Delay and not deficiency in cap formation of peripheral blood B cells in patients with multiple myeloma.

A major problem in the study of peripheral blood (PB) B cells from patients with multiple myeloma (MM) is the distinction between the cells really able to synthesize membrane (m) immunoglobulins (Ig) and those able only to absorb serum Ig passively, since the lymphocytes of such patients are bathed in very high concentrations of monoclonal Ig. In order to reappraise PB B cells (including putative pre-B cells) in MM, we have used three different criteria: (a) the capacity of PB B cells to cap mIg when triggered by an anti-Ig; (b) the presence of B-cell differentiation antigens (CD19, CD20, CD21, and CD37) as specific B-cell markers; and (c) the expression of cytoplasmic mu heavy chain as a marker of pre-B cells. We have found that, in active myeloma (N = 13), the percentages and absolute numbers of PB B cells able to cap mIg (4.25%; 45.43 cells/mm3) were significantly lower than those in healthy donors (8.4%; 151.2 cells/mm3) and those in stable MM (7.67%; 134.39 cells/mm3). In addition, the capping formation in patients with stable or active MM was significantly delayed compared to that in healthy donors. For all the normal individuals and patients investigated, there has been found an excellent correlation between the percentages and absolute numbers of PB B cells able to cap their mIg and those of PB mononuclear cells bearing the four B cell-specific differentiation antigens: CD19, CD20, CD21, and CD37. Finally, virtually no pre-B cells bearing cytoplasmic mu chains have been identified in the peripheral blood from healthy donors and patients with MM.