Clinical Experience and Prognostic Factors with Bortezomib-Combined Regimen in 40 Patients with Multiple Myeloma

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 5211-5211
Author(s):  
Juan Li ◽  
Ying Zhao
Keyword(s):  
Multiple Myeloma ◽  
Renal Function ◽  
Prognostic Factors ◽  
Adverse Effects ◽  
Light Chain ◽  
Response Rate ◽  
Total Response ◽  
Light Chain Type ◽  
Total Response Rate ◽  
Chain Type

Abstract To explore the medical effects, prognostic factors relating to the effects and side effects of bortezomib-combined regimen in treatment of multiple myeloma (MM), and evaluate the safety of this regimen in patients with special conditions. Methods: Forty newly diagnosed and relapsed or refractory MM treated with the regimen of combination of bortezomib and dexamethasone in a cycle of 3 weeks. All of the patients received a median of 3 (1–9) cycles of the treatment. Response to bortezomib was evaluated according to the criteria of the European Group for Blood and Marrow Transplantation (EBMT) and adverse events were graded according to the National Cancer Institute Common Toxicity Criteria. Results: Total response rate was 75.0% (30/40), and the rate of CR+nCR was 42.5% (17/40). Eighty percent patients (24/30) showed effects after the first cycle, although the median time of best effect was 2 cycles. Compare to the other types, light-chain type had higher total response rate (100.0% vs. 65.5%, P=0.038)and CR rate (36.4% vs. 6.9%, P=0.039), and also responded earlier with 81.8% (9/11) patients reached the best effect after the first cycle. The factors which showed no relationship to the effects were age (<65 years vs. >65 years, P=0.081), sex (P=0.696), DS staging (P=1.0), ISS staging(P=0.969), newly or retreated (P=0.731), using thalidomide or not(P=0.338), renal function damage or not(P=0.401), PLT level(P=1.0), hypercalcemia or not(P=0.306), Hb level(P=0.70)and the ratio of tumor cells in bone marrow(P=0.693). Grade III~IV adverse effects in this VD regimen was low, including leucocytopenia, thrombocytopenia, diarrh ea and debility, could be relieved by symptomatic treatment or delay the chemotherapy. The rate of infection was high and which was one of the important cause of death. Renal function improvement could be showed in all of the 10 patients who had renal inadequacy, and compared with normal patients, the incidences of side and adverse effects had no statistical differences. Conclusion: The Bortezomib combination regimen has significant effect in MM treatment. It shows more significant in light-chain type patients, and show earlier effect onset. This regimen can be tolerant in most patients, and is also safe in patients with renal inadequacy.

A Case of Eosinophilic Pleural Effusion Complicating Multiple Myeloma

1988 ◽  
Vol 33 (3) ◽  
pp. 278-278 ◽  
Author(s):  
B.J. Lipworth ◽  
D.P. Dhillon
Keyword(s):  
Multiple Myeloma ◽  
Pleural Effusion ◽  
Light Chain ◽  
Recent Literature ◽  
Rare Complication ◽  
Light Chain Type ◽  
First Case ◽  
Eosinophilic Pleural Effusion ◽  
Chain Type

Pleural effusion is a rare complication of multiple myeloma. We report the first case of eosinophilic effusion due to light chain type disease and review the recent literature.

scholarly journals Isotypic discordance of paraproteins and lymphocyte surface immunoglobulins in myeloma

Blood ◽  
1981 ◽  
Vol 57 (1) ◽  
pp. 192-195 ◽  
Author(s):  
M Nicholls ◽  
PC Vincent ◽  
E Repka ◽  
J Saunders ◽  
FW Gunz
Keyword(s):  
Multiple Myeloma ◽  
Heavy Chain ◽  
Light Chain ◽  
B Lymphocyte ◽  
Plasma Cells ◽  
Light Chains ◽  
Lymphocyte Surface ◽  
Light Chain Type ◽  
Surface Immunoglobulins ◽  
Chain Type

Abstract B lymphocyte surface immunoglobulins (Smlg) were studied in 24 patients with multiple myeloma by means of anti-isotypic antisera, and their heavy and light chain isotypes were compared in each patient with those of the paraprotein. In 21 patients, lymphocyte Smlg consisted of only one light chain type, and in 16 of only 1 heavy chain type. However, the Smlg and paraprotein heavy and light chain types were identical in only 5 patients while in 6 they differed in heavy and light chain types, in 7 in light chain type, and in 4 in heavy chain type. In 2 patients with light chain myeloma, Smlg light chains were isotypically the same as the paraprotein. Isotypic discordance between paraprotein and Smlg may signify the proliferation of a second malignant clone with failure to differentiate into secreting plasma cells. Alternatively, it is conceivable that the lymphocyte Smlg could have the same idiotypic specificity as the paraprotein despite the isotypic differences, but this will require further studies using anti-idiotypic antisera.

