title: Aggressive FLC Escape in a Patient with IgD Myeloma.
abstract: Background. Some patients who are stable or in remission from a myeloma secreting intact monoclonal immunoglobulin (+/- associated free light-chains (FLCs)) relapse with production of FLC. This FLC escape is one of the illustrations of the intraclonal heterogeneity of multiple myeloma. Results. We report FLC escape in a patient with IgD myeloma characterized by a severe outcome. We discuss parameters that negatively impacted prognosis in this patient, including bone lesions, biochemical parameters, and genomic abnormalities. Conclusion. This case illustrates the selective pressure exerted by therapeutic drugs and the variable sensitivity of subclones to these drugs; it also highlights the importance of FLC monitoring in treated MM patients.
authors.affiliation: Laboratoire d'Immunologie, CHU de Toulouse, Hôpital Rangueil, 1 Avenue Jean Poulhès, TSA 50032, 31 059 Toulouse Cedex 9, France.
authors.forename: Cédric
authors.initials: C
authors.lastname: Farges
authors.affiliation: Hematology Department, University Hospital, 31059 Toulouse, France.
authors.forename: Murielle
authors.initials: M
authors.lastname: Roussel
authors.affiliation: Hematology Department, University Hospital, 31059 Toulouse, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Huynh
authors.affiliation: Laboratoire d'Immunologie, CHU de Toulouse, Hôpital Rangueil, 1 Avenue Jean Poulhès, TSA 50032, 31 059 Toulouse Cedex 9, France ; Laboratoire d'Immunogénétique Moléculaire (EA3034), Faculté de Médecine Toulouse-Rangueil, Université Paul Sabatier Toulouse III, Bâtiment A2, 133 route de Narbonne, 31062 Toulouse Cedex 04, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Blancher
authors.affiliation: Laboratoire d'Immunologie, CHU de Toulouse, Hôpital Rangueil, 1 Avenue Jean Poulhès, TSA 50032, 31 059 Toulouse Cedex 9, France ; Laboratoire d'Immunogénétique Moléculaire (EA3034), Faculté de Médecine Toulouse-Rangueil, Université Paul Sabatier Toulouse III, Bâtiment A2, 133 route de Narbonne, 31062 Toulouse Cedex 04, France.
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Puissant-Lubrano