Jerbi Ameni, Turki Omar, Hachicha Hend, Kallel Sarbeji Faten, Feki Sawsan, Mejdoub Sabrina, Kammoun Khaoula, Ben Hmida Mohamed, Elloumi Moez, Masmoudi Hatem
Immunology Department, Habib Bourguiba University Hospital, University of Sfax, 3000, Sfax, Tunisia.
Hematology Department, Hedi Chaker University Hospital, University of Sfax, 3000, Sfax, Tunisia.
Ann Hematol. 2023 Jun;102(6):1459-1466. doi: 10.1007/s00277-023-05221-6. Epub 2023 Apr 15.
We aimed to describe the clinical and biological characteristics and the prognosis of patients presenting with an additional light chain (LC) band along with a complete monoclonal protein on immunofixation (IF).An 8-year descriptive study was conducted to assess all cases with confirmed monoclonal gammopathies (MG). We studied those with an entire M-protein with 2 bands of LC of the same isotype based on the results of IF. Data were collected from patients' files.Among 548 cases of MG, we found 32 cases (5.8%) with an additional LC band. We included 28 patients (5%) with a confirmed diagnosis of multiple myeloma (MM). The m/f ratio was 2.5 with a median age of 63 years [32-80 years]. All MM patients had anemia, 16 (57%) had renal failure, 14 (50%) had lytic lesions, 9 (32%) received hemodialysis, and 7 (25%) had hypercalcemia. The free-kappa-lambda ratio was abnormal in all cases: median = 0.07 [0.002-58.57]. The mean overall survival (OS) was 22 months ± 38.76.Fifteen MM patients (48%) received chemotherapy, and 7 (22%) autologous stem cell transplants (SCT). Patients who received SCT had an OS higher than those who received other treatments (p = 0.038). OS was low in patients with high β2microglobulin levels (rho = -0.791; p = 0.001), and abnormally low free-kappa-lambda ratio (rho = -0.852;p = 0.04).The presence of an additional LC band with a complete monoclonal protein seems to identify newly diagnosed MM patients with poor outcomes and frequent renal impairment.
我们旨在描述免疫固定电泳（IF）显示存在额外轻链（LC）条带以及完整单克隆蛋白的患者的临床和生物学特征及预后。进行了一项为期8年的描述性研究，以评估所有确诊的单克隆丙种球蛋白病（MG）病例。根据IF结果，我们研究了那些具有完整M蛋白且有两条相同同种型LC条带的病例。数据从患者病历中收集。在548例MG病例中，我们发现32例（5.8%）有额外的LC条带。我们纳入了28例（5%）确诊为多发性骨髓瘤（MM）的患者。男女比例为2.5，中位年龄为63岁[32 - 80岁]。所有MM患者均有贫血，16例（57%）有肾衰竭，14例（50%）有溶骨性病变，9例（32%）接受血液透析，7例（25%）有高钙血症。所有病例的游离κ-λ比值均异常：中位数 = 0.07 [0.002 - 58.57]。平均总生存期（OS）为22个月±38.76。15例（48%）MM患者接受了化疗，7例（22%）接受了自体干细胞移植（SCT）。接受SCT的患者的OS高于接受其他治疗的患者（p = 0.038）。β2微球蛋白水平高的患者OS较低（rho = -0.791；p = 0.001），游离κ-λ比值异常低的患者OS也较低（rho = -0.852；p = 0.04）。存在额外的LC条带以及完整的单克隆蛋白似乎可识别出预后不良且常有肾功能损害的新诊断MM患者。
