Summary. We previously showed that serum beta -2-microglobulin (b2m)-free human leucocyte antigen (HLA) class I heavy chain (FHC) levels were increased in MM and correlate with disease activity. The present investigation, carried out in 124 multiple myeloma patients, studied the expression of the three size variants of FHC, namely the 42 kDa intact heavy chain (A variant, AV), released through a shedding process, and the truncated FHC (tFHC) 39 kDa (BV) and 36-35 kDa (CV) released by means of membrane-type metalloprotease activity. The increase in FHC correlated with a high expression percentage of BV (r ¼ 0AE32, P ¼ 0AE0002) and tFHC (r ¼ 0AE42, P < 0AE0001), which could help to discriminate multiple myeloma from monoclonal gammopathy of undetermined significance (tFHC mean ratio ¼ 3AE2; Mann-Whitney U-test, P < 0AE0001). tFHC levels highly correlated with other disease activity markers, namely haemoglobin (r ¼ )0AE35; Spearman's rank, P ¼ 0AE0001), percentage of bone marrow plasma cells (r ¼ 0AE4, P < 0AE0001) and b2m levels (r ¼ 0AE36, P < 0AE0001), while only the last barely correlated (r ¼ 0AE2, P ¼ 0AE03) with AV. Finally, the 0AE4, 0AE57 and 0AE71 mg/l BV, tFHC and (to a lesser extent) FHC cut-off values divided patients into two groups with different survival curves (P ¼ 0AE0005, P ¼ 0AE0025 and P ¼ 0AE04 respectively). These data are in favour of a correlation between disease aggressiveness and cleavage of these variants by membrane-type metalloprotease enzymes.Keywords: b2m-free HLA class I heavy chain, multiple myeloma, monoclonal gammopathy of undetermined significance, soluble HLA-I.Two forms of soluble human leucocyte antigen (HLA) class I can usually be found in sera: the beta-2-microglobulin (b2m)-associated HLA class I heavy chain (HLA-I) and b2m-free HLA class I heavy chain (FHC). FHC consists of three size variants, namely the intact lipid-soluble 43 kDa heavy chain (A variant, AV) and the two truncated forms, namely the water-soluble 39 kDa (B variant, BV), which lacks the transmembrane segment, and the 34-36 kDa (C variant, CV), which lacks the transmembrane and the intracytoplasmic portions of the molecule. While AV release occurs through a shedding process, controversy still exists about the origin of BV. Initial studies in healthy individuals (Krangel, 1986;Haga et al, 1991) showed that its expression had no pathological significance, as it is produced following deletion of exon 5 (the one coding for the transmembrane region) based on an alternative RNA splicing and appears to be inherited in association with HLA haplotypes (Kubens et al, 1994). However, studies performed in vitro on solid and lymphoid tumour cell lines (Datema et al, 1999), and limited papain digestion experiments of detergent-solubilized cellular or soluble HLA-I have shown that, similarly to CV (Demaria et al, 1994), FHC with a size similar to that of BV can also be released by lytic cleavage at the cell surface, and membrane-type metalloprotease (MT-MPs) enzymes seem to be involved in this process (Datema et al, 1999)...