Asymptomatic immunoglobulin light chain amyloidosis (AL) at the time of diagnostic bone marrow biopsy in newly diagnosed patients with multiple myeloma and smoldering myeloma. A series of 144 cases and a review of the literature

Sergio Siragusa, William Morice, Morie Gertz, Robert A. Kyle, Philip R. Greipp, John A. Lust, Thomas Elmer Witzig, Martha Lacy, Steven R. Zeldenrust, S Vincent Rajkumar, Stephen J Russell, Suzanne R. Hayman, Francis Buadi, Shaji K Kumar, David M Dingli, Angela Dispenzieri

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Abstract

The rate of asymptomatic amyloidosis (AL) among patients with newly diagnosed multiple myeloma (MM) or smoldering multiple myeloma (SMM) is unknown. We evaluated number and clinical significance of asymptomatic AL in consecutive MM and SMM patients, not having recognition of symptomatic AL at the time of their diagnostic bone marrow biopsy. Bone marrow biopsies were stained with Congo red and considered diagnostic for AL in case of positive Congo red staining with apple-green birefringence. Biopsies from 144 patients were evaluated: 77 had a diagnosis of MM and 67 of SMM. The median age was 59 (range 26-84) years; the median follow-up was 76 months (range 0-216). Immunoglobulin isotypes were 96/144 (67%), IgG; 23/144 (16%), IgA; 12/144 (8%), light chain only; 1/77 (1%), IgD; and biclonal or indeterminate, 12/144 (8%). Fifty-eight percent (84/144) were κ restricted. The presence of amyloid was found in two cases (1%, 95% CI -0.6 to 3.2), one in MM, and one in SMM group, and none had or developed signs or symptoms suggestive of organ involvement by amyloid. Among the 142 other patients without amyloid deposition in their index bone marrow, one (0.7%, 95% CI -0.6 to 2.0) developed symptomatic AL after 119 months.

Original languageEnglish (US)
Pages (from-to)101-106
Number of pages6
JournalAnnals of Hematology
Volume90
Issue number1
DOIs
StatePublished - Jan 2011

Fingerprint

Immunoglobulin Light Chains
Amyloidosis
Multiple Myeloma
Bone Marrow
Biopsy
Amyloid
Congo Red
Birefringence
Immunoglobulin D
Immunoglobulin Isotypes
Immunoglobulin A
Signs and Symptoms
Immunoglobulin G
Staining and Labeling
Light

Keywords

  • Amyloid
  • Asymptomatic
  • Bone marrow biopsy
  • Multiple myeloma
  • Smoldering myeloma

ASJC Scopus subject areas

  • Hematology

Cite this

@article{b84db712b6c848f4bc993b4e1575a92c,
title = "Asymptomatic immunoglobulin light chain amyloidosis (AL) at the time of diagnostic bone marrow biopsy in newly diagnosed patients with multiple myeloma and smoldering myeloma. A series of 144 cases and a review of the literature",
abstract = "The rate of asymptomatic amyloidosis (AL) among patients with newly diagnosed multiple myeloma (MM) or smoldering multiple myeloma (SMM) is unknown. We evaluated number and clinical significance of asymptomatic AL in consecutive MM and SMM patients, not having recognition of symptomatic AL at the time of their diagnostic bone marrow biopsy. Bone marrow biopsies were stained with Congo red and considered diagnostic for AL in case of positive Congo red staining with apple-green birefringence. Biopsies from 144 patients were evaluated: 77 had a diagnosis of MM and 67 of SMM. The median age was 59 (range 26-84) years; the median follow-up was 76 months (range 0-216). Immunoglobulin isotypes were 96/144 (67{\%}), IgG; 23/144 (16{\%}), IgA; 12/144 (8{\%}), light chain only; 1/77 (1{\%}), IgD; and biclonal or indeterminate, 12/144 (8{\%}). Fifty-eight percent (84/144) were κ restricted. The presence of amyloid was found in two cases (1{\%}, 95{\%} CI -0.6 to 3.2), one in MM, and one in SMM group, and none had or developed signs or symptoms suggestive of organ involvement by amyloid. Among the 142 other patients without amyloid deposition in their index bone marrow, one (0.7{\%}, 95{\%} CI -0.6 to 2.0) developed symptomatic AL after 119 months.",
keywords = "Amyloid, Asymptomatic, Bone marrow biopsy, Multiple myeloma, Smoldering myeloma",
author = "Sergio Siragusa and William Morice and Morie Gertz and Kyle, {Robert A.} and Greipp, {Philip R.} and Lust, {John A.} and Witzig, {Thomas Elmer} and Martha Lacy and Zeldenrust, {Steven R.} and Rajkumar, {S Vincent} and Russell, {Stephen J} and Hayman, {Suzanne R.} and Francis Buadi and Kumar, {Shaji K} and Dingli, {David M} and Angela Dispenzieri",
year = "2011",
month = "1",
doi = "10.1007/s00277-010-1028-8",
language = "English (US)",
volume = "90",
pages = "101--106",
journal = "Annals of Hematology",
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TY - JOUR

