article Open Access (green) EN 2009-02-21

A monoclonal gammopathy precedes multiple myeloma in most patients

Brendan M. Weiss, Jude Abadie, Pramvir S. Verma, Robin Howard, W. Michael Kuehl

Blood, Vol. 113, Issue 22, pp. 5418–5422 (2009)

Walter Reed Army Institute of Research, Womack Army Medical Center, National Cancer Institute, Center for Cancer Research

DOI: 10.1182/blood-2008-12-195008 PMID: 19234139

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Abstract

Preexisting plasma cell disorders, monoclonal gammopathy of undetermined significance, or smoldering myeloma are present in at least one-third of multiple myeloma patients. However, the proportion of patients with a preexisting plasma cell disorder has never been determined by laboratory testing on prediagnostic sera. We cross-referenced our autologous stem cell transplantation database with the Department of Defense Serum Repository. Serum protein electrophoresis, immunofixation electrophoresis, and serum free light-chain analysis were performed on all sera collected 2 or more years before diagnosis to detect a monoclonal gammopathy (M-Ig). In 30 of 90 patients, 110 prediagnostic samples were available from 2.2 to 15.3 years before diagnosis. An M-Ig was detected initially in 27 of 30 patients (90%, 95% confidence interval, 74%-97%); by serum protein electrophoresis and/or immunofixation electrophoresis in 21 patients (77.8%), and only by serum free light-chain analysis in 6 patients (22.2%). Four patients had only one positive sample within 4 years before diagnosis, with all preceding sera negative. All 4 patients with light-chain/nonsecretory myeloma evolved from a light-chain M-Ig. A preexisting M-Ig is present in most multiple myeloma patients before diagnosis. Some patients progress rapidly through a premalignant phase. Light-chain detected M-Ig is a new entity that requires further study.

Topics

Multiple Myeloma Research and Treatments 1.00 Glycosylation and Glycoproteins Research 1.00 Monoclonal and Polyclonal Antibodies Research 1.00

Field: Medicine · Subfield: Hematology

Keywords

Serum protein electrophoresis,Multiple myeloma,Immunofixation,Monoclonal gammopathy of undetermined significance,Immunoglobulin light chain,Medicine,Monoclonal,Plasma cell,Myeloma protein,Plasmacytoma