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Follow-up of IgD- κ multiple myeloma by monitoring free light chains and total heavy chain IgD: A case report

View Article: PubMed Central - PubMed

ABSTRACT

Immunoglobulin (Ig)D-κ multiple myeloma (MM) is a rare neoplastic disease characterized by an aggressive and rapidly progressing course, which constitutes only a very small proportion of all MM cases. In the present report, the clinical case of a 51-year-old Caucasian woman diagnosed with IgD-κ MM is described. The patient underwent different chemotherapeutic treatments subsequently to a single autologous stem cell transplantation. Despite the inherent difficulty of monitoring IgD levels and performing serum immunofixation electrophoresis, the clinical outcome of the patient was almost uniquely monitored by measuring the levels of κ and λ free light chains (FLCs) and total heavy chain IgD. The data suggest the non-invasive potential and usefulness of FLCs evaluation for early detection of stringent complete remission, follow-up and early detection of disease relapse. In addition, this diagnostic procedure has successfully been employed for the therapeutic monitoring of the present patient, and may represent a very helpful, non-invasive tool for the follow-up of IgD myeloma patients without the requirement of serial bone marrow aspirate.

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Flow cytometric analysis and IFE detection during patient monitoring. (A) Flow cytometric evaluation of the expression of κ and λ chains in normal vs. malignant PCs at diagnosis, upon ASCT and at relapse. Q1-Q4 represent the distinct regions analyzed by flow cytometry, where Q1 comprises λ-positive PCs and Q4 contains κ-positive ones. The green color in the plots represents normal PCs, whereas the red color depicts the presence of neoplastic PCs. These bone marrow aspirates indicate the presence of neoplastic cells at diagnosis, which disappear following ASCT, while they are still present at the time of relapse. Their progress was coherent with the values of serum free light chains tested (B) IFE and Bence Jones protein at diagnosis, pre/post ASCT and during relapse. The term ‘early’ inside parentheses refers to the first post-ASCT timepoint. IFE was performed with the immunoglobulin antisera indicated above each lane. IFE, immunofixation electrophoresis; CD, cluster of differentiation; PC, plasma cell; ASCT, autologous stem cells transplantation; BJ, Bence Jones; GAM, mixed antisera against immunoglobulins G, A and M; SPE, serum protein electrophoresis.
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f1-ol-0-0-4869: Flow cytometric analysis and IFE detection during patient monitoring. (A) Flow cytometric evaluation of the expression of κ and λ chains in normal vs. malignant PCs at diagnosis, upon ASCT and at relapse. Q1-Q4 represent the distinct regions analyzed by flow cytometry, where Q1 comprises λ-positive PCs and Q4 contains κ-positive ones. The green color in the plots represents normal PCs, whereas the red color depicts the presence of neoplastic PCs. These bone marrow aspirates indicate the presence of neoplastic cells at diagnosis, which disappear following ASCT, while they are still present at the time of relapse. Their progress was coherent with the values of serum free light chains tested (B) IFE and Bence Jones protein at diagnosis, pre/post ASCT and during relapse. The term ‘early’ inside parentheses refers to the first post-ASCT timepoint. IFE was performed with the immunoglobulin antisera indicated above each lane. IFE, immunofixation electrophoresis; CD, cluster of differentiation; PC, plasma cell; ASCT, autologous stem cells transplantation; BJ, Bence Jones; GAM, mixed antisera against immunoglobulins G, A and M; SPE, serum protein electrophoresis.

Mentions: In March 2007, a 51 year-old woman presented for the first time at the Hematology and Stem Cell Trasplantation Unit of the Italian National Cancer Institute ‘Regina Elena’ with multiple osteolytic lesions. PC flow cytometry characterization (FACSCanto™; BD Biosciences, Franklin Lakes, NJ, USA) identified an infiltration (23% of bone marrow population) of cluster of differentiation (CD)38+ CD138+ CD28+ CD56+ CD117+ CD19− CD45− tumor PCs, with κ-sFLC restriction, as illustrated by flow cytometric analysis at diagnosis (Fig. 1A). Bone marrow examination by FISH revealed no abnormalities.


