosis
December 10, 2018 - Study clarifies ApoE4’s role in dementia
December 10, 2018 - Eating disorders now a top priority with Australian Government
December 10, 2018 - Neuronal activity in the brain allows prediction of risky or safe decisions
December 10, 2018 - FDA Alerts Health Care Professionals and Patients Not to Use Drug Products Intended to be Sterile from Promise Pharmacy
December 10, 2018 - Improving dementia care and treatment saves thousands of pounds in care homes
December 10, 2018 - Heroin-assisted treatment can offer benefits, reduce harms
December 10, 2018 - People covered by Michigan’s expanded Medicaid program report improvements in health, finds study
December 10, 2018 - Hazelnuts improve micronutrient levels in older adults
December 9, 2018 - History of Partner Violence Tied to Menopause Symptoms
December 9, 2018 - Clean Up Safely After a Disaster|Natural Disasters and Severe Weather
December 9, 2018 - Drug wholesalers drove fentanyl’s deadly rise, report concludes
December 9, 2018 - Deprescribing could help manage polypharmacy in older adults
December 9, 2018 - Retraction of article “Joy of cooking too much” from journal
December 9, 2018 - FDA Warns of Rare Stroke Risk With MS Drug Lemtrada (Alemtuzumab)
December 9, 2018 - Feds say heroin, fentanyl remain biggest drug threat to US
December 9, 2018 - Eliminating microglia can reverse some aspects of stress sensitization, study shows
December 9, 2018 - New genetic insight could help treat rare debilitating heart and lung condition
December 9, 2018 - MiRagen Therapeutics Announces Final Safety, Biodistribution and Clinical Efficacy Data From Phase 1 Cobomarsen Clinical Trial in Patients With Mycosis Fungoides
December 9, 2018 - Work with your doctor to weigh pros, cons of treatment options for hyperthyroidism
December 9, 2018 - CWRU researcher secures $14.6 million funding for genetic study into Alzheimer’s disease
December 9, 2018 - High intensity statin treatment and adherence could save more lives
December 9, 2018 - Surgery patients use only 1/4 of prescribed opioids, and prescription size matters
December 9, 2018 - AXT offers Phi Optics upgrade to QPI systems for inverted light microscopes
December 9, 2018 - New booklet could help improve conditions of young pupils with albinism
December 9, 2018 - Few Physicians Work in Practices That Use Telemedicine
December 9, 2018 - Older Adults and Oral Health
December 9, 2018 - Health utility values improve after septorhinoplasty
December 9, 2018 - New EU-funded project provides insight into how the brain develops
December 9, 2018 - Expanded use of tele-emergency services can help strengthen rural hospitals
December 9, 2018 - Infections in the Young May Be Tied to Risk for Mental Illness: Study
December 9, 2018 - Profile: Native Hawaiians and Pacific Islanders
December 9, 2018 - Snoring poses greater cardiac risk to women
December 9, 2018 - Researcher takes further steps in understanding how and why cute aggression occurs
December 9, 2018 - Researchers create new light-activated tools for controlling neurons
December 9, 2018 - Spinal cord injury disrupts the body’s internal clock, study shows
December 9, 2018 - Babies recognize nested structures similar to our grammar
December 9, 2018 - UT Austin researcher receives $2.5 million CZI grant for neurodegenerative disease research
December 9, 2018 - Sleep problems found to be prevalent and increasing among college students
December 9, 2018 - Study reveals why some children are susceptible to the effects of maltreatment
New study suggests testing urine and blood serum as better way to diagnose myeloma

New study suggests testing urine and blood serum as better way to diagnose myeloma

image_pdfDownload PDFimage_print

When it comes to diagnosing a condition in which the plasma cells that normally make antibodies to protect us instead become cancerous, it may be better to look at the urine as well as the serum of our blood for answers, pathologists say.

The condition is monoclonal gammopathy, in which immune cells called plasma cells start making just one immunoglobulin, or antibody, instead of their usual vast array. The result can be the cancer multiple myeloma.

“When you test the serum, we suggest you also test the urine whenever you suspect that somebody has a tumor of the plasma cells,” says Dr. Gurmukh Singh, vice chair of clinical affairs for the Department of Pathology at the Medical College of Georgia at Augusta University.

