Study of Electrophoretic pattern in serum of Multiple Myeloma Patients

Multiple myeloma (MM) is a progressive and fatal disease characterised by clonal proliferation and accumulation of immunoglobulin producing cells that are terminally differentiated B cells. MM occurs when the plasma cells in the bone marrow are 10% or more than 10% population. The symptoms of MM include pain in the lower back region or in the ribs , recurrent infections, loss of appetite, nausea , thirst, fatigue, muscle weakness, restlessness etc.Clinically, MM is recognised by the proliferation of malignant plasma cells in the bone marrow, osteolytic lesions seen in radiological examinations, monoclonal gammopathies,anemia, hypercalcaemia, and renal failure. The diagnosis of MM relies primarily on: Blood and urine tests, serum protein electrophoresis, non-invasive radiological examinations and invasive bone marrow biopsy. Electrophoresis separates proteins based on their physical properties, and the subsets of these proteins albumin, alpha-1globulin, alpha-2globulin, beta globulin, and gamma globulins are used in interpreting the results. In the study serum protein electrophoresis was carried out on 0.5% agarose gel by method of Laurell and Laurell, (1955) at biochemistry research division, GCRI, Ahmedabad. Healthy individuals were considered as control group (n = 25) and patients with multiple myeloma (n =28) to access the monoclonal gammopathies, diagnosis of MM and treatment monitoring in MM. In the present study out of twentyeight (n=28) patients; fifteen patients (n=15) were recently diagnosed and 13 were follow-up patients.Out of 15 patients 53 % exhibited monoclonal band (n=8) and 47 % exhibited polyclonal band (n=7). In monoclonal band patients albumin levels were increased and attained values closer to higher limits of normal albumin level, while hypoalbuminaemia occurred in polyclonal band patients.All patients depicting either monoclonal or polyclonal band showed elevated alpha, beta, gamma and total protein levels. In the recently diagnosed 15 MM patients; 73 % suffered from anaemia, along with high ESR and Serum creatinine level was elevated in 86.7 % patients indicating renal damage.In the study, 13 patients were follow-up patients, whose serum protein electrophoresis was performed previously in biochemistry research division; G.C.R.I Ahmedabad .The data of 10 patients was available and was collected. Above patients were treated with standard anti-cancer chemotherapy comprising of combination of Vincristine, Melphelan, Cyclophosphamide, Prednisolone. Serum protein electrophoresis was performed for the above 10 patients following treatment. The results of post-treated patients were compared with pre treated patients. The results of serum protein electrophoresis showed increased albumin level in 50% patients with decrease in alpha fractions, decrease in gamma or beta globulin and increase in albumin / globulin (A/G) ratio in post-treated patients as compared to pre-treated patients. However, the decrease in gamma globulin level and change in A/G ratio were statistically insignificant in post treated patients as compared to pre treated patients, indicating poor response to the treatment. However, based on A/G ratio they were classified as responders and non-responders. Seventy percent patients responded to treatment, while thirty percent were non-responders to treatment as evident by A/G ratio. In the study, responders age range from 33-55 years while non-responder age ranged from 52-67 years, indicating that younger patients were more responsive to the treatment as compared to older patients, inferring the prognostic impact of age on survival seems to be better among younger patients than older patients.