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Maria Stella Graziani

Deputy Director
Martina Zaninotto

Associate Editors
Ferruccio Ceriotti
Davide Giavarina
Bruna Lo Sasso
Giampaolo Merlini
Martina Montagnana
Andrea Mosca
Paola Pezzati
Rossella Tomaiuolo
Matteo Vidali

EIC Assistant
Francesco Busardò

International Advisory Board Khosrow Adeli Canada
Sergio Bernardini Italy
Marcello Ciaccio Italy
Eleftherios Diamandis Canada
Philippe Gillery France
Kjell Grankvist Sweden
Hans Jacobs The Netherlands
Eric Kilpatrick UK
Magdalena Krintus Poland
Giuseppe Lippi Italy
Mario Plebani Italy
Sverre Sandberg Norway
Ana-Maria Simundic Croatia
Tommaso Trenti Italy
Cas Weykamp The Netherlands
Maria Willrich USA
Paul Yip Canada

Biomedia srl
Via L. Temolo 4, 20126 Milano

Responsible Editor
Giuseppe Agosta

Editorial Secretary
Chiara Riva
Biomedia srl
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Tel. 0245498282


ISSN print: 0393 – 0564
ISSN digital: 0392- 7091

BC: Articoli scritti da A. Vernocchi

Revisione e aggiornamento del documento di consenso SIBioC per la ricerca e quantificazione della proteina di Bence Jones
Update of the Italian Society of Clinical Biochemistry (SIBioC) Consensus document on the detection and quantification of the Bence Jones protein
<p>Bence Jones protein (BJP) refers to urine monoclonal free immunoglobulin light chains produced by the clonal expansion of a plasma cell in the bone marrow. BJP is strongly associated with systemic amyloidosis AL, light chain deposition disease, and multiple myeloma; less frequently, BJP may be recognized either in patients with monoclonal gammopathies of uncertain significance (MGUS) and with other plasma cell dyscrasias or in patients with malignant non-Hodgkin&#39;s lymphomas and chronic lymphocytic leukemia. This paper contains updated recommendations for the detection and the measurement of BJP in clinical practice from the Working Group &ldquo;Proteins&rdquo; of the Italian Society of Clinical Biochemistry (SIBioC), with specific indications for improving all the steps of the preanalytical, analytical, and postanalytical phases. The first morning void is the urine sample recommended for BJP detection, while 24-hours urine collection is preferred for BJP quantification. Native urine cannot be used for samples with low or very low content in urine total protein; in these cases, samples should be concentrated by using specific disposables, such as ultrafiltration membranes retaining proteins with molecular weight around 10 kDa. The required degree of concentration may vary according to sensitivity of the electrophoretic method utilized and the protein content of the sample. The detection of BJP may be performed directly by the recommended method agarose gel immunofixation (IFE) with specific polyvalent immunoglobulin antisera IgG-IgA-IgM, total  and  light chains; alternatively, an electrophoretic screening may be acceptable to rule out negative test results. However, positive test results should be confirmed by IFE. Tests based on immunometric methods can be used neither as screening test, nor for the BJP quantification; however, it could be useful for monitoring purposes, provided that the renal function of the patient is preserved. BJP measurement should be performed by the densitometric scanning of the electrophoretic peak corresponding to BJP, and results should be expressed as ratio of the BJP peak percentage to the urine total protein. Test results should be always integrated by standardized interpretative comments included in the laboratory reports.</p>
Biochimica Clinica ; 45(1) 075-086
Documenti SIBioC - SIBioC Documents
Interferenze da farmaci biologici: un caso di accumulo di Bevacizumab
Interference by biological anti-cancer drugs: the case of Bevacizumab
<p>We report a case of interference with electrophoretic (CZE) and immunofixation (IFE) techniques after repeated cycles of a biological anti-cancer drug. A man, with colon neoplasia, underwent a prolonged therapy with Bevacizumab and other chemoterapeutic agents from September 2013 until May 2015. Before therapy, the electrophoretic pattern was normal while, during treatment, it showed a modification suggestive of the presence of a monoclonal component (MC) that was possible to type (IgG <span style="font-family:symbol; font-size:11.0pt">k</span>) and to quantify (8 g/L) after 22 cycles of therapy. The cooperation with clinicians and our study about biological drugs, allowed us to recognize this MC as an interference due to the accumulation of Bevacizumab in the serum of the patient. The laboratory report of a MC would have involved the patient in further procedures that are invasive, cost and time expensive. This case emphasizes the importance of a strict collaboration between physicians and the clinical laboratory in the management of patients treated with biological drugs.</p>
Biochimica Clinica ; 42(1) e05-e07
Casi clinici - Case report
Indicazioni per la quantificazione delle componenti monoclonali nel siero
Recommendations for the quantification of serum monoclonal components (MC)
