The Monoclonal Gammopathies (Paraproteins)

Kyle, Robert A.; Lust, John A.

doi:10.1016/s0065-2423(08)60137-7

Cited by 17 publications

(7 citation statements)

References 278 publications

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“…7 The actuarial progression from MGUS to malignancy has been reported as being 17% at 10 years, rising to 33% at 20 years. 15 It will require the results from similar long-term follow-up studies to ascertain whether our patients will progress at the same rate, particularly those with chronic infections.…”

Section: Discussionmentioning

confidence: 99%

Monoclonal Gammopathy of Unknown Significance and Malignant Paraproteinemia in Hong Kong

1996

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The incidence of multiple myeloma is lower in Southeast Asia than in the West. However, there are few reports on the overall incidence of paraproteinemia and its disease-associations in the Chinese. Therefore, the authors have correlated the laboratory features with the eventual clinical diagnosis in patients with paraproteinemia in a Hong Kong general/teaching hospital. Over 18 months, 1,600 patients were investigated for the presence of paraproteinemia. Paraproteinemia was detected in 157 (10%) patients. In 11 patients, investigations could not be completed. The remaining 146 patients were subjected to detailed clinical, radiologic, and laboratory investigations. Eighty-seven (59.6%) had monoclonal gammopathy of unknown significance (MGUS), 44 (30.1%) myeloma and 15 (10.3%) other lymphoproliferative disorder (LPD). There was no significant difference in the paraprotein concentration, frequency of hypogammaglobulinemia or Bence Jones proteinuria (BJP) or concentration of nonparaprotein immunoglobulin (Ig) between the myeloma and LPD groups. The overall kappa:lambda light chains ratios were 2.9,1.6 and 3.3 in the MGUS, MM and LPD groups, Paraproteinemia occurs both more frequently with increasing age and in association with a variety of diseases, and is thus a relatively common finding in hospital patients. The differential diagnosis in these patients will be between either myeloma, other lymphoproliferative disorder (LPD), or monoclonal gammopathy of uncertain significance (MGUS). The incidence of multiple myeloma is said to be lower in countries in Southeast Asia, including Hong Kong, compared to those in the West. 1 However, with the exception of a recent study from Taiwan, 2 there are no reports on the overall incidence of paraproteinemia and the frequency of associated diseases in this population. It was our clinical impression that the finding of a paraprotein in the Hong Kong hos- respectively. Polyclonal Ig elevation was rare with myeloma (4.5%) but was detected in 33% of patients with LPD (P <.02) and 40% of those with MGUS (P <.0001). Biclonal (and one triclonal) gammopathy was detected in 11.5% of patients with MGUS, 11% with LPD and 4.5% with myeloma. In the MGUS group, infection was the commonest associated clinical disorder (29.3%). Moreover, 70% of patients with biclonal gammopathy and MGUS had an infection. Five of 15 patients with LPD had a T-cell malignancy, including 3 lymphomas and 2 large granular cell leukemias. Only one patient had primary systemic amyloidosis.It is concluded that the high frequency of biclonality and its association with infection, of paraproteinemia in association with T-cell malignancy and of kappa light chains in the MGUS and LPD groups are at variance with reports from the West and probably reflect local differences.

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Section: Discussionmentioning

confidence: 99%

Monoclonal Gammopathy of Unknown Significance and Malignant Paraproteinemia in Hong Kong

1996

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“…There are only a few reports of multiple myeloma or monoclonal gammopathy accompanied by prostate cancer [3, 4, 8, 9]. Kao et al [3] suggested the possible impact of immunosuppression from multiple myeloma and chemokines, including insulin-like growth factor-1 (IGF-1), interleukin-6 (IL-6), stromal cell-derived factor-1 (SDF-1), and vascular endothelial growth factor (VEGF), released by circulating myeloma cells on the progression of prostate cancer.…”

