The concentration and type of monoclonal protein and their impact on clinical severity in patients with symptomatic myeloma

Ahmed Khudair  Yassin; Najmaddin Salih Husen  Khsohnaw; Sana Dlawar  Jalal; Akram Mahmood  Mohammed; Kawa Mohamedamin  Hasan; Dana Ahmed  Abdulla; Ameer   Badi; Banaz Mubarak  Safar; Basil Kadhim  Abdulla; Rawand Polus  Shamoon; Diveen Jalal  Hussein; Nawsherwan Sadiq  Mohammed; Kanar Jalal  Karim; Abid Mohiaddin  Hassen; Hisham Arf  Getta; Rezhin Nawzad  Rajab; Friad Hiwaizi Hiwaizi; Truska Awat  Amin; Zeki Ali  Mohamed; Ali Ibrahim  Mohammed; Hameed  Saeed; Parween  Ismael; Alaa  Alwan

doi:10.56056/amj.2022.147

Authors

Ahmed Khudair Yassin MBChB, CABM, FIBMS, Department of Medicine, College of Medicine, Hawler Medical University, Kurdistan Region, Iraq
Najmaddin Salih Husen Khsohnaw MBChB, HDH, KBMS-candidate Department of Haematology, Hiwa Cancer hospital, Sulaymaniyah, Ministry of Health, Department of MLS, Komar University of Science and Technology, Kurdistan region, Iraq
Sana Dlawar Jalal Department of Pathology, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq
Akram Mahmood Mohammed MBChB, HDH, KBMS-candidate Department of Haematology, Hiwa Cancer hospital, Sulaymaniyah, Ministry of Health, Kurdistan region, Iraq.
Kawa Mohamedamin Hasan MBChB, CABM, FIBMS, Department of Medicine, College of Medicine, Hawler Medical University, Kurdistan Region, Iraq
Dana Ahmed Abdulla Department of Pathology, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq
Ameer Badi Department of Pathology, College of Medicine, University of Duhok, Duhok, Kurdistan Region, Iraq
Banaz Mubarak Safar MBChB, HDH, KBMS-candidate Department of Haematology, Hiwa Cancer hospital, Sulaymaniyah, Ministry of Health, , Kurdistan region, Iraq
Basil Kadhim Abdulla MBChB, HDH, KBMS-candidate Department of Haematology, Hiwa Cancer hospital, Sulaymaniyah, Ministry of Health, Kurdistan region, Iraq
Rawand Polus Shamoon Department of Pathology, College of Medicine, Hawler Medical University, Erbil, Iraq
Diveen Jalal Hussein Department of Haematology, Nanakali Hospital, Erbil, Kurdistan Region, Iraq
Nawsherwan Sadiq Mohammed Department of Pathology, College of Medicine, Hawler Medical University, Erbil, Iraq
Kanar Jalal Karim MBChB, HDH, KBMS-candidate Department of Haematology, Hiwa Cancer hospital, Sulaymaniyah, Ministry of Health, Kurdistan region, Iraq
Abid Mohiaddin Hassen Department of Medicine, College of Medicine, University of Duhok, Duhok, Iraq
Hisham Arf Getta Department of Pathology, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq
Rezhin Nawzad Rajab Department of Haematology, Nanakali Hospital, Erbil, Kurdistan Region, Iraq
Friad Hiwaizi Hiwaizi Department of Haematology, Nanakali Hospital, Erbil, Kurdistan Region, Iraq
Truska Awat Amin MBChB, HDH, KBMS-candidate Department of Haematology, Hiwa Cancer hospital, Sulaymaniyah, Ministry of Health, Kurdistan region, Iraq
Zeki Ali Mohamed Department of Medicine, College of Medicine, University of Duhok, Duhok, Iraq
Ali Ibrahim Mohammed Department of Pathology, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq
Hameed Saeed MBChB, HDH, KBMS-candidate Department of Haematology, Hiwa Cancer hospital, Sulaymaniyah, Ministry of Health,Kurdistan region, Iraq
Parween Ismael MBChB, HDH, KBMS-candidate Department of Haematology, Hiwa Cancer hospital, Sulaymaniyah, Ministry of Health, Kurdistan region, Iraq
Alaa Alwan Department of the Haematology University of Mustansiriyah, National Center of Hematology, Baghdad, Iraq

DOI:

https://doi.org/10.56056/amj.2022.147

Keywords:

Multiple Myelomas, Immune-fixation, Light chain, Serum and Urine Protein electrophoresis

Abstract

Background and objectives: Multiple Myeloma is a clonal plasma cell proliferation in the bone marrow that produces abnormal monoclonal proteins in serum and /or urine that leads to end-organ damage. We aimed to evaluate concentration, type of monoclonal protein, and their impact on the severity of symptomatic multiple myeloma patients.

