Long-term follow-up of plasma cells in bone marrow and serum free light chains in primary systemic AL amyloidosis.
OBJECTIVE
Primary systemic AL amyloidosis arises from immunoglobulin light chains produced by plasma cell dyscrasia. To prospectively investigate the production of M-protein and plasma cells in bone marrow before and after chemotherapy, we performed flow cytometry and analysis of serum free light chains (FLCs).


METHODS
Fifty-nine patients with primary systemic AL amyloidosis (mean age, 59.9+/-8.8 years) were enrolled in this study, and of these 31 were serially studied before and after chemotherapy. Complete hematological remission was defined as normalization of the FLC kappa/lambda ratio.


RESULTS
MPC-1(-)CD45(-) (p<0.05) and MPC-1(+)CD45(-)CD49e(-) (p<0.005) were significantly higher, and MPC-1(-)-CD45(+) (p<0.05), MPC-1(+)CD45(+)CD49e(-) (p<0.0001) and MPC-1(+)CD45(+)CD49e(+) (p<0.0005) were significantly lower in the patients with AL amyloidosis than in controls. There was a significantly positive correlation between the serum predominant FLC/serum creatinine ratio and MPC-1(+)CD45(-)CD49e(-) (p<0.05). After chemotherapies, such as high-dose melphalan with autologous stem cell support, 20 of 31 patients with AL amyloidosis achieved complete hematological remission. There were no significant differences in any subtype of plasma cells before treatment between the remission and non-remission groups, but in the former group MPC-1(+)CD45(-)CD49e(-) and MPC-1(-)CD45(+) were significantly decreased and increased after chemotherapy compared with before, respectively.


CONCLUSIONS
Abnormal plasma cells in the bone marrow, particularly the MPC-1(+)CD45(-)CD49e(-) subset, may be important as a follow-up marker before and after chemotherapy in primary systemic AL amyloidosis. These cells maintain low levels as long as no relapse occurs.
Department of Internal Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto.
Takuhiro
T
Yoshida
Masayuki
M
Matsuda
Nagaaki
N
Katoh
Ko-ichi
K
Tazawa
Yasuhiro
Y
Shimojima
Takahisa
T
Gono
Wataru
W
Ishii
Yozo
Y
Nakazawa
Kazuo
K
Sakashita
Kenichi
K
Koike
Toshiyuki
T
Yamada
Shu-Ichi
S
Ikeda
D000328:Adult; D000368:Aged; D000686:Amyloidosis / Q000097:blood* / Q000175:diagnosis / Q000473:pathology*; D015415:Biomarkers / Q000097:blood; D001853:Bone Marrow / Q000473:pathology*; D016022:Case-Control Studies; D018932:Chemokine CCL2 / Q000097:blood; D064211:Connectin; D003404:Creatinine / Q000097:blood; D004358:Drug Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007147:Immunoglobulin Light Chains / Q000097:blood*; D039482:Integrin alpha5 / Q000097:blood; D017493:Leukocyte Common Antigens / Q000097:blood; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009124:Muscle Proteins / Q000097:blood; D010950:Plasma Cells / Q000378:metabolism / Q000473:pathology*; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome
D015415:Biomarkers; C111835:CCL2 protein, human; D018932:Chemokine CCL2; D064211:Connectin; D007147:Immunoglobulin Light Chains; D039482:Integrin alpha5; D009124:Muscle Proteins; D003404:Creatinine; D017493:Leukocyte Common Antigens; C516769:PTPRC protein, human