A randomized trial of melphalan and prednisone versus melphalan, prednisone, cyclophosphamide, MeCCNU, and vincristine in untreated multiple myeloma.

1984 ◽  
Vol 2 (7) ◽  
pp. 836-840 ◽  
Author(s):  
S Pavlovsky ◽  
J Saslavsky ◽  
M Tezanos Pinto ◽  
L Palmer ◽  
M Curuchet ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Renal Function ◽  
Prognostic Factors ◽  
Partial Response ◽  
Randomized Trial ◽  
Survival Time ◽  
Creatinine Level ◽  
Response Rate ◽  
Randomized Study ◽  
Significant Difference

In a randomized study with 234 previously untreated patients with multiple myeloma, 129 were treated with melphalan (8 mg/m2 perorally for four days) and prednisone (40 mg/m2 perorally for seven days, both every four weeks) and 105 with melphalan and prednisone at the same doses plus cyclophosphamide (600 mg/m2 intravenously every four weeks), MeCCNU (100 mg/m2 PO every eight weeks), and vincristine (MPCCV, 0.6 mg/m2 IV every four weeks). A total of 49 (38%) of the 129 patients treated with melphalan and prednisone (MP) and 48 (46%) of the 105 patients treated with MPCCV showed good response (GR) (P not significant); the overall response rates were 58% and 70%, respectively. Thirty-seven percent of the MP group and 39% of the MPCCV group remain alive at 48 months from first treatment (P not significant). The estimated 48-month survival from first treatment, according to different prognostic factors at diagnosis, in both groups was as follows: stage 1,56%; stage II, 46%, and stage III, 23% (I and II v III P less than .001). Survival at 48 months according to response was GR, 68%; partial response (PR), 33%; and null, 16% (GR v null, P less than .0005; GR v PR, P less than .0005). Survival according to renal function was 43% for a creatinine level less than 2 mg/100 mL and 27% for a creatine level greater than or equal to 2 mg/100 mL (P less than .0005). No significant difference has been found between the two treatment schedules in terms of response rate and survival time, in any stage of disease.

scholarly journals Isotypic discordance of paraproteins and lymphocyte surface immunoglobulins in myeloma

Blood ◽  
1981 ◽  
Vol 57 (1) ◽  
pp. 192-195
Author(s):  
M Nicholls ◽  
PC Vincent ◽  
E Repka ◽  
J Saunders ◽  
FW Gunz
Keyword(s):  
Multiple Myeloma ◽  
Heavy Chain ◽  
Light Chain ◽  
B Lymphocyte ◽  
Plasma Cells ◽  
Light Chains ◽  
Lymphocyte Surface ◽  
Light Chain Type ◽  
Surface Immunoglobulins ◽  
Chain Type

B lymphocyte surface immunoglobulins (Smlg) were studied in 24 patients with multiple myeloma by means of anti-isotypic antisera, and their heavy and light chain isotypes were compared in each patient with those of the paraprotein. In 21 patients, lymphocyte Smlg consisted of only one light chain type, and in 16 of only 1 heavy chain type. However, the Smlg and paraprotein heavy and light chain types were identical in only 5 patients while in 6 they differed in heavy and light chain types, in 7 in light chain type, and in 4 in heavy chain type. In 2 patients with light chain myeloma, Smlg light chains were isotypically the same as the paraprotein. Isotypic discordance between paraprotein and Smlg may signify the proliferation of a second malignant clone with failure to differentiate into secreting plasma cells. Alternatively, it is conceivable that the lymphocyte Smlg could have the same idiotypic specificity as the paraprotein despite the isotypic differences, but this will require further studies using anti-idiotypic antisera.

scholarly journals A case of light-chain-type multiple myeloma in a hemodialysis patient that was diagnosed based on an elevated free light chain κ/λ ratio alone

2020 ◽  
Vol 53 (2) ◽  
pp. 93-98
Author(s):  
Fumiko Kojima ◽  
Yoshiko Tanaka ◽  
Midori Ishiyama ◽  
Junji Tanaka ◽  
Atsushi Suzuki ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Light Chain ◽  
Hemodialysis Patient ◽  
Free Light Chain ◽  
Light Chain Type ◽  
Chain Type

Renal Impairment in Patients With Multiple Myeloma: A Consensus Statement on Behalf of the International Myeloma Working Group

2010 ◽  
Vol 28 (33) ◽  
pp. 4976-4984 ◽  
Author(s):  
Meletios A. Dimopoulos ◽  
Evangelos Terpos ◽  
Asher Chanan-Khan ◽  
Nelson Leung ◽  
Heinz Ludwig ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Renal Function ◽  
Renal Impairment ◽  
Light Chain ◽  
Renal Injury ◽  
High Dose ◽  
Acute Renal Injury ◽  
High Dose Dexamethasone ◽  
Cast Nephropathy ◽  
High Dose Melphalan