<p>The quantification of MC&nbsp;provides a surrogate for monitoring the size of the population of malignant cells in patients affected by plasma cell&nbsp;disease (PCD). Consequently, clinical and laboratory guidelines on diagnosis, risk stratification and monitoring of PCD&nbsp;recommend MC quantification as a key information for patient management. To do that, liquid phase immunochemical&nbsp;determination of IgG, IgA and IgM in serum should not be used, because of the inability of the technique to distinguish&nbsp;between monoclonal and polyclonal immunoglobulins. However, new available immunoassays specifically measuring&nbsp;free light chains, or the &ldquo;so-called&rdquo; Hevylite assay, may reliably quantify specific MC. As a general recommendation, MC&nbsp;should be quantified on agarose gel electrophoresis by scanning densitometry or from capillary zone electrophoresis&nbsp;readout only, provided that a high resolution electrophoresis is performed and a low concentration MC obscured by other&nbsp;proteins is not present. For integration of the MC peak on electrophoresis, perpendicular drop method is recommended.&nbsp;MC is a critical &ldquo;analyte&rdquo; as the potential analytical pitfalls (detection limit depending on the position of the MC and on&nbsp;the polyclonal background, poor linearity of scanning methods, precision performance) show. Thus, a comprehensive&nbsp;program of IQC of MC quantification should be implemented as well as an EQAS.</p>
Biochimica Clinica ; 39(3) 199-207
Documenti SIBioC - SIBioC Documents
Prevalenza di gammopatia monoclonale di incerto significato (MGUS) in soggetti ambulatoriali di età >50 anni: un’indicazione all’esecuzione dell’elettroforesi delle sieroproteine?
Prevalence of the monoclonal gammopathy of undetermined significance (MGUS) in out-patients >50 years old: an indication to carry out electrophoresis of serum protein?
Biochimica Clinica ; 38(2) 154-155
Lettere all'Editore - Letters to the Editor
Il contributo della diagnostica proteica nella gestione delle gammopatie monoclonali
Protein diagnostics in the management of monoclonal gammopathies
<p>This document examines laboratory tests&nbsp;to be used for the management of monoclonal gammopathies in different clinical scenarios, from screening to&nbsp;monitoring and assessment of the response to therapy. The content is based on international recommendations and&nbsp;guidelines currently available. It includes sections on the analytical aspects of different tests&nbsp;(serum&nbsp;protein&nbsp;electrophoresis, typing and quantification of monoclonal components, Bence Jones protein determination and free&nbsp;light chain measurement) and on their clinical significance as well. Different clinical settings are examined: screening,&nbsp;diagnosis, risk stratification, monitoring and response assessment. For each of those, laboratory tests to be used are&nbsp;indicated. Aim of the document is to help clinical laboratories avoiding unnecessary tests, ensuring in the meantime&nbsp;that all the investigations required for a optimal patient management are carried out.</p>
Biochimica Clinica ; 38(1) 47-53
Documenti SIBioC - SIBioC Documents
Aspetti metodologici nella ricerca e caratterizzazione delle componenti monoclonali nel siero
Methodological issues in detection and typing of serum monoclonal components.
<p>Serum protein electrophoresis (SPE) is a screening test widely used in clinical practice to identify patients with monoclonal gammopathies. SPE, performed on agarose gel (AGE) or by capillary zone electrophoresis (CZE), is the only technique able to recognize a monoclonal immunoglobulin. To detect monoclonal components (MC), SPE must be visually inspected. The two available techniques show similar sensitivity for MC detection (CZE 95%, AGE 91%), with a higher specificity for AGE (99% vs. 78% for CZE). Any MC detected must be reported, because also small B-cell clones could be dangerous. Once detected, MCs need to be quantitatively measured directly on the SPE pattern by setting the limits of the corresponding peak. A concentration-related bias in MC quantitation between AGE and CZE exists. Immunotyping is the further mandatory test for confirmation and characterization of MC by either immunofixation (IFE) or immunosubtraction (ISE). In general, IFE is more sensitive than ISE, but high resolution (HRIFE) must be warranted. However, &#126;25% of IFE carried out on commercially available kits are difficult to interpret and thus not reportable. For identification of&#160; amyloidogenic light chain MC, sensitivity of the manual HR-IFE is 95% vs. 80% of conventional semiautomated assays. The recently introduced quantitative serum assay for immunoglobulin free light chains (FLC) is an accurate index of clonality, particularly for FLC myeloma and AL amyloidosis. To reach the highest sensitivity in MC detection a comprehensive screening panel including SPE, HR-IFE and FLC determination is recommended.</p>
Biochimica Clinica ; 36(2) 084-089
Rassegna - Reviews