Limits...
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.

No MeSH data available.


Related in: MedlinePlus

Graphical representation of serum free light chains, κ/λ ratio and IgD during the overall monitoring phase of the IgD-κ multiple myeloma patient. The plot depicts all collected data in the course of the monitoring of the patient, from October 2007 to June 2013. The numbers of cycles of bortezomib, Myocet® and dexamethasone chemotherapy are indicated. The black arrow represents the initiation of the relapse phase. ASCT, autologous stem cell transplant; BMD, bortezomib, Myocet® and dexamethasone chemotherapy; Ig, immunoglobulin.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4998028&req=5

f3-ol-0-0-4869: Graphical representation of serum free light chains, κ/λ ratio and IgD during the overall monitoring phase of the IgD-κ multiple myeloma patient. The plot depicts all collected data in the course of the monitoring of the patient, from October 2007 to June 2013. The numbers of cycles of bortezomib, Myocet® and dexamethasone chemotherapy are indicated. The black arrow represents the initiation of the relapse phase. ASCT, autologous stem cell transplant; BMD, bortezomib, Myocet® and dexamethasone chemotherapy; Ig, immunoglobulin.

Mentions: The patient was classified as ‘non responder’ to the different chemotherapeutic agents; however, the patient was selected for ASCT in April 10, 2008 (Fig. 2). Following ASCT, severe complications occurred, including pneumonia with Morganella morganii infection and then sepsis. Based on these observations, the hematological asset of the patient was re-evaluated upon ASCT, and bone barrow immunophenotyping revealed a 0.1% of PC population in the lymphocytes region. As displayed by post-ASCT flow cytometric analysis, the sFLC κ/λ ratio decreased, and no presence of neoplastic PCs was detected (Fig. 1A). In parallel, sIFE appeared without a monoclonal component, and the level of BJ protein was less pronounced overtime (Fig. 1B). Furthermore, these parameters were associated with a marked reduction in κ-sFLC (Fig. 3), suggesting that the patient was effectively responding to the treatment. However, osteolytic lesions were still present but did not progress overtime.


Follow-up of IgD- κ multiple myeloma by monitoring free light chains and total heavy chain IgD: A case report
Graphical representation of serum free light chains, κ/λ ratio and IgD during the overall monitoring phase of the IgD-κ multiple myeloma patient. The plot depicts all collected data in the course of the monitoring of the patient, from October 2007 to June 2013. The numbers of cycles of bortezomib, Myocet® and dexamethasone chemotherapy are indicated. The black arrow represents the initiation of the relapse phase. ASCT, autologous stem cell transplant; BMD, bortezomib, Myocet® and dexamethasone chemotherapy; Ig, immunoglobulin.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f3-ol-0-0-4869: Graphical representation of serum free light chains, κ/λ ratio and IgD during the overall monitoring phase of the IgD-κ multiple myeloma patient. The plot depicts all collected data in the course of the monitoring of the patient, from October 2007 to June 2013. The numbers of cycles of bortezomib, Myocet® and dexamethasone chemotherapy are indicated. The black arrow represents the initiation of the relapse phase. ASCT, autologous stem cell transplant; BMD, bortezomib, Myocet® and dexamethasone chemotherapy; Ig, immunoglobulin.
Mentions: The patient was classified as ‘non responder’ to the different chemotherapeutic agents; however, the patient was selected for ASCT in April 10, 2008 (Fig. 2). Following ASCT, severe complications occurred, including pneumonia with Morganella morganii infection and then sepsis. Based on these observations, the hematological asset of the patient was re-evaluated upon ASCT, and bone barrow immunophenotyping revealed a 0.1% of PC population in the lymphocytes region. As displayed by post-ASCT flow cytometric analysis, the sFLC κ/λ ratio decreased, and no presence of neoplastic PCs was detected (Fig. 1A). In parallel, sIFE appeared without a monoclonal component, and the level of BJ protein was less pronounced overtime (Fig. 1B). Furthermore, these parameters were associated with a marked reduction in κ-sFLC (Fig. 3), suggesting that the patient was effectively responding to the treatment. However, osteolytic lesions were still present but did not progress overtime.

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