Results were presented as the 95% reference populations, as well as the 100% reference range,

so as to allow a comparison to the Freelite™ assay (Katzmann et al., 2002). To generate p38 MAPK signaling pathway the 95% reference results, extreme outliers three times the size of the inter-quartile range were removed. Due to a positively skewed distribution after outlier removal, results were ranked by z-scores to identify the central 95% intervals. 1000 consecutive serum samples received by the Clinical Immunology Service (CIS) for routine clinical measurement of κ and λ FLCs (on Freelite™) were analysed simultaneously on the mAb assay. This exercise served three purposes: to establish the specificity of each mAb at detecting FLC levels in patients with a wide range of disease conditions; to make a comparison with Freelite™; and to serve as a preliminary assessment of the mAb assay in a clinical setting. 209 samples were from patients enrolled in myeloma trials. Of the 791 non-trial patient samples, 292 had a known serum paraprotein, 106 had no paraprotein, and no admission diagnosis was available for the remaining 393 samples. In addition, 289 samples had a matched urine sample and 711 samples had no matched urine. Samples were collected chronologically throughout July and August 2011 as they arrived PLX4032 price at the Clinical

Immunology Service, and inclusion criteria required the sample volume be greater than 500 μL; no other inclusion/exclusion criteria were set. Results generated by each mAb were compared to the results obtained by Freelite™. Edoxaban Experimenters were blind to the original Freelite™ result and patient diagnosis. Any discrepant results between Freelite™ and the mAb assay were repeated on both platforms to exclude the possibility of user/instrument error. A discrepancy was defined as any sample with an abnormal κ:λ FLC ratio on one assay but not the other, or, an elevated FLC concentration outside the normal 95% reference range on one assay but not the other (see

Fig. 2 for reference ranges). To exclude the possibility that anti-FLC mAbs ‘missed’ any monoclonal FLC, any discrepant samples were further investigated by routine serum IFE analysis, IFE and mAb assay analysis of urine, and patient history, if available. The specificity of the anti-FLC mAbs at measuring FLC levels and ability to detect FLC from all patients was further tested in a large cohort of urine samples. An initial comparison was made between the mAb assay and commercially available radial immunodiffusion assays (RID; the Binding Site, UK). Correlations between the two assays were good (results not shown) and a further comparison was made between the mAb assay and densitometric scanning of protein electrophoresis, regarded as the “gold standard” in urine FLC paraprotein quantitation. Individual concentrated urine (30 × concentrated; Zeba) was analysed by densitometry according to the manufacturer’s instructions (Interlab, Italy), total protein (Total Protein Gen.