An Overview of Light Chain Multiple Myeloma: Clinical Characteristics and Rarities, Management Strategies, and Disease Monitoring

Rafae, Abdul; Malik, Mustafa Nadeem; Zar, Muhammad Abu; Durer, Seren; Durer, Ceren

doi:10.7759/cureus.3148

Cited by 25 publications

(43 citation statements)

References 50 publications

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“…IgA MM accounts for approximately 20% of MM and has been reported to have a poor prognosis compared with IgG‐type MM due to higher risk of cytogenetic abnormalities and extramedullary disease 23,24 . BJP‐type MM constitutes approximately15% of MM and has a shorter survival compared with IgG‐ or IgA‐type MM because of its high occurrences of renal failure, bone lesions, and amyloidosis 25,26 . In this study, the proportions of IgG‐, IgA‐, and BJP‐type MM were not greatly different from past reports.…”

Section: Discussioncontrasting

confidence: 55%

Outcomes of ixazomib/lenalidomide/dexamethasone for multiple myeloma: A multicenter retrospective analysis

Takakuwa

Yamamura

Ohta³

et al. 2021

European J of Haematology

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Objectives This study aimed to investigate real‐world data of ixazomib plus lenalidomide and dexamethasone (IRd) therapy for patients with relapsed and refractory multiple myeloma (RRMM). Methods We retrospectively analyzed 122 patients treated with IRd at 16 centers from May 2017 to January 2019 by using the Kansai Myeloma Forum database. Result At the start of IRd, the median age was 72 years, 66.7% of patients had IgG type, and the median number of prior therapies was 4, comprising bortezomib (85.4%) and lenalidomide (89.3%)‐based regimens. Disease progression and adverse events accounted for treatment discontinuation in 46 and 32 patients, respectively. The median overall survival (OS) was not reached, and the median progression‐free survival (PFS) was 11.9 months. Sensitivity to bortezomib did not affect the PFS, whereas lenalidomide‐refractory patients had significantly lower PFS than lenalidomide‐sensitive patients, who were comparable to TOURMALINE‐MM1 study. The patients with IgG type had significantly better PFS and OS than those with non‐IgG type. Conclusion This study presents the largest real‐world data of patients treated with IRd in Asia. However, in real clinical practice, the patient background is different from the TOURMALINE‐MM1 study, and IRd showed poor efficacy, especially in the non‐IgG type and lenalidomide‐refractory patients with RRMM.

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Section: Discussioncontrasting

confidence: 55%

Outcomes of ixazomib/lenalidomide/dexamethasone for multiple myeloma: A multicenter retrospective analysis

Takakuwa

Yamamura

Ohta³

et al. 2021

European J of Haematology

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“…In this retrospective analysis, we described 23 myeloma patients younger than 50 years of age. This cohort, mainly diagnosed in ISS stage I–II (79% of cases), showed a high frequency of bone lytic lesions (89%) [17], soft-tissue EMPs (26%) [18], and light-chain myeloma (45%) [19]. The PFS of the entire group was relatively short (median 12 months).…”

Section: Discussionmentioning

confidence: 99%

Multiple Myeloma Presenting in Patients Younger than 50 Years of Age: A Single Institution Experience

et al. 2020

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Introduction: Multiple myeloma (MM) is uncommon in persons younger than 50 years of age. The presenting features in this age group are unclear. Methods: We analyzed a cohort of patients <50 years of age with MM treated in our center. Results: Twenty-three patients at a median age of 41.5 years (range 27–49) were analyzed. Patients presented at International Staging System (ISS) I–II (79%), had high frequency of bone lytic lesions (89%), extramedullary disease (26%), light-chain myeloma (45%), and translocation t(11;14) (68%). The subpopulation of patients carrying t(11;14) were younger (p = 0.025). This subgroup had higher bone marrow infiltration of plasma cells (75 vs. 47.5%), higher incidence of proteinuria (2.9 vs. 0.19 g/day), and poorer response to therapy: 85.7% of patients achieving complete/very good partial remission after induction therapy did not have t(11;14). A trend toward inferior progression-free survival (PFS) was observed in patients with t(11; 14) compared to patients without this translocation (median PFS 18 and 36 months, respectively). Discussion/Conclusion: Translocation t(11; 14) seems to be more prevalent in young myeloma patients. Young myeloma patients and especially those who harbor translocation t(11; 14) may represent a distinct clinical entity that confers a poor outcome.

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“…61% patients had kappa light chain disease, while 38% had kappa light chain disease in the present study. The lambda light chains have a significantly shorter overall survival than those secreting kappa light chains 8 , 9 .…”

Section: Discussionmentioning

confidence: 97%

Early Normalization of Free Light Chains Predicts Better Outcomes in Patients with Multiple Myeloma

Benson¹,

Nair²,

Narayanan³

2020

IJHOSCR

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Background: The half-life of free light chain is short and can be used as an early marker for tumor response in patients with multiple myeloma [MM]. This prospective study is aimed at evaluating whether early light chain response can predict response to treatment in patients with MM. Materials and Methods: Thirty six patients with a diagnosis of MM and with an abnormal to normal light chain ratio of > 10 were included in this study. Results: The median age at presentation was 56 years. Fourteen patients had lambda light chain disease, whereas 22 patients had kappa light chain disease. Twenty-four patients [66.6%] had reduction of abnormal to normal light chain ratio to < 10 after 2 cycles, of whom 15 [62.5%] achieved a CR or VGPR after 6 cycles. Among 12 patients who did not have reduction of abnormal to normal light chain ratio to < 10, only 1 patient achieved CR while 11 patients [91.6%] achieved a PR or less[Fishers exact p=0.004]. Median follow-up was 13 months. Median progression-free survival for the entire cohort was 15 months. One-year Progression-Free Survival was 77% vs 57.1%, [p= 0.008], respectively for patients with early normalization and those who did not show early normalization. Conclusion: Early light chain response after 2 cycles of chemotherapy is a good predictor for treatment response in patients with MM treated with bortezomib based chemotherapy. Treatment intensification based on early light chain response merits further evaluation in a prospective trial

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An Overview of Light Chain Multiple Myeloma: Clinical Characteristics and Rarities, Management Strategies, and Disease Monitoring

Cited by 25 publications

References 50 publications

Outcomes of ixazomib/lenalidomide/dexamethasone for multiple myeloma: A multicenter retrospective analysis

Outcomes of ixazomib/lenalidomide/dexamethasone for multiple myeloma: A multicenter retrospective analysis

Multiple Myeloma Presenting in Patients Younger than 50 Years of Age: A Single Institution Experience

Early Normalization of Free Light Chains Predicts Better Outcomes in Patients with Multiple Myeloma

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