Department of Hematology, Amyloidosis and Myeloma Unit, Hospital Clínic, Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
Haematologica. 2013 Jul;98(7):1142-6. doi: 10.3324/haematol.2013.084350. Epub 2013 May 3.
The emergence of an oligoclonal humoral response, resulting in the appearance of a different serum M-protein to that observed at diagnosis is a well-recognized event after autologous stem cell transplantation in multiple myeloma in complete response, and it has been considered to be a benign phenomenon. The aim of the present study was to investigate the incidence, biological characteristics and prognostic value of the oligoclonal bands in patients with myeloma who underwent autologous transplantation at our institution in the last 18 years. We proceed with a retrospective systematic review of all serum and urine immunofixation studies performed in the 211 patients with multiple myeloma who underwent melphalan-based autologous transplantation. Oligoclonal bands were observed in 34% of the patients, with a significantly higher prevalence with the use of novel agents versus conventional chemotherapy in induction (63% vs. 22%; P=0.0001). The incidence of oligoclonal bands was most frequent in non-IgG isotype, particularly in light chain only myeloma. The oligoclonal phenomenon was almost exclusive to patients in complete remission compared to other degrees of response (87% vs. 13%; P=0.0001), and lasted for a median of 1.35 years, persisting during follow up in all patients except in those who relapsed. In prognostic terms, the presence of oligoclonality resulted in a significantly longer progression-free and overall survival. Patients with oligoclonal humoral response lasting for more than one year after transplantation had a significantly longer clinical progression-free and overall survival than those with shorter duration (P=0.008 and P=0.0001, respectively), likely reflecting the importance of a robust humoral immune response.
寡克隆体液反应的出现导致血清 M 蛋白与诊断时观察到的不同，这是多发性骨髓瘤患者在完全缓解后自体干细胞移植后公认的事件，并且被认为是良性现象。本研究旨在调查过去 18 年来我院接受自体移植的骨髓瘤患者寡克隆带的发生率、生物学特征和预后价值。我们对 211 例接受马法兰为基础的自体移植的多发性骨髓瘤患者进行了血清和尿液免疫固定研究的回顾性系统评价。在 34%的患者中观察到寡克隆带，与诱导时使用新型药物与常规化疗相比，其发生率明显更高（63%对 22%；P=0.0001）。寡克隆带在非 IgG 同种型中更为常见，尤其是在仅轻链骨髓瘤中。寡克隆现象几乎仅见于完全缓解的患者，而与其他反应程度（87%对 13%；P=0.0001）相比，其发生率较低，中位数为 1.35 年，在所有患者中持续存在，除了那些复发的患者。在预后方面，寡克隆性的存在导致无进展生存期和总生存期显著延长。移植后寡克隆体液反应持续 1 年以上的患者无进展生存期和总生存期明显长于持续时间较短的患者（P=0.008 和 P=0.0001），这可能反映了强大的体液免疫反应的重要性。
