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.

中文翻译：

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血液质谱法比轻链淀粉样变性的标准技术更能检测残留疾病。

在免疫球蛋白轻链 (AL) 淀粉样变性患者中，血液学反应的深度与器官反应和总生存率相关。我们的团队已经证明，使用基质辅助激光解吸/电离飞行时间 (TOF) 质谱 (MS) 进行筛查是诊断和监测浆细胞疾病患者血清的快速、灵敏和准确的方法. 微流液相色谱结合电喷雾电离和四极杆 TOF MS 进一步提高了灵敏度。我们确定了 33 名 AL 淀粉样变性患者，他们获得了淀粉样蛋白完全的血液学反应，他们的骨髓也通过六色流式细胞术检测为阴性，并且将血清样本配对以进行 MS 检测。这些样品进行了血液 MS。通过这些技术发现 4 名患者 (12%) 有残留病灶。MS 残留疾病的存在与更短的进展时间相关（50 个月时为 75% 对 13%，p = 0.003）。在检测残留疾病方面，血液的 MS 优于血清和尿液免疫固定、血清免疫球蛋白游离轻链和骨髓六色流式细胞术。包括尿液 MS 和检测骨髓中克隆浆细胞的下一代技术在内的其他研究将进一步阐明该技术的全部潜力。