Prognostic value of unrelated atypical serum immunofixation patterns during Multiple Myeloma therapy

Abstract

Autologous stem cell transplantation (ASCT) is the gold standard therapy for suitable multiple myeloma (MM) patients after induction with high dose therapy. To date, the evidence of a reliable marker of prognosis in these cases remains scarce. Our aim was to evaluate appearance of unrelated atypical serum immunofixation patterns (ASIPs) as a marker of prognosis in MM patients submitted to ASCT. We retrospectively analysed data from 65 patients. Interestingly, we observed that presence of ASIPs was associated with longer progression-free survival and longer overall survival. Our results suggested that presence of ASIPs could be a novel marker of good prognosis in MM patients submitted to ASCT.

Secondary monoclonal gammopathy of undetermined significance after allogeneic stem cell transplantation in multiple myeloma

“…The association of development of sMGUS with an improved outcome after allo-SCT, as demonstrated in this study, is consistent with several other reports that showed a better survival in MM patients with emergence of sMGUS after autologous SCT or chemotherapy. 1,2,4,6,9,10,[12][13][14]17 However, some studies did not observe a favorable outcome in patients with sMGUS. This may be related to differences in sample size, duration of follow up, technical and procedural variability, use of novel agents, and the percentage of patients that underwent autologous transplantation, or, as shown here, allo-SCT.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Several terms have been used to describe this phenomenon, including abnormal protein band, oligoclonal protein bands, transient mono-or oligoclonal gammopathy, apparent isotype switch, oligoclonal humoral response, atypical serum immunofixation pattern, and in myeloma patients, as we will use in this study, secondary monoclonal gammopathy of undetermined significance MGUS (sMGUS). 18 We consider post-transplant MGUS as a subtype of sMGUS.…”

“…Secondary MGUS occurs more frequently after treatment with autologous stem cell transplantation (auto-SCT) (10%-73%) [1][2][3][4][5][6][8][9][10][11][12][13][14]17 than in patients who have not undergone auto-SCT (1.6%-3.1%). 4,9 Several studies also showed a higher frequency of sMGUS in patients treated with novel agents when compared to conventional chemotherapy.…”

“…3,17,19,20 In fact, some studies found that patients who develop sMGUS have a superior prognosis in terms of progression-free survival (PFS) and overall survival (OS) than those without sMGUS. 1,2,4,6,9,10,[12][13][14]17 However, other studies, often with a small sample size, concluded that the presence of sMGUS does not relate to the prognosis of MM, or that it is only associated with a better response and not with a benefit in terms of PFS or OS. 5,7,8,11 In MM, allogeneic stem cell transplantation (allo-SCT) results in a high rate of molecular remissions and lower risk of relapse by virtue of the graft-versus-myeloma (GvM) effect.…”

Use of isoelectric focusing to discriminate transient oligoclonal bands from monoclonal protein in treated myeloma

“…They may be either multiple oligoclonal or single diffuse monoclonal protein bands on a diffuse polyclonal background on serum protein electrophoresis and therefore, difficult to interpret. Small APB are likely associated with improved depth of remission and possibly overall survival [1][2][3][4]. The presence of oligoclonality has been suggested to indicate longer progression-free survival and overall survival [4][5][6].…”