SummaryMultiple myeloma is a B cell malignancy characterized by the expansion of plasma cells producing monodonal immunoglobulins (Ig). It has been regarded as a tumor arising at the B, pre-B lymphocyte, or even stem cell level. Precursor cells are presumed to proliferate and differentiate giving rise to the plasma cell donal expansion. Antigenic features and specific Ig gene rearrangement shared by B lymphocytes and myeloma ceils have supported this hypothesis. However, the existence of such a precursor is based upon indirect evidence and is still an open question. During differentiation, B cells rearrange variable (V) regions of Ig heavy chain genes, providing a specific marker of clonality. Using an anchor polymerase chain reaction assay, these rearranged regions from five patients with multiple myeloma were cloned and sequenced. The switch of the Ig constant (C) region was used to define the B call differentiation stage: V regions are linked to C# genes in pre-B and B lymphocytes (pre-switch B cells), but to C'I/or Cot in post-switch B lymphocytes and plasma ceUs (post-switch B cells). Analysis of bone marrow calls at diagnosis revealed the presence of pre-switch B ceils bearing plasma cell V regions still joined to the C/~ gene. These cells were not identified in peripheral blood, where tumor post-switch B cells were detected. These pre-switch B cells may be regarded as potential myeloma cell precursors.M ultiple myeloma is a B-cell malignancy characterized by a clonal expansion of plasma cells producing monoclonal Ig. Several lines of evidence suggest B lymphocyte involvement in the pathogenesis of multiple myeloma. First, B lymphocytes, or even pre-B lymphocytes expressing the same idiotype as myeloma protein have been found in bone marrow and peripheral blood (1-3). Second, malignant plasma cells expressing pre-B lymphocyte antigens have been described (4-6). Third, PBMC may show the same IgH gene rearrangement as myeloma cells (7,8). However, the existence of a myeloma cell precursor is still a subject of controversy (9, 10).Our molecular approach involved in the use of tumor cell IgH V region as a marker ofclonality. The antigen specificity in B lymphocyte clones is derived primarily from the rearrangement of V, D, and J segments of H chain genes. Assembled variable regions (VDJ) contain three CDR that codify for the antigen-binding site. These regions are unique to each B cell done (11), and can be used to define oligonudeotide primers and probes characteristic of the tumor cell After antigenic stimulation, B lymphocytes switch the IgH isotype by deleting the C# gene, without changing the VDJ-encoded specificity Hence, pre-B and B lymphocytes (pre-switch B cells) can be discriminated from post-switch B lymphocytes and plasma calls (post-switch B cells) because of their C region usage.We reasoned that myeloma cell precursor may be located at the pre-switch B cell stage, and be identifiable as a cell in which the IgH transcript is composed of plasma ceU VDJ still joined to C# gene. The sequence of the p...