Page 455 - Clinical Hematology_ Theory _ Procedures ( PDFDrive )

CHAPTER 22 ■ Lymphoid and Plasma Cell Neoplasms 439

Battery

Normal Patient Blank Patient

serum serum urine

Albumin Albumin

Alpha globulins Monoclonal Gamma
(“M-protein”) globulins

spike

Beta globulins
Monoclonal Beta
protein globulins

(“M-protein”)
Alpha

Gamma globulins globulins

Serum initially Direction of Urine initially Patient

placed here protein migration placed here serum
in electrical field

FIGURE 22.20 Protein electrophoresis in pl s cell ise se. Seru or urine is pl ce t one en o strip o

gel, cross which n electric l current is pplie . Most proteins h ve neg tive ch rge n igr te tow r the

positive pole t v rious spee s ccor ing to their olecul r weight n ch rge. T e seru on the le shows
n rrow b n in the g globulin region. Seru protein h s spille into urine, which e onstr tes tching

b n . In the sc n o p tient seru on the right, the height o the tr cing is proportion l to the ount o protein

st ine in e ch b n . Monoclon l protein ppe rs s t ll, n rrow ( onoclon l) “M-protein.” (Reprinte ro

McConnell H. T e Nature o Disease Pathology or the Health Pro essions, Phil elphi , PA: Lippincott Willi s
& Wilkins, 2007, with per ission.)

Em erging Therapies t rgeting tu or cells n e ectively e i tes killing

re t ent o newly i gnose n rel pse yelo is o CD38-neg tive–be ring pl s cells vi ntibo y-

r pi ly exp n ing f el bec use o i prove un erst n ing epen ent cell- e i te cytotoxicity (ADCC) n

o ise se biology n ccess to new rugs. When “novel” poptosis. D r tu u b is the ost ctive onoclon l

gents, i uno o ul tory gents (IMiDs), n prote se ntibo y in clinic l tri ls.

inhibitors (PIs) entere the f el ec e go, they were con- ■ Elotuzu b is hu nize nti-SLAMF-7 ntibo y th t

si ere s er in co bin tions with gre ter e c cy. t rgets the cell sur ce glycoprotein CS1 on the yelo

Rese rch is now exten ing to p tients who re experienc- cell n on NK cells resulting in ctiv tion o the NK cells.

ing rel pse. Recent ph se 3 rug tri ls suggest th t co bi- It exerts nti yelo e ect vi ADCC in yelo cell

n tions o new gents with e ch other or with lkyl tor-b se lines n yelo cells.

ther py pro uce response with ore i p ct n prolonge ■ Nivolu b is n ex ple o novel rug th t is b se on

ur tion o re ission n over ll surviv l. V rious novel the ssu ption th t progr e e th 1 (PD-1) p thw y

co bin tion ther pies re e erging or rel pse yelo serves s checkpoint to li it -cell– e i te i une

p tients (see Box 22.4). responses. PD-1–blocking ntibo ies h ve been use to
enh nce i unity in soli tu ors n obt in ur ble

clinic l responses with n ccept ble s ety prof le. PD-1
IMMUNE APPROACHES eng ge ent y represent one e ns by which tu ors

ev e i unosurveill nce.
A newer tre t ent che oi unother py w s intro- ■ A optive cellul r ther py consists o chi eric nti-

uce in 2000. T is str tegy incorpor tes v rious i une gen receptor (CAR) cells or regul tory -cell

ppro ches: interventions.

Chi eric ntigen receptor (CAR) cells represents
Antibodies
process o o i ying utologous cells with CARs g inst

■ D r tu u b is hu nize nti-CD38 ntibo y. It CD19 s ther peutic str tegy or yelo by co bining

cts through ultiple ech nis s o ction by irectly utologous cells with nti-CD CAR.