Polyclonal Bence Jones Proteinuria Associated with Reactive Plasmacytosis

Abstract Introduction: Plasma cells (PCs) have conventionally been counted on the bone marrow aspirate, and small focal involvement may be missed even on bone marrow biopsy sections. Material and Methods: We aimed to study the role of CD138, CD56, anti-κ, and anti-λ immunohistochemistry (IHC) to separate PC myeloma from reactive plasmacytosis and to study the utility of these in cases suspected as myelomas and lacking >10% PCs on bone marrow aspirate. The study comprised 35 diagnosed myelomas, 20 reactive plasmacytosis, and 19 M-band positive suspected myelomas. CD138 IHC was performed on all cases along with CD56, anti-κ, and anti-λ IHC. PCs were counted on CD138-immunostained sections by manual count and by image analysis. In addition, CD56 expression was correlated with clinical features in diagnosed myeloma group. Results: In all cases, both manual counts and image analysis, PC counts were significantly higher on the CD138 stained sections than bone marrow aspirates. It was seen that the manual PC counts and image analysis counts were equivalent in diagnosed myeloma cases. CD56 expression was seen in ~62.85% diagnosed myeloma cases while it was negative in cases of reactive plasmacytosis. CD56 expression was significantly higher in patients with lytic lesions (78.26% vs. 21.74%). CD138, anti-κ, and anti-λ IHC also helped classify 11/19 (57.8%) cases correctly. Conclusion: The use of CD138 along with the light chain and CD56 IHC adds a high diagnostic value in myeloma patients and suspected myeloma cases. The PCs can be counted manually on the CD138-immunostained sections and correlate well with the counts obtained by image analysis.

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Bence Jones proteinuria revisited.

Clinical Chemistry ◽

10.1093/clinchem/27.4.636 ◽

1981 ◽

Vol 27 (4) ◽

pp. 636-636 ◽

Cited By ~ 1

Author(s):

J F Quaranta ◽

J P Cassuto ◽

G Viot ◽

P U Audoly ◽

R Masseyeff

Keyword(s):

Bence Jones Proteinuria

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Macroglobulinemia in a Child With Acute Leukemia

Blood ◽

10.1182/blood.v43.2.191.191 ◽

1974 ◽

Vol 43 (2) ◽

pp. 191-199 ◽

Cited By ~ 8

Author(s):

Jan Čejka ◽

Robert O. Bollinger ◽

Henrica R.E. Schuit ◽

Jeanne M. Lusher ◽

Chung-Ho Chang ◽

...

Keyword(s):

Acute Leukemia ◽

Immunoglobulin M ◽

Leukemia Cells ◽

Bence Jones Protein ◽

Electron Microscopic ◽

Lymphoid Leukemia ◽

Β2 Microglobulin ◽

Immunofluorescence Studies ◽

Bence Jones Proteinuria ◽

Serum And Urine

Abstract A 12-yr-old boy with acute leukemia was found to have paraproteinemia and Bence-Jones proteinuria. The paraprotein was characterized as immunoglobulin M, type κ and the Bence Jones protein as free κ-chains. Increased amounts of β2-microglobulin were found in the patient’s serum and urine. Electron microscopic and immunofluorescence studies provided evidence of the presence of lymphoid leukemia cells apparently responsible for the production of the paraprotein.

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Prognostic Factors for Malignant Transformation in Monoclonal Gammopathy of Undetermined Significance and Smoldering Multiple Myeloma

Journal of Clinical Oncology ◽

10.1200/jco.2002.20.6.1625 ◽

2002 ◽

Vol 20 (6) ◽

pp. 1625-1634 ◽

Cited By ~ 82

Author(s):

Clara Cesana ◽

Catherine Klersy ◽

Luciana Barbarano ◽

Anna Maria Nosari ◽

Monica Crugnola ◽

...

Keyword(s):

Multiple Myeloma ◽

Monoclonal Gammopathy ◽

Extramedullary Plasmacytoma ◽

Lymphocytic Leukemia ◽

Cumulative Probability ◽

Primary Amyloidosis ◽

Smoldering Multiple Myeloma ◽

Bence Jones Proteinuria ◽

Undetermined Significance

PURPOSE: To evaluate the natural history of monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM), identify early predictors of evolution, and assess whether associated conditions correlate with disease progression. PATIENTS AND METHODS: A total of 1,231 consecutive patients with either MGUS (n = 1,104) or SMM (n = 127) diagnosed from July 1975 to March 1998 were included in the study. Cumulative survival probability and cumulative probability of transformation into lymphoproliferative disease were calculated by means of the Kaplan-Meier estimator. Univariate and multivariate Cox models were used to identify possible predictors of malignant evolution. RESULTS: Cumulative transformation probability at 10 and 15 years was 14% and 30%, respectively. At a median follow-up of 65 months (range, 12 to 239 months), 64 MGUS cases (5.8%) evolved to multiple myeloma (MM) (n = 43), extramedullary plasmacytoma (n = 1), primary amyloidosis (n = 1), Waldenström’s macroglobulinemia (n = 12), non-Hodgkin’s lymphoma (n = 6), and B-chronic lymphocytic leukemia (n = 1). At a median follow-up of 72 months (range, 12 to 247 months), 25 SMMs (19.7%) evolved to overt MM. A lower evolution risk was observed in MGUS than in SMM (P < .0001). Greater than 5% marrow plasmacytosis, detectable Bence Jones proteinuria, polyclonal serum immunoglobulin reduction, and high erythrocyte sedimentation rate (ESR) were independent factors influencing MGUS transformation. SMM progression correlated with greater than 10% marrow plasma cells, detectable Bence Jones proteinuria, and immunoglobulin (Ig) A isotype. Neither concomitant diseases nor immunosuppression correlated with progression. CONCLUSION: Careful evaluation of marrow plasmacytosis, urinary paraprotein, background immunoglobulins, ESR, and paraprotein isotype might help identify at presentation patients with benign monoclonal gammopathies requiring stricter monitoring.

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