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Challenges with serum protein electrophoresis in assessing progression and clinical response in patients with Waldenström macroglobulinemia.
[waldenström macroglobulinemia]
Accurate
determination
of
the
immunoglobulin
(
Ig
)
M
paraprotein
concentration
is
crucial
to
evaluating
response
in
patients
with
Waldenström
macroglobulinemia
(
WM
)
.
In
most
clinical
laboratories
,
M-
spike
quantitation
is
performed
by
serum
protein
electrophoresis
,
which
is
the
same
method
used
to
quantitate
IgG
and
IgA
paraproteins
in
patients
with
multiple
myeloma
(
MM
)
.
However
,
the
migration
pattern
and
propensity
of
IgM
paraproteins
to
form
higher-order
complexes
in
serum
makes
laboratory
evaluation
of
samples
from
patients
with
WM
especially
challenging
.
We
review
examples
of
patients
whose
IgM
paraprotein
is
particularly
ill-suited
to
M-
spike
quantitation
by
serum
protein
electrophoresis
:
a
case
of
"
sticky
M
,
"
a
case
of
IgM
multimers
that
can
not
be
resolved
,
and
a
case
of
an
IgM
in
the
β
region
.
In
these
and
similar
cases
,
a
method
other
than
M-
spike
quantitation
,
such
as
IgM
heavy
chain
nephelometry
,
should
be
considered
in
laboratory
evaluation
of
paraprotein
concentration
.
