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, A. W. Butch

Research output: Contribution to journalArticle

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Abstract

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 O8 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.

Original languageEnglish (US)
Pages (from-to)3518-3523
Number of pages6
JournalBlood
Volume91
Issue number9
StatePublished - May 1 1998
Externally publishedYes

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Oligoclonal Bands
Immunoglobulin Class Switching
Cell Transplantation
Multiple Myeloma
Switches
Proteins
Clone cells
Paraproteins
Plasma Cells
Transplants
Therapeutics
Electrophoresis
Plasmas
Clone Cells
Recovery
Bone Marrow Examination
Bone
Blood Proteins
Cells
B-Lymphocytes

ASJC Scopus subject areas

  • Hematology

Cite this

Zent, C. S., Wilson, C. S., Tricot, G., Jagannath, S., Siegel, D., Desikan, K. R., ... Butch, A. W. (1998). Oligoclonal protein bands and Ig isotype switching in multiple myeloma treated with high-dose therapy and hematopoietic cell transplantation. Blood, 91(9), 3518-3523.

Oligoclonal protein bands and Ig isotype switching in multiple myeloma treated with high-dose therapy and hematopoietic cell transplantation. / Zent, C. S.; Wilson, C. S.; Tricot, G.; Jagannath, S.; Siegel, D.; Desikan, K. R.; Munshi, N.; Bracy, D.; Barlogie, B.; Butch, A. W.

In: Blood, Vol. 91, No. 9, 01.05.1998, p. 3518-3523.

Research output: Contribution to journalArticle

Zent, CS, Wilson, CS, Tricot, G, Jagannath, S, Siegel, D, Desikan, KR, Munshi, N, Bracy, D, Barlogie, B & Butch, AW 1998, 'Oligoclonal protein bands and Ig isotype switching in multiple myeloma treated with high-dose therapy and hematopoietic cell transplantation', Blood, vol. 91, no. 9, pp. 3518-3523.
Zent CS, Wilson CS, Tricot G, Jagannath S, Siegel D, Desikan KR et al. Oligoclonal protein bands and Ig isotype switching in multiple myeloma treated with high-dose therapy and hematopoietic cell transplantation. Blood. 1998 May 1;91(9):3518-3523.
Zent, C. S. ; Wilson, C. S. ; Tricot, G. ; Jagannath, S. ; Siegel, D. ; Desikan, K. R. ; Munshi, N. ; Bracy, D. ; Barlogie, B. ; Butch, A. W. / Oligoclonal protein bands and Ig isotype switching in multiple myeloma treated with high-dose therapy and hematopoietic cell transplantation. In: Blood. 1998 ; Vol. 91, No. 9. pp. 3518-3523.
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AU - Siegel, D.

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