J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 9, Number 10, October 2017, pages 826-830

Prospective Identification of Oligoclonal/Abnormal Band of the Same Immunoglobulin Type as the Malignant Clone by Differential Location of M-Spike and Oligoclonal Band

Figures

Figure 1. SPEP and SIFE in November 2016. A prominent monoclonal band is present at the beta-gamma interface on SPEP, which typed as IgG kappa on SIFE. The background immunoglobulins are markedly suppressed.

Figure 2. SPEP and SIFE in April 2017. The original malignant IgG kappa clone is absent on both SPEP and SIFE. A faint (0.25 g/dL) IgG kappa band is present in the mid-gamma region, clearly in a different location than the original malignant spike seen in Figure 1. Background immunoglobulins are more abundant than those in Figure 1.

Figure 3. SPEP and SIFE in June 2017. The original malignant clone is still absent in both SPEP and SIFE. The mid-gamma IgG kappa band, first noted in April is present at a higher concentration (0.38 g/dL) and an additional, cathodal IgG kappa band is noted at a concentration of about 0.12 g/dL. The second lower concentration band is more readily discernible in the densitometric scan, shown in Figure 4.

Figure 4. Densitometric scan of SPEP from Figure 3 shows the two spikes in gamma region, both of which typed as IgG kappa and constituted about 0.38 and 0.12 g/dL. The higher concentration peak is more anodal to the lower concentration one. The other, normal, peaks are: 1 = albumin; 2 = alpha 1 globulin; 3 = alpha 2 globulin; 4 = beta 1 globulin; 5 = beta 2 globulin; 6 = gamma globulins.

Table

**Table 1.** SPEP/SIFE Data Over Three Tests
Date	Malignant spike	Oligoclonal band	Second oligoclonal band	Immunoglobulin level mg/dL			UPEP/UIFE	Serum free light chain assay results
Date	Malignant spike	Oligoclonal band	Second oligoclonal band	IgA	IgG	IgM	UPEP/UIFE	Kappa	Lambda	K/L ratio
The initial malignant clone disappeared, while an oligoclonal pattern developed, in the following two SPEPs. A second oligoclonal band is also noted on the third SPEP. The κ/λ ratio is kappa dominant in the first two samples, but is in the normal range in the June 2017 sample.
November 2016	2.19 g/dL	0	0	25	2,631	17	IgG kappa	9.25	0.71	13.03
March 2017	0	0.25 g/dL	0	29	994	65	IgG kappa	4.84	2.19	2.21
June 2017	0	0.38 g/dL	0.12 g/dL	51	1,124	46	NA	4.7	3.01	1.56