Renal impairment is a common complication of multiple myeloma (MM). The estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease formula is the recommended method for the assessment of renal function in patients with MM with stabilized serum creatinine. In acute renal injury, the RIFLE (risk, injury, failure, loss and end-stage kidney disease) and Acute Renal Injury Network criteria seem to be appropriate to define the severity of renal impairment. Novel criteria based on eGFR measurements are recommended for the definition of the reversibility of renal impairment. Rapid intervention to reverse renal dysfunction is critical for the management of these patients, especially for those with light chain cast nephropathy. Bortezomib with high-dose dexamethasone is considered as the treatment of choice for such patients. There is limited experience with thalidomide in patients with myeloma with renal impairment. Thus, thalidomide can be carefully administered, mainly in the context of well-designed clinical trials, to evaluate if it can improve the rapidity and probability of response that is produced by the combination with bortezomib and high-dose dexamethasone. Lenalidomide is effective in this setting and can reverse renal insufficiency in a significant subset of patients, when it is given at reduced doses, according to renal function. The role of plasma exchange in patients with suspected light chain cast nephropathy and renal impairment is controversial. High-dose melphalan (140 mg/m2) and autologous stem-cell transplantation should be limited to younger patients with chemosensitive disease.

Immunoglobulin light-chain type in Sjögren's syndrome

1983 ◽  
Vol 14 (4) ◽  
pp. 380
Author(s):  
Guillermo J. Ruiz-Argüelles ◽  
Efraín Díaz-Jouanen ◽  
Donato Alarcó-Segovia
Keyword(s):  
Sjögren’S Syndrome ◽  
Light Chain ◽  
Sjögren's Syndrome ◽  
Sjogren’S Syndrome ◽  
Sjogren's Syndrome ◽  
Immunoglobulin Light Chain ◽  
Light Chain Type ◽  
Chain Type ◽  
Sjögren‘S Syndrome

scholarly journals Heterogeneity of factor VIII antibodies: further immunochemical and biologic studies

Blood ◽  
1977 ◽  
Vol 49 (5) ◽  
pp. 807-817 ◽  
Author(s):  
MB Hultin ◽  
FS London ◽  
SS Shapiro ◽  
WJ Yount
Keyword(s):  
Factor Viii ◽  
Isoelectric Focusing ◽  
Heavy Chain ◽  
Light Chain ◽  
Major Peak ◽  
Igg Antibodies ◽  
Multiple Peaks ◽  
Light Chain Type ◽  
Apparent Homogeneity ◽  
Chain Type

Abstract Previous studies using immunoneutralization techniques have shown that many factor VIII inhibitors are IgG antibodies of a single light chain type. We have investigated this apparent homogeneity by immunoneutralization assay and liquid isoelectric focusing of inhibitor fractions from five hemophiliacs and two nonhemophiliacs. By immunoneutralization assay, inhibitors from four hemophiliacs and one nonhemophiliac were exclusively k light chain type: the fifth hemophilic inhibitor was predominantly k1 and the second nonhemophilic inhibitor was a mixture of k and gamma. However, heavy chain subtyping of the six predominantly or exclusively k inhibitors showed all to be mixtures of IgG4 and IgG1. By isoelectric focusing, two inhibitors showed multiple peaks of activity between pH 5 and 9. The remaining five showed predominant peaks of activity, which were solely IgGk1 between pH 5.8 and 7, with smaller peaks between pH 7 and 9. The most acidic major peak, focusing at pH 6, was IgG4 in the three cases tested. Two of these acidic peaks neutralized factor VIII more efficiently than other peaks in the same focusing profiles, suggesting greater affinity for factor VIII. These studies demonstrate that factor VIII inhibitors are composed of heterogenous subpopulations of immunoglobulins which can be separated by isoelectric focusing.

scholarly journals Light chain type predicts organ involvement and survival in AL amyloidosis patients receiving stem cell transplantation

2018 ◽  
Vol 2 (7) ◽  
pp. 769-776 ◽  
Author(s):  
M Hasib Sidiqi ◽  
Mohammed A. Aljama ◽  
Eli Muchtar ◽  
Francis K. Buadi ◽  
Rahma Warsame ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Light Chain ◽  
Organ Involvement ◽  
Al Amyloidosis ◽  
Light Chain Type ◽  
Key Points ◽  
Λ Light Chain ◽  
Chain Type

Key Points λ Light chain AL amyloidosis is associated with a shorter PFS and OS compared with κ. Light chain type predicts likelihood of organ involvement in AL amyloidosis.

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