2017 Roman Lecturer
2017 Roman Lecturer - Ms Jill Tate
Jill works as a Senior Scientist at the Pathology Queensland Department of Chemical Pathology at the Royal Brisbane and Women’s Hospital in Brisbane, Australia. She chairs the International Federation of Clinical Chemistry and Laboratory Medicine Working Group for the Standardisation of Cardiac Troponin I (IFCC WG-TNI) and has previously worked on the IFCC Committee on Standardisation of Markers of Cardiac Damage and the IFCC Working Group on Standardisation of Lipoprotein(a). Jill is currently chair of the Australasian Association of Clinical Biochemists’ Harmonisation Committee which is working on a range of harmonisation activities including common reference intervals, standardised units, terminology and reporting in pathology, and critical laboratory results.
Lecture: 'The paraprotein - an enduring biomarker'
Like many other analytes measured in clinical chemistry, the “paraprotein” (also known as monoclonal or M-protein) has stood the test of time and remains an important biomarker in the diagnosis and monitoring of disease response in plasma cell dyscrasia and other monoclonal gammopathies.
The measurement of paraproteins by electrophoresis gained popularity in the clinical laboratory in the 1960’s. Over the last 40 years new electrophoretic and immunological methods with increased sensitivity have been developed. The introduction of the serum free light chain immunoassay in 2001 has led to a greater understanding of light chain diseases especially AL amyloidosis, nonsecretory myeloma, light chain cast nephropathy, light chain escape (LCE), and monoclonal gammopathy of renal significance (MGRS) in which trace amounts of paraprotein may be difficult to detect by standard electrophoresis and immunofixation techniques in these diseases. Mass spectrometry and flow cytometry methods are now playing a greater role in the detection of minimal residual disease (MRD) and determination of the depth of the “complete response (CR)” as newer treatments in myeloma extend the length of overall patient survival.
Although serum free light chains are now an important part of the guidelines for myeloma and AL amyloidosis, and are recommended for diagnosis and monitoring of disease response, the assay has not been without its technical drawbacks and frustrations to laboratory scientists. Recent clinical evidence suggests that, for the monitoring of response, serum free light chains is more sensitive than urinary Bence Jones protein (BJP). Is this the death knell for urinary BJP?
Serum protein electrophoresis and quantification of paraprotein concentration by densitometry is the cornerstone testing for monoclonal gammopathy. The quantitation of small monoclonal bands hidden among normal proteins remains problematic however and a combination of analytical and reporting strategies are required to differentiate sinister small bands from transient, inflammatory ones. Moreover, a harmonised approach to the quantification, interpretation, and reporting of such bands is needed among laboratories in Australasia. This is because patients are mobile and move between public and private pathology for their laboratory testing.
With continuing development of new technologies and treatments for myeloma, protein laboratories will need to change their testing strategies to keep up with the increasing number of test requests for electrophoresis and serum free light chains as patients are monitored more frequently and live longer.
- 16 May - NSW/ACT Branch
- 23 May - SA/NT Branch
- 25 May - WA Branch
- 15 July - TAS Branch
- 18 July - VIC Branch
- 8 August - QLD Branch
- 7 November - NZ Branch Wellington
- 10 November - NZ Branch Auckland
Further details will be available soon via the Branch events.