title: Immunoglobulin light chain variable (V) region genes influence clinical presentation and outcome in light chain-associated amyloidosis (AL).
abstract: Light chain-associated amyloidosis (AL) is a plasma cell dyscrasia in which the secreted monoclonal immunoglobulin (Ig) light chains form amyloid fibrils. There is considerable heterogeneity in clinical presentation, and prognosis of the disease relates to the severity of organ dysfunction induced by amyloid deposits. The mechanisms by which the amyloid fibrils are deposited as well as the predilection for specific organ sites have not been clearly elucidated. This study characterizes the repertoire of immunoglobulin light chain variable genes used by the clonal B cell in AL amyloid patients, and the association of light chain variable region (VL) genes with clinical presentation and outcome is assessed in 58 (32 lambda and 26 kappa) patients. A preferential use of VL germ-line genes was noted for both AL kappa and lambda patients. There was a significant correlation between the use of the Vlambda VI germ-line donor, 6a, and renal involvement as well as the Vlambda III gene, 3r, with soft-tissue AL. The use of a biased VL gene repertoire also correlated with clinical outcome, revealing important trends for predicting prognosis. The use of Vlambda II germ-line genes was associated with cardiac amyloidosis and affected survival adversely. The presence of multiple myeloma also correlated with a poor prognosis. The presence of renal disease, on the other hand, was associated with improved survival. Therefore, identification of the clonal VL gene in AL has important implications in determining clinical outcome.
authors.affiliation: Division of Clinical Biochemistry and Immunology, Mayo Cancer Center, Mayo Clinic, Rochester, MN, USA. abraham.roshini@mayo.edu
authors.forename: Roshini S
authors.initials: RS
authors.lastname: Abraham
authors.forename: Susan M
authors.initials: SM
authors.lastname: Geyer
authors.forename: Tammy L
authors.initials: TL
authors.lastname: Price-Troska
authors.forename: Cristine
authors.initials: C
authors.lastname: Allmer
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kyle
authors.forename: Morie A
authors.initials: MA
authors.lastname: Gertz
authors.forename: Rafael
authors.initials: R
authors.lastname: Fonseca
mesh_terms: D028226:Amyloidosis, Familial / Q000145:classification / Q000235:genetics* / Q000276:immunology*; D016208:Databases, Factual; D005260:Female; D005803:Genes, Immunoglobulin; D006801:Humans; D007147:Immunoglobulin Light Chains / Q000235:genetics*; D007135:Immunoglobulin Variable Region / Q000235:genetics*; D008297:Male; D018579:Patient Selection; D012189:Retrospective Studies; D013577:Syndrome
chemical_list: D007147:Immunoglobulin Light Chains; D007135:Immunoglobulin Variable Region