Follow-up of IgD- κ multiple myeloma by monitoring free light chains and total heavy chain IgD: A case report
Flow cytometric analysis and IFE detection during patient monitoring. (A) Flow cytometric evaluation of the expression of κ and λ chains in normal vs. malignant PCs at diagnosis, upon ASCT and at relapse. Q1-Q4 represent the distinct regions analyzed by flow cytometry, where Q1 comprises λ-positive PCs and Q4 contains κ-positive ones. The green color in the plots represents normal PCs, whereas the red color depicts the presence of neoplastic PCs. These bone marrow aspirates indicate the presence of neoplastic cells at diagnosis, which disappear following ASCT, while they are still present at the time of relapse. Their progress was coherent with the values of serum free light chains tested (B) IFE and Bence Jones protein at diagnosis, pre/post ASCT and during relapse. The term ‘early’ inside parentheses refers to the first post-ASCT timepoint. IFE was performed with the immunoglobulin antisera indicated above each lane. IFE, immunofixation electrophoresis; CD, cluster of differentiation; PC, plasma cell; ASCT, autologous stem cells transplantation; BJ, Bence Jones; GAM, mixed antisera against immunoglobulins G, A and M; SPE, serum protein electrophoresis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998028&req=5

f1-ol-0-0-4869: Flow cytometric analysis and IFE detection during patient monitoring. (A) Flow cytometric evaluation of the expression of κ and λ chains in normal vs. malignant PCs at diagnosis, upon ASCT and at relapse. Q1-Q4 represent the distinct regions analyzed by flow cytometry, where Q1 comprises λ-positive PCs and Q4 contains κ-positive ones. The green color in the plots represents normal PCs, whereas the red color depicts the presence of neoplastic PCs. These bone marrow aspirates indicate the presence of neoplastic cells at diagnosis, which disappear following ASCT, while they are still present at the time of relapse. Their progress was coherent with the values of serum free light chains tested (B) IFE and Bence Jones protein at diagnosis, pre/post ASCT and during relapse. The term ‘early’ inside parentheses refers to the first post-ASCT timepoint. IFE was performed with the immunoglobulin antisera indicated above each lane. IFE, immunofixation electrophoresis; CD, cluster of differentiation; PC, plasma cell; ASCT, autologous stem cells transplantation; BJ, Bence Jones; GAM, mixed antisera against immunoglobulins G, A and M; SPE, serum protein electrophoresis.
Mentions: In March 2007, a 51 year-old woman presented for the first time at the Hematology and Stem Cell Trasplantation Unit of the Italian National Cancer Institute ‘Regina Elena’ with multiple osteolytic lesions. PC flow cytometry characterization (FACSCanto™; BD Biosciences, Franklin Lakes, NJ, USA) identified an infiltration (23% of bone marrow population) of cluster of differentiation (CD)38+ CD138+ CD28+ CD56+ CD117+ CD19− CD45− tumor PCs, with κ-sFLC restriction, as illustrated by flow cytometric analysis at diagnosis (Fig. 1A). Bone marrow examination by FISH revealed no abnormalities.

View Article: PubMed Central - PubMed

ABSTRACT

Immunoglobulin (Ig)D-κ multiple myeloma (MM) is a rare neoplastic disease characterized by an aggressive and rapidly progressing course, which constitutes only a very small proportion of all MM cases. In the present report, the clinical case of a 51-year-old Caucasian woman diagnosed with IgD-κ MM is described. The patient underwent different chemotherapeutic treatments subsequently to a single autologous stem cell transplantation. Despite the inherent difficulty of monitoring IgD levels and performing serum immunofixation electrophoresis, the clinical outcome of the patient was almost uniquely monitored by measuring the levels of κ and λ free light chains (FLCs) and total heavy chain IgD. The data suggest the non-invasive potential and usefulness of FLCs evaluation for early detection of stringent complete remission, follow-up and early detection of disease relapse. In addition, this diagnostic procedure has successfully been employed for the therapeutic monitoring of the present patient, and may represent a very helpful, non-invasive tool for the follow-up of IgD myeloma patients without the requirement of serial bone marrow aspirate.

No MeSH data available.


Related in: MedlinePlus