Section: Discussionmentioning

confidence: 99%

“…They suggested that surgical stress may have exacerbated the clinical course of the myeloma, partly because of elevated IL-6 levels after surgery, which would stimulate the growth of myelomas. Kyle and Lust [9] have also reported that repeated antigenic stimulation of the reticuloendothelial system, genetic susceptibility for the development of plasma cell dyscrasia in patients with a positive family history, Epstein-Barr virus infection, lymphoid growth factors (such as IL-6), impairment of T-cell function, and lack of suppression of B cells by T cells play a role in the development of gammopathy. Most studies suggested that immune mechanisms may affect the development of other malignancies, but none of these mechanisms were clearly identified.…”

Section: Discussionmentioning

confidence: 99%

Multiple Myeloma with Biclonal Gammopathy Accompanied by Prostate Cancer

et al. 2011

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We report a rare case of multiple myeloma with biclonal gammopathy (IgG kappa and IgA lambda type) in a 58-year-old man with prostate cancer who presented with lower back pain. Through computed tomography (CT) imaging, an osteolytic lesion at the L3 vertebra and an enhancing lesion of the prostate gland with multiple lymphadenopathies were found. In the whole body positron emission tomography-computed tomography (PET-CT), an additional osteoblastic bone lesion was found in the left ischial bone. A prostate biopsy was performed, and adenocarcinoma was confirmed. Decompression surgery of the L3 vertebra was conducted, and the pathologic result indicated that the lesion was a plasma cell neoplasm. Immunofixation electrophoresis showed the presence of biclonal gammopathy (IgG kappa and IgA lambda). Bone marrow plasma cells (CD138 positive cells) comprised 7.2% of nucleated cells and showed kappa positivity. We started radiation therapy for the L3 vertebra lesion, with a total dose of 3,940 cGy, and androgen deprivation therapy as treatment for the prostate cancer.

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“…Diagnoses were established using previously published criteria. 15 All samples used in this study were obtained from patients with written informed consent according to Institutional Review Board Guidelines.…”

Section: Patientsmentioning

confidence: 99%

IL-1β expression in IgM monoclonal gammopathy and its relationship to multiple myeloma

et al. 2002

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We have shown that IL-1␤ is not detectable in normal plasma cells but is produced by plasma cells from virtually all patients with multiple myeloma (MM). To extend our earlier work, IL-1␤ expression was determined in 13 newly diagnosed patients with IgM monoclonal gammopathy. Eleven patients with Waldenstrom's macroglobulinemia (WM) and two patients with IgM MM were investigated for IL-1␤ expression by in situ hybridization (ISH). All patients with WM had bone marrow biopsies consistent with the diagnosis, an IgM M-protein in the serum, and subsequently required chemotherapy. Seven of 11 patients with WM had an M-protein Ͼ3 g/dl and five patients had bone surveys performed that were negative for osteolytic disease. Two patients were diagnosed with IgM MM because of the presence of significant osteolytic disease on a metastatic bone survey. ISH for kappa, lambda, and IL-1␤ expression was performed on bone marrow aspirates from each of the 13 patients. None of the neoplastic cells from the 11 patients with WM showed detectable IL-1␤ expression by ISH. However, the neoplastic cells from both patients with IgM MM expressed IL-1␤ mRNA at high levels. This aberrant IL-1␤ production may explain the presence of bone lesions in the patients with IgM MM. Leukemia (2002) 16, 382-385.

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The Monoclonal Gammopathies (Paraproteins)

Cited by 17 publications

References 278 publications

Monoclonal Gammopathy of Unknown Significance and Malignant Paraproteinemia in Hong Kong

Monoclonal Gammopathy of Unknown Significance and Malignant Paraproteinemia in Hong Kong

Multiple Myeloma with Biclonal Gammopathy Accompanied by Prostate Cancer

IL-1β expression in IgM monoclonal gammopathy and its relationship to multiple myeloma

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