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Case Reports
. 2024 May 23;12(6):1153.
doi: 10.3390/biomedicines12061153.

Mass Spectrometry as Alternative Method to Identify and Monitor Non-Secretory Progressive Disease in Patients with Multiple Myeloma

Cristina Agulló  1 , Noemí Puig  2 , Teresa Contreras  1 , Sergio Castro  1 , Borja Puertas  2 , Verónica González-Calle  2 , Beatriz Rey-Búa  2 , María Victoria Mateos  2
Affiliations
Case Reports

Mass Spectrometry as Alternative Method to Identify and Monitor Non-Secretory Progressive Disease in Patients with Multiple Myeloma

Cristina Agulló et al. Biomedicines. .

Abstract

Introduction: After receiving different lines of treatment, multiple myeloma patients tend to present with less secretory and more frequent extramedullary disease. These features make treatment monitoring and follow-up very complex since they have to be based on the use of imaging methods and/or bone marrow aspirations or biopsies.

Objective: To present the case of a patient with myeloma progressing with non-secretory bone disease and to discuss the potential impact of mass spectrometry as a new highly sensitive method able to identify the monoclonal protein (MP) in the serum of these types of patients.

Materials and methods: Informed consent was signed by the patient prior to receiving each line of treatment. The clinical information and images were obtained from anonymized electronic files. The mass spectrometry was performed with the Immunoglobulin Isotypes (GAM) assay for the mass spectrometry EXENT® Analyser Technology from Binding Site, part of Thermofisher.

Results: A 73-year-old male with IgG kappa multiple myeloma progressing with a new lytic lesion after receiving 14 cycles of Talquetamab as a third line of therapy who, due to the non-secretory nature of the disease at this point, could not be enrolled in a clinical trial, thus limiting his therapeutic options. The mass spectrometry was able to identify and quantify the presence of the patient's MP when the serum protein electrophoresis and immunofixation were still negative and therefore could have been used to confirm the progression, to permit the inclusion of the patient in a clinical trial and to further monitor the disease response.

Conclusions: The higher sensitivity of the mass spectrometry methods to detect the MP in patients with myeloma and other monoclonal gammopathies translates into better identification of the disease progression, permits the inclusion of more patients in clinical trials and facilitates treatment monitoring.

Keywords: mass spectrometry; multiple myeloma; non-secretory disease; treatment monitoring.

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Conflict of interest statement

C.A. has received a speaker honorarium from Company The Binding Site; N.P. has received research grants from Celgene, Janssen, Amgen, Takeda; and speaker honorarium from Celgene and The Binding Site; M.V.M. has received honorarium and is a membership on an entity’s Board of Directors or advisory committees for Janssen, Celgene, Takeda and Amgen, Adaptive, GSK, Sanofi and Oncopeptides and also is honoraria from membership in Board of Directors or advisory committees for Abbvie, Roche, Pfizer, Regeneron and Seattle Genetics; T.C. has received speaker honorarium from The Binding Site.; V.G.-C. has received research grants from Janssen and consulting or advisory role for Prothena and Janssen; B.P. has received research grants from Janssen; B.R.-B. has received research grants from Janssen. The rest of the authors declare no conflicts of interest. The funders had no role in the study’s design, in the collection, analyses, or interpretation of data, in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
(a) SPEP (positive, showing the presence of MP IgG kappa migrating in the gamma region of proteinogram, with 7 g/L concentration) and mass spectra (positive, showing the presence of MP IgG kappa with 11,796 m/z and 6.95 g/L concentration) regarding patient relapse in 2022; (b) IFE (negative) and mass spectra (positive, showing the presence of a small kappa peak with the exact m/z identified previously, 11,796 m/z).
Figure 1
Figure 1
(a) SPEP (positive, showing the presence of MP IgG kappa migrating in the gamma region of proteinogram, with 7 g/L concentration) and mass spectra (positive, showing the presence of MP IgG kappa with 11,796 m/z and 6.95 g/L concentration) regarding patient relapse in 2022; (b) IFE (negative) and mass spectra (positive, showing the presence of a small kappa peak with the exact m/z identified previously, 11,796 m/z).
Figure 2
Figure 2
Hypermetabolic lytic lesion (SUVmax = 7.7) in the medial third of the right clavicle, not present in the previous study and highly suggestive of progressive disease.
Figure 3
Figure 3
IFE (negative) and mass spectra (positive, showing the presence and concentration of an IgG kappa peak with the exact m/z identified at relapse, 11,796 m/z, with 0.368 g/L of MP concentration).
Figure 4
Figure 4
Progression of hypermetabolic lytic lesion (SUVmax = 19) in the medial third of the right clavicle four months after the previous one.
See this image and copyright information in PMC

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