Blood mass spectrometry detects residual disease better than standard techniques in light-chain amyloidosis

Angela Dispenzieri, Bonnie Arendt, Surendra Dasari, Mindy Kohlhagen, Taxiarchis Kourelis, Shaji K. Kumar, Nelson Leung, Eli Muchtar, Francis K. Buadi, Rahma Warsame, Robert A. Kyle, Martha Q. Lacy, David Dingli, Prashant Kapoor, Wilson I. Gonsalves, Ronald S. Go, Suzanne R. Hayman, Yi Lisa Hwa, Amy Fonder, Miriam HobbsDragan Jevremovic, John A. Lust, Steven Zeldenrust, Steve J. Russell, S. Vincent Rajkumar, Morie A. Gertz, David Murray

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

In patients with immunoglobulin light-chain (AL) amyloidosis, depth of hematologic response correlates with both organ response and overall survival. Our group has demonstrated that screening with a matrix-assisted laser desorption/ionization-time-of-flight (TOF) mass spectrometry (MS) is a quick, sensitive, and accurate means to diagnose and monitor the serum of patients with plasma cell disorders. Microflow liquid chromatography coupled with electrospray ionization and quadrupole TOF MS adds further sensitivity. We identified 33 patients with AL amyloidosis who achieved amyloid complete hematologic response, who also had negative bone marrow by six-color flow cytometry, and who had paired serum samples to test by MS. These samples were subjected to blood MS. Four patients (12%) were found to have residual disease by these techniques. The presence of residual disease by MS was associated with a poorer time to progression (at 50 months 75% versus 13%, p = 0.003). MS of the blood out-performed serum and urine immunofixation, the serum immunoglobulin free light chain, and six-color flow cytometry of the bone marrow in detecting residual disease. Additional studies that include urine MS and next-generation techniques to detect clonal plasma cells in the bone marrow will further elucidate the full potential of this technique.

Original languageEnglish (US)
Article number20
JournalBlood cancer journal
Volume10
Issue number2
DOIs
StatePublished - Feb 1 2020

ASJC Scopus subject areas

  • Hematology
  • Oncology

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