The decades-old urine test is still used by pathologists and requested by physicians, but its use declined when the serum free light chain assay became available about a dozen years ago, Singh says, and some physicians may now think that the urine test is redundant. The different tests look in the serum or urine for signs of the abnormal antibody, and to see if the usual ratio is off for two types of a portion of the antibody, called light chains.

The new study, published in the Journal of Clinical Medicine Research, indicates that if the multiple myeloma is associated with the type called the lambda light chain, there is about a 25 percent chance the problem will not be detected by the serum test for free light chains, the investigators report from their retrospective review of tests on 175 patients.

“If you have a lambda chain-associated lesion and you don’t do a urine study, just rely on the serum free light chain assay, about 1 out of 4 times, the assay will tell you that you don’t have anything when you actually do,” says Dr. Won Sok Lee, fourth-year pathology resident at MCG and AU Health and the study’s coauthor.

Plasma cells are immune cells that live in our bone marrow and produce immunoglobulins, antibodies that attach to and attack invaders. When the plasma cells go bad, they instead start producing a single, dysfunctional immunoglobulin.

The Y-shaped immunoglobulins are comprised of pieces of protein called “heavy” and “light” chains and, as the name implies, the light chains are literally lighter. Light chains have two different types, kappa and lambda, which are distinctive in their amino acid sequence. We normally make about twice as many kappa light chains, but cancer can affect both light chains.

In multiple myeloma, the relevant light chain production goes up but kappa goes up a lot more, says Singh, the study’s corresponding author and Walter L. Shepheard Chair in Clinical Pathology at MCG.

Sometimes their ratio stays normal even when an abnormal lambda immunoglobulin is showing up in the urine.

Conversely, nearly 40 percent of patients have an abnormal ratio without having monoclonal gammopathy, the investigators write.

These variabilities mean some patients, particularly those with the less-common lambda chain-associated lesions, could go undiagnosed, Lee says.

“You may go undiagnosed because the serum free light chain test either is not picking up those abnormal proteins or the lambda lesions don’t make that many excess abnormal proteins,” Singh notes.

Underdetection of the lambda light chains floating in the serum may account for the false negative ratio found in about 25 percent of patients who clearly had an abnormal antibody produced by a lambda lesion present in their urine, the investigators report.

Underproduction of lambda free light chains in these patients likely accounts for another 5 percent of false negatives, they write.

In fact, the kappa/lambda ratio showed excess kappa chains in about 90 percent of the patients who had an abnormal ratio without a tumor of the plasma cells, the investigators say.

With lambda chain-associated lesions, the ratio is not abnormal nearly as frequently. In fact, there is a high false negative rate for a lambda-dominant ratio in monoclonal gammopathies associated with lambda chains, they write, possibly due to the under-detection of lambda light chains in the serum.

Therein lies the problem with not looking for errant antibodies and light chain ratios in the urine, Lee says. Ratios can look normal in the serum, while the urine has monoclonal lambda chains.

“If it’s in the urine, you are making abnormal free light chains,” Lee says. Conversely, the ratio can look abnormal in the serum in people who don’t have cancer.

Although more costly, the urine test is a better diagnostic tool in this case, because it enables the pathologist to give better information back to physicians and patients, Lee says. He notes that kappa lesions are more common.

The investigators found a systematic underdetection of serum free lambda light chains by the serum free light chain assay and an underdetection as well of the lambda dominant ratio.

Examination of serum free light chains is currently recommended for diagnosing and monitoring monoclonal gammopathies, although, the investigators write, there are differing opinions on its usefulness. If initial tests indicate a problem, a bone marrow biopsy is typically performed to confirm a diagnosis.

Excessive light chains produced normally are easily excreted in the urine because of their small size. With monoclonal gammopathy, some of the excess light chains can get trapped in the kidneys and damage kidney function.

They examined test results on 175 patients who had serum protein electrophoresis/serum protein immunofixation electrophoresis; urine protein electrophoresis/urine protein immunofixation electrophoresis; and serum free light chain assay from 2010-16.

Early symptoms of monoclonal gammopathy can be nonspecific, like feeling poorly, and if it becomes cancer, one of the first symptoms may be a fractured bone because the cancerous cells have started consuming bone, Singh says. Anemia, an increase in serum calcium and kidney failure are other symptoms.

Tagged with:

About author

Related Articles