title: Natural history and prognostic impact of oligoclonal humoral response in patients with multiple myeloma after autologous stem cell transplantation: long-term results from a single institution.
abstract: The emergence of an oligoclonal humoral response, resulting in the appearance of a different serum M-protein to that observed at diagnosis is a well-recognized event after autologous stem cell transplantation in multiple myeloma in complete response, and it has been considered to be a benign phenomenon. The aim of the present study was to investigate the incidence, biological characteristics and prognostic value of the oligoclonal bands in patients with myeloma who underwent autologous transplantation at our institution in the last 18 years. We proceed with a retrospective systematic review of all serum and urine immunofixation studies performed in the 211 patients with multiple myeloma who underwent melphalan-based autologous transplantation. Oligoclonal bands were observed in 34% of the patients, with a significantly higher prevalence with the use of novel agents versus conventional chemotherapy in induction (63% vs. 22%; P=0.0001). The incidence of oligoclonal bands was most frequent in non-IgG isotype, particularly in light chain only myeloma. The oligoclonal phenomenon was almost exclusive to patients in complete remission compared to other degrees of response (87% vs. 13%; P=0.0001), and lasted for a median of 1.35 years, persisting during follow up in all patients except in those who relapsed. In prognostic terms, the presence of oligoclonality resulted in a significantly longer progression-free and overall survival. Patients with oligoclonal humoral response lasting for more than one year after transplantation had a significantly longer clinical progression-free and overall survival than those with shorter duration (P=0.008 and P=0.0001, respectively), likely reflecting the importance of a robust humoral immune response.
authors: Department of Hematology, Amyloidosis and Myeloma Unit, Hospital Clínic, Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
authors: Natalia
authors: N
authors: Tovar
authors: Carlos Fernández
authors: CF
authors: de Larrea
authors: Juan I
authors: JI
authors: Aróstegui
authors: Maria Teresa
authors: MT
authors: Cibeira
authors: Laura
authors: L
authors: Rosiñol
authors: Montserrat
authors: M
authors: Rovira
authors: Montserrat
authors: M
authors: Elena
authors: Xavier
authors: X
authors: Filella
authors: Jordi
authors: J
authors: Yagüe
authors: Joan
authors: J
authors: Bladé
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000639:trends*; D006801:Humans; D056724:Immunity, Humoral / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000276:immunology* / Q000601:surgery; D043025:Oligoclonal Bands / Q000276:immunology*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014182:Transplantation, Autologous
chemical_list: D043025:Oligoclonal Bands
references: Leukemia. 2009 Jan;23(1):3-9
references: 18971951
references: Clin Biochem Rev. 2009 Aug;30(3):113-8
references: 19841693
references: Cancer Immunol Immunother. 2012 Oct;61(10):1639-51
references: 22350072
references: Blood. 2009 Oct 8;114(15):3276-84
references: 19587378
references: Leukemia. 2006 Sep;20(9):1467-73
references: 16855634
references: J Autoimmun. 2012 Aug;39(1-2):43-8
references: 22297146
references: Blood. 2010 May 6;115(18):3655-63
references: 20203260
references: Haematologica. 2011 Apr;96(4):e29
references: 21454876
references: Bone Marrow Transplant. 2000 Apr;25(7):723-8
references: 10745257
references: Br J Haematol. 2008 Dec;143(5):654-60
references: 18950461
references: Bone Marrow Transplant. 2012 Sep;47(9):1212-6
references: 22158387
references: Br J Haematol. 1998 Sep;102(5):1115-23
references: 9753033
references: Blood. 2011 Sep 15;118(11):2985-7
references: 21765020
references: Br J Haematol. 2011 Nov;155(4):509-11
references: 21539533
references: Blood. 2008 Mar 1;111(5):2516-20
references: 17975015
references: Blood. 1989 Dec;74(8):2764-8
references: 2819246
references: Blood. 2009 Dec 3;114(24):4954-6
references: 19797521
references: Blood. 1998 May 1;91(9):3518-23
references: 9558413
references: J Clin Oncol. 2011 Oct 1;29(28):3805-12
references: 21900099
references: Haematologica. 2011 Jan;96(1):171-3
references: 20884709
references: Blood. 1993 Dec 1;82(11):3493-502
references: 8241517
references: Leuk Lymphoma. 2006 Jan;47(1):21-8
references: 16321823
references: Nat Rev Neurol. 2012 Nov 5;8(11):613-23
references: 23045237
references: Br J Haematol. 1999 Mar;104(4):748-54
references: 10192436
references: Blood. 1990 Oct 15;76(8):1647-56
references: 1698484
references: Blood. 2011 May 5;117(18):4701-5
references: 21292778