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

Annals of Hematology
Sergio SiragusaAngela Dispenzieri

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.

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Citations

Aug 27, 2011·Leukemia·M A Gertz
Nov 15, 2007·Cytogenetic and Genome Research·C Sreekantaiah
Nov 15, 2012·BMC Public Health·Kari HemminkiKristina Sundquist
Nov 22, 2011·Journal of Hematology & Oncology·Michael Rosenzweig, Heather Landau
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Jun 20, 2014·Journal of Clinical and Experimental Hematopathology : JCEH·Seiji ShidaKenichi Sawada
Mar 14, 2012·Annals of Hematology·Kristel B Van LanduytKon-Siong G Jie
Jan 9, 2013·British Journal of Haematology·Moshe E Gatt, Giovanni Palladini
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Feb 28, 2018·Amyloid : the International Journal of Experimental and Clinical Investigation : the Official Journal of the International Society of Amyloidosis·Natalia TovarCarlos Fernández de Larrea
Oct 2, 2019·British Journal of Haematology·Leonid L YavorkovskyRobin Baker
Jun 23, 2016·British Journal of Haematology·Rajshekhar ChakrabortyShaji K Kumar
Apr 30, 2017·Oncology Letters·Ying-Hui XuKe-Wei Ma
Sep 5, 2020·American Journal of Clinical Pathology·Gauri PanseMina L Xu
Apr 25, 2017·Amyloid : the International Journal of Experimental and Clinical Investigation : the Official Journal of the International Society of Amyloidosis·Christoph KimmichUte Hegenbart
May 1, 2021·Thrombosis and Haemostasis·Akitada IchinoseMasayoshi Souri
Aug 28, 2021·Journal of the Formosan Medical Association = Taiwan Yi Zhi·Shao-Yu YangHeng-Chih Pan

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