Prospective follow‐up of monoclonal gammopathies in HIV‐infected individuals

Abstract

A cohort of 341 symptomless anti-human immunodeficiency virus (HIV)-1 positive individuals was screened over a 6-year period to detect a serum monoclonal gammopathy (MG) and to approach the prognostic significance of such anomaly in HIV infection. Eleven individuals with a MG were followed-up over a mean period of 50 months from the date of discovery of the MG. At the end of this period, the MG had disappeared in seven individuals, was still present in the four others. The appearance of a second MG was noticed in two cases, and of a third in one case. Immunoglobulin (Ig) typing identified eleven IgG kappa and three IgG lambda. Mean serum concentration of MG of individuals with persistent MG (14.3 g/l) and of individuals without (4.2 g/l) was significantly different (P < 0.05). The discovery of a MG was without prognosis value on the disease progression and did not appear as a primary event in the subsequent development of lymphoma.

Paraproteinemia, plasmacytoma, myeloma and HIV infection

“…Moreover, the follow-up time of these studies is much less than the median of 10 years between detection of paraproteinemia and onset of plasma cell neoplasm seen in the general population. The high concentration, persistent paraproteins reported by Lefrère 68 and others (paraprotein concentrations of 65, 52 64, 67 43 63 and 37 61 g/l have been described) are much more likely to represent pre-malignant states, similar to MGUS in the general population. Conclusive proof, however, must come from long-term follow-up of MGUS-positive AIDS patients who are carefully screened for signs of B lineage neoplasms, particularly plasma cell malignancies.…”

“…They noted that a number of these patients experienced transient gammopathies lasting for 1-2 years, whereas others had persistent gammopathy. 68,89 The size of the monoclonal component correlated with longevity: persistent monoclonal gammopathies averaged 14.3 g/l, and transient monoclonal gammopathies averaged 4.2 g/l. 68 None of the patients were reported to develop B lineage malignancies over the follow-up periods (averages, 2 years 89 and 4 years 68 ); thus, the authors conclude that monoclonal gammopathy is not a prelymphomatous state.…”

“…68,89 The size of the monoclonal component correlated with longevity: persistent monoclonal gammopathies averaged 14.3 g/l, and transient monoclonal gammopathies averaged 4.2 g/l. 68 None of the patients were reported to develop B lineage malignancies over the follow-up periods (averages, 2 years 89 and 4 years 68 ); thus, the authors conclude that monoclonal gammopathy is not a prelymphomatous state. However, they did not provide clinical or laboratory data to indicate whether any of these patients might have developed a plasma cell neoplasm.…”

“…57,63 Although these cases suggest that paraproteinemia in AIDS patients is not a precursor lesion for malignancy, this may be true only for low concentration, transient paraproteins as described by Lefrère. 68 The presence of such immunoglobulins may indeed reflect a temporary expansion of a clonal population in response to an antigenic challenge, be it from HIV or from an opportunistic infection. Alternatively, small, transient monoclonal gammopathies might simply reflect the fluctuating ability of the HIV-infected immune system to control a monoclonal expansion, even a truly premalignant one.…”

Concomitant HIV infection in newly diagnosed multiple myeloma patients is hard to recognise and should be tested for routinely in areas of high endemicity

“…[8] Three other studies reported paraproteins that were specific for the HIV p24 and p31 antigens, and all paraproteins were of the IgGκ type. [9][10][11] Lefrère et al [36] screened 341 asymptomatic HIV patients for over 6 years and found 11 cases of monoclonal gammopathy; again all para proteins were of the IgGκ and IgGλ type. These data may suggest a possible role for antigenic stimulation directly by the HIV virion or other antigens in the pathogenesis of plasma-cell neoplasms in HIVassociated cases, and may indicate a causative role for HIV or an HIVassociated infection in MM.…”