Methods: The study was conducted on 124 patients with symptomatic myeloma who were registered in the three centers in Kurdistan-Iraq from January–to June 2019. Out of the 74 were males, and 50 were females. Demographic details, laboratory investigations, and imaging studies were reviewed, and informed consent was obtained for all patients; smoldering myeloma was excluded.

Results: The most prevalent subtypes were IgG followed by IgA (61.3%, 18.5% respectively), whereas free light chain and non-secretory myeloma formed the rest, 12.1% and 6.45% for each subtype. There is a statistically positive association found between the concentration of monoclonal protein and the level of hemoglobin, ß₂-microglobulin, and lactic acid dehydrogenase. There is no association between the concentration of monoclonal protein with each calcium, albumin, creatinine, and erythrocyte sedimentation rate.

Conclusions: We found a higher percentage of IgG/Kappa, high rates of non-secretory myeloma, low rates of light chain myeloma, and younger age at presentation in comparison to western reports. The association between monoclonal protein concentration and some parameters of prognostic value in patients studied underscores its relevance to the severity of disease in our locality.

Downloads

Download data is not yet available.

References

Kyle RA, Larson DR, Therneau TM, et al. Long-term follow-up of monoclonal gammopathy of undetermined significance. N Engl J Med. 2018;378(3):241–9.

Rajkumar SV. Updated Diagnostic Criteria and Staging System for Multiple Myeloma. Am Soc Clin Oncol Educ B. 2016;36: e418–23.

Rajkumar SV, Dimopoulos MA, Palumbo A, et.al. International Myeloma Working Group (IMWG) criteria for the diagnosis of multiple myeloma. Lancet Onco. 2014;15(12):538–48.

O’Connell TX, Horita TJ, Kasravi B. Understanding and interpreting serum protein electrophoresis. Am Fam Physician. 2005;71(1):105–12.

Dispenzieri A, Kyle R, Merlini G, et al. International Myeloma Working Group guidelines for serum-free light chain analysis in multiple myeloma and related disorders. Leukemia. 2009; 23:215–24.

Greipp P, San Miguel J, Brian G et.al. International Staging System for Multiple Myeloma. J Clin Oncol. 2005 23:15, 3412-20.

Drayson M, Tang LX, Drew R, et.al. Brief report Serum free light-chain measurements for identifying and monitoring patients with non-secretory multiple myeloma. Blood. 2001;97(9):2900–2.

Rajkumar SV, Kyle RA. Multiple myelomas: diagnosis and treatment. Mayo Clin Proc. 2005;80(1): 80:1371-82.

Munshi NC. Investigative tools for diagnosis and management. Hematology Am Soc Hematol Educ Program. 2008:298-305.

Yassin AK. Clinical and Laboratory Profiles of 109 Patients diagnosed as Multiple Myeloma in Erbil City. J Fac Med Baghdad. 2013;55(2):121–4.

Khoshnaw N, Mohammed HA, Abdullah DA. Patterns of Cancer in Kurdistan - Results of Eight Years Cancer Registration in Sulaymaniyah Province-Kurdistan-Iraq.

Asian Pac J Cancer Prev. 2015;16(18):8525-31.

Yassin AK. Survival advantage of adding thalidomide as compared with chemotherapy only in the treatment of symptomatic myeloma in Kurdistan/Iraq. Iraqi J Hematol. 2016;42(1):9–14.

Kyle RA, Gertz MA, Witzig TE et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc. 2003;78(1):21-33

Durie BG, Harousseau JL, Miguel JS, et al. International uniform response criteria for multiple myeloma. Leukemia. 2006; 20:1467–73.

Katzmann JA, Dispenzieri A, Kyle RA, et.al. Elimination of the need for urine studies in the screening algorithm for monoclonal gammopathies by using serum immunofixation and free light chain assays. Mayo Clin Proc. 2006; 81:1575–8.

Eleutherakis-Papaiakovou V, Bamias A GD. Renal failure in mul¬tiple myeloma: incidence, correlations, and prognostic significance. Leuk Lymphoma. 2007; 48:48:337-41.

Palumbo A, Anderson K. Multiple Myeloma. N Engl J Med. 201; 364:1046–60.

Durie BG. The role of anatomic and functional staging in myeloma: description of Durie/Salmon plus staging system. Eur J Cancer. 2006;42(11):1539-43.

Hari PN, Zhang MJ, Roy V, et al., Is the international staging system superior to the Durie – Salmon staging system? A comparison in multiple myeloma patients undergoing autologous transplant. Leukemia. 2009;23(8):1528–34.

Avet-Loiseau H, Attal M, Moreau Ph., et.al. Genetic abnormalities and survival in multiple myeloma: the experience of the Intergroupe Francophone du Mye' lome. Blood. 2007;109(8):3489–95.

Palumbo A, Avet-Loiseau H, Oliva S, et al. Revised International Staging System for Multiple Myeloma: A Report from International Myeloma Working Group. J Clin Oncol.2015; 33:26, 2863-9.