Multiple myeloma and multiple plasmacytomas associated with free gamma heavy chain, free kappa light chain and IgGk paraproteins: an unusual triple gammopathy

Abstract

Multiple myeloma is a malignant plasma cell dyscrasia that is becoming more prevalent in an increasingly ageing population. It is a complex disease with clinical phases ranging from the premalignant monoclonal gammopathy of undetermined significance to asymptomatic (smouldering) myeloma and then symptomatic myeloma; the latter occasionally terminating in the clonal proliferation of plasma cells outside the bone marrow. We present a patient whose clonally evolved disease from monoclonal gammopathy of undetermined significance to multiple myeloma demonstrated the presence of an unusual combination of monoclonal immunoproteins. Capillary electrophoresis demonstrated the presence of three paraproteins in the gamma region (γ-region), two of which were additional to the IgGk paraprotein which migrated in the slow γ-region at initial diagnosis. Subsequent isotypic identification of the new paraproteins was not possible by immunotyping and initial immunofixation studies failed to definitively characterize the monoclonal proteins. After reduction with beta-mercaptoethanol, two paraproteins were detected by both capillary and gel electrophoresis. However, only immunofixation was able to resolve three distinct monoclonal bands, confirming the presence of free monoclonal kappa light chains in the mid-gamma region and free monoclonal heavy chains in the fast gamma region. Triple gammopathies in themselves are uncommon; this case presents a very unusual combination of paraproteins which required various electrophoretical and immunochemical techniques to identify and characterize them. The change of electrophoretic signature from the monoclonal gammopathy of undetermined significance phase to the diagnosis of multiple myeloma suggested that a number of genetically distinct subclones were present in the pretreatment clonal evolution of the disease.

Mid-arm muscle circumference as a substantial factor against mortality among people with elevated gamma gaps

“…Gamma gap is also known as paraprotein gap or globulin gap [ 7 ]. High gamma gap has important implications of inflammatory states [ 8 , 9 , 10 ].…”

Gamma-heavy chain disease

“…V květnu 2019 mu byla provedena bio psie žaludku a střev s podezřením na extramedulární plazmocytom, popř. B-lymfom z marginální zóny ( Stejnou problematikou se zabývali i Deighan et al [11], kteří u pacienta s mnohočetným myelomem prokázali trojitou monoklonální gamapatii tvořenou paraproteinem IgG kappa, volnými lehkými řetězci kappa a těžkým řetězcem gama. Pacienta monitorovali kombinací elektroforézy sérových proteinů, měřením koncentrace volných lehkých řetězců pomocí dia gnostických souprav Freelite a Hevylite testů (The Binding Site).…”

“…Také Zushi et al [13] studovali pacienta, který byl hospitalizován kvůli Účinnost u celé řady méně častých mutací 1 1 Účinnost u mozkových metastáz 8 Pozitivní vliv na příznaky nádorového onemocnění a kvalitu života 9,10 Vyšší účinnost oproti ERLOTINIBU u skvamózního karcinomu 7 * Bez omezení následných možností léčby [11][12][13] Delší PFS oproti chemoterapii v 1. linii léčby 4,14 Delší OS u del19 oproti chemoterapii 4,12,[14][15][16] Ireverzibilní blokáda receptorů rodiny ErbB prokázaná ve 2 globálních srovnávacích studiích 4,6,11,12,14,[17][18][19][20] Vyšší účinnost oproti ge tinibu 6 **…”

Development of novel methods for non-canonical myeloma protein analysis with an innovative adaptation of immunofixation electrophoresis, native top-down mass spectrometry, and middle-down de novo sequencing

“…In brief, analysis by capillary electrophoresis revealed a triple gammopathy in the gamma zone, which included two truncated species (Figure 1). The relevant clinical details and disease progression of the patient were previously published as a case report [9], and a succinct summary is provided in the Supplementary Material section of this manuscript. We selected this challenging sample as an example of an aberrant class of malignant immunoproteins that potentially could enhance and expand the current repertoire of immunoprotein analyses.…”