T1 - Asymptomatic immunoglobulin light chain amyloidosis (AL) at the time of diagnostic bone marrow biopsy in newly diagnosed patients with multiple myeloma and smoldering myeloma. A series of 144 cases and a review of the literature

AU - Siragusa, Sergio

AU - Morice, William

AU - Gertz, Morie

AU - Kyle, Robert A.

AU - Greipp, Philip R.

AU - Lust, John A.

AU - Witzig, Thomas Elmer

AU - Lacy, Martha

AU - Zeldenrust, Steven R.

AU - Rajkumar, S Vincent

AU - Russell, Stephen J

AU - Hayman, Suzanne R.

AU - Buadi, Francis

AU - Kumar, Shaji K

AU - Dingli, David M

AU - Dispenzieri, Angela

PY - 2011/1

Y1 - 2011/1

N2 - The rate of asymptomatic amyloidosis (AL) among patients with newly diagnosed multiple myeloma (MM) or smoldering multiple myeloma (SMM) is unknown. We evaluated number and clinical significance of asymptomatic AL in consecutive MM and SMM patients, not having recognition of symptomatic AL at the time of their diagnostic bone marrow biopsy. Bone marrow biopsies were stained with Congo red and considered diagnostic for AL in case of positive Congo red staining with apple-green birefringence. Biopsies from 144 patients were evaluated: 77 had a diagnosis of MM and 67 of SMM. The median age was 59 (range 26-84) years; the median follow-up was 76 months (range 0-216). Immunoglobulin isotypes were 96/144 (67%), IgG; 23/144 (16%), IgA; 12/144 (8%), light chain only; 1/77 (1%), IgD; and biclonal or indeterminate, 12/144 (8%). Fifty-eight percent (84/144) were κ restricted. The presence of amyloid was found in two cases (1%, 95% CI -0.6 to 3.2), one in MM, and one in SMM group, and none had or developed signs or symptoms suggestive of organ involvement by amyloid. Among the 142 other patients without amyloid deposition in their index bone marrow, one (0.7%, 95% CI -0.6 to 2.0) developed symptomatic AL after 119 months.

AB - The rate of asymptomatic amyloidosis (AL) among patients with newly diagnosed multiple myeloma (MM) or smoldering multiple myeloma (SMM) is unknown. We evaluated number and clinical significance of asymptomatic AL in consecutive MM and SMM patients, not having recognition of symptomatic AL at the time of their diagnostic bone marrow biopsy. Bone marrow biopsies were stained with Congo red and considered diagnostic for AL in case of positive Congo red staining with apple-green birefringence. Biopsies from 144 patients were evaluated: 77 had a diagnosis of MM and 67 of SMM. The median age was 59 (range 26-84) years; the median follow-up was 76 months (range 0-216). Immunoglobulin isotypes were 96/144 (67%), IgG; 23/144 (16%), IgA; 12/144 (8%), light chain only; 1/77 (1%), IgD; and biclonal or indeterminate, 12/144 (8%). Fifty-eight percent (84/144) were κ restricted. The presence of amyloid was found in two cases (1%, 95% CI -0.6 to 3.2), one in MM, and one in SMM group, and none had or developed signs or symptoms suggestive of organ involvement by amyloid. Among the 142 other patients without amyloid deposition in their index bone marrow, one (0.7%, 95% CI -0.6 to 2.0) developed symptomatic AL after 119 months.

KW - Amyloid

KW - Asymptomatic

KW - Bone marrow biopsy

KW - Multiple myeloma

KW - Smoldering myeloma

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JO - Annals of Hematology

JF - Annals of Hematology

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