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Oligoclonal Protein Bands and Ig Isotype Switching in Multiple
Myeloma Treated With High-Dose Therapy and Hematopoietic Cell
Transplantation
C.S. Zent,
C.S. Wilson,
G. Tricot,
S. Jagannath,
D. Siegel,
K.R. Desikan,
N. Munshi,
D. Bracy,
B. Barlogie, and
A.W. Butch
From the Division of Hematology/Oncology and Department of Pathology,
University of Arkansas for Medical Sciences, Little Rock, AR.
Multiple myeloma (MM) is usually characterized by production of a
single serum monoclonal protein of constant isotype and light-chain
restriction. Multiple Ig isotypes and isotype switches, which are rare
in untreated patients, are reported to be more common in patients
undergoing myeloablative therapy. These additional protein bands,
detected by immunofixation electrophoresis (IFE), could be due to
altered paraprotein production by the malignant plasma cell clone or
oligoclonal Ig production during recovery of B-cell function after
myeloablative therapy. We analyzed abnormal protein bands (APB),
distinct from the presenting paraprotein, in 550 patients receiving
high-dose therapy with autologous hematopoietic cell transplantation at
a single institution. Fifty-five patients (10%) had APB, 48 had
oligoclonal bands (OB), and 23 had an apparent isotype switch (IS) on
IFE (16 had both OB and IS). Morphologic and flow cytometric
examination of bone marrow in 17 patients with IS showed no evidence of
a clonal plasma cell isotype switch. Patients with APB had
significantly higher complete response to therapy (67% v 37%,
P = .001). To assess the independent prognostic relevance of
APB, a multivariate analysis was performed among 471 patients surviving
at least 12 months from first transplant (all patients developing APB
had done so by 12 months from first transplant). APB (in 50 patients)
was a favorable feature for both event-free (rank 3, P = .004) and overall survival (rank 3, P = .0005). We propose
that OB and IS are likely to be due to recovery of Ig production rather
than alterations in the biology of the malignant plasma cell clone.
Blood, Vol. 91 No. 9 (May 1), 1998:
pp. 3518-3523
© 1998 by The American Society of Hematology.
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