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.
authors.affiliation: Cattedra ed U.O. di Ematologia conTrapianto, Azienda Ospedaliera Universitaria Policlinico di Palermo, via del Vespro 127, 90127, Palermo, Italy. sergio.siragusa@unipa.it
authors.forename: Sergio
authors.initials: S
authors.lastname: Siragusa
authors.forename: William
authors.initials: W
authors.lastname: Morice
authors.forename: Morie A
authors.initials: MA
authors.lastname: Gertz
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kyle
authors.forename: Philip R
authors.initials: PR
authors.lastname: Greipp
authors.forename: John A
authors.initials: JA
authors.lastname: Lust
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Witzig
authors.forename: Martha Q
authors.initials: MQ
authors.lastname: Lacy
authors.forename: Steven R
authors.initials: SR
authors.lastname: Zeldenrust
authors.forename: S Vincent
authors.initials: SV
authors.lastname: Rajkumar
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Russell
authors.forename: Suzanne R
authors.initials: SR
authors.lastname: Hayman
authors.forename: Francis
authors.initials: F
authors.lastname: Buadi
authors.forename: Shaji K
authors.initials: SK
authors.lastname: Kumar
authors.forename: David
authors.initials: D
authors.lastname: Dingli
authors.forename: Angela
authors.initials: A
authors.lastname: Dispenzieri
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000686:Amyloidosis / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D058070:Asymptomatic Diseases / Q000453:epidemiology; D001706:Biopsy; D001853:Bone Marrow / Q000473:pathology*; D005260:Female; D006801:Humans; D007147:Immunoglobulin Light Chains / Q000032:analysis / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D012189:Retrospective Studies
chemical_list: D007147:Immunoglobulin Light Chains