Treatment of multiple myeloma with monoclonal antibodies and the dilemma of false positive M-spikes in peripheral blood Journal Article


Authors: Murata, K.; McCash, S. I.; Carroll, B.; Lesokhin, A. M.; Hassoun, H.; Lendvai, N.; Korde, N. S.; Mailankody, S.; Landau, H. J.; Koehne, G.; Chung, D. J.; Giralt, S. A.; Ramanathan, L. V.; Landgren, O.
Article Title: Treatment of multiple myeloma with monoclonal antibodies and the dilemma of false positive M-spikes in peripheral blood
Abstract: Objectives To characterize the effect of three humanized IgG κ monoclonal antibodies (daratumumab, isatuximab, and elotuzumab) on the interpretation of results generated by protein electrophoresis, immunofixation, free light chain, and heavy/light chain assays performed on human serum. Methods Healthy volunteer serum and serum from multiple myeloma patients were supplemented with clinically relevant concentrations of each of the three monoclonal antibodies. These specimens then underwent analysis via serum protein electrophoresis, immunofixation, serum free light chain quantification, heavy/light chain quantification, total IgG, and total protein. In addition, serum specimens from patients who had undergone treatment with elotuzumab for multiple myeloma underwent similar analysis. Results Addition of the study drugs to serum from both the healthy donor as well as multiple myeloma patients resulted in a visible and quantifiable M-protein on SPEP and a visible IgGκ band by IFE. Increases were also noted in total IgG, IgGκ, and IgGκ/IgGλ-ratios. Analysis of serum from multiple myeloma patients receiving study drug showed similar findings with an additional IgGκ band and quantifiable M-protein with similar migration patterns in specimens drawn after administration. Conclusion The treatment of multiple myeloma patients with monoclonal antibodies results in a visible and quantifiable M-protein that has the potential to falsely indicate poor response to therapy. © 2016 The Canadian Society of Clinical Chemists
Keywords: cancer patient; multiple myeloma; light chain; in vivo study; in vitro study; drug blood level; m protein; protein electrophoresis; electrophoresis; myeloma; immunofixation; heavy chain; human; male; priority journal; article; elotuzumab; daratumumab; isatuximab; maximum concentration
Journal Title: Clinical Biochemistry
Volume: 51
ISSN: 0009-9120
Publisher: Elsevier Inc.  
Date Published: 2018-01-01
Start Page: 66
End Page: 71
Language: English
DOI: 10.1016/j.clinbiochem.2016.09.015
PROVIDER: scopus
PMCID: PMC5360528
PUBMED: 27664535
DOI/URL:
Notes: Article -- Export Date: 1 March 2018 -- Source: Scopus
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MSK Authors
  1. Sergio Andres Giralt
    516 Giralt
  2. Kazunori Murata
    12 Murata
  3. Hani Hassoun
    146 Hassoun
  4. Guenther Koehne
    174 Koehne
  5. Heather Jolie Landau
    180 Landau
  6. Nikoletta Lendvai
    83 Lendvai
  7. Alexander Meyer Lesokhin
    115 Lesokhin
  8. David Chung
    78 Chung
  9. Samuel Isaac McCash
    8 McCash
  10. Carl Ola Landgren
    188 Landgren
  11. Neha Sanat Korde
    62 Korde