Similar survival outcomes in patients with biclonal versus monoclonal myeloma: a multi-institutional matched case-control study

Abstract

Multiple myeloma is a plasma cell malignancy characterized by clonal proliferation of plasma cells in the bone marrow and associated organ damage. Usually, patients with myeloma present with a single monoclonal protein in serum and/or urine constituted by one heavy chain and one light chain. In less than 5% of the patients, more than one monoclonal protein can be identified. The aim of our retrospective multicenter matched case-control study was to describe the characteristics of cases with biclonal myeloma and compare them against a control group of monoclonal myeloma patients matched by age, sex, and year of diagnosis. A total of 50 previously untreated cases with biclonal myeloma and 50 matched controls with monoclonal myeloma were included in this study. The controls were matched (1:1) for age, sex, year of diagnosis, and participating center. There were no differences in the rates of anemia (52 vs. 59%; p = 0.52), renal dysfunction (36 vs. 34%; p = 0.83), hypercalcemia (9 vs. 16%; p = 0.28), or presence of lytic lesions (23 vs. 16%; p = 0.38) between groups. Similarly, there was no difference in the rates of overall response to therapy (85 vs. 90%; p = 0.88) or survival rates of cases with biclonal myeloma and controls with monoclonal myeloma (4-year survival 72 vs. 76%; p = 0.23). Results of our study suggest that patients with biclonal myeloma have similar response and survival rates than patients with monoclonal myeloma.

Biclonal myeloma in renal failure

“…Biclonal myeloma and biclonal gammopathy of unknown significance (BGUS) represent rare clinical entities. Their clinical course, therapeutic response, and survival rates do not differ from that of monoclonal gammopathies [7][8][9][10]. The disease is usually diagnosed during diagnostic evaluation for renal failure, anemia, hypercalcemia, or pathological fracture.…”

Nietypowe objawy kliniczne szpiczaka plazmocytowego

“…Niedokrwistość (52% vs 59%; p = 0,52), uszkodzenie nerek (36% vs 34%; p = 0,83), hiperkalcemia (9% vs 16%; p = 0,28) i zmiany osteolityczne (23% vs 16%; p = 0,38) występowały w obu grupach z podobną częstością. Zarówno biklonalne jak monoklonalne postacie szpiczaka podobnie odpowiadały na leczenie (ORR: 85% vs 90%; p = 0,88), co przekładało się na zbliżone przeżycie w 4-letniej obserwacji (4-letnie OS 72% vs 76%;p = 0,23) [12] (Ryc. 4).…”

The effect of paraprotein polymerisation on quantitation by capillary zone electrophoresis and Hevylite®

“…However, studies have demonstrated no clinical difference between monoclonal and biclonal gammopathy in terms of patient survival, response to therapy and rate of myeloma-associated anaemia, renal dysfunction or lytic bone lesions. 3,8 The International Myeloma Working Group 2015 criteria for the diagnosis of multiple myeloma suggest the use of serum monoclonal protein concentration in the classification of monoclonal gammopathies but do not address the effect of biclonal isotype-matched (BIM) gammopathy. 9 This study aims to improve understanding of potential biclonal gammopathies of the same heavy and light chain (HLC) combination and to help with consistency of paraprotein reporting in patients being monitored.…”