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Abstract
ABSTRACTObjectives:To investigate the value of urine immunofixation electrophoresis in prognostic evaluation of hematopoietic stem cell transplantation in patients with myeloma.Methods:Thirty-four patients with multiple myeloma admitted to Affiliated Hospital of Hebei University from November 2013 to December 2014 were included as research subjects. All patients received hematopoietic stem cell transplantation and were followed up for five years. Outcomes were evaluated according to the recovery status: complete response (CR), very good partial response (VGPR), partial response (PR), stable disease (SD), and progression disease (PD). In addition, the overall response rate (CR+VGPR) of patients was observed and their urine immunoglobulin status was measured by immunofixation electrophoresis. The Kaplan-Meier method was utilized to plot the survival curve, and the Log-rank method was adopted to analyze the relationship between CR+VGPR and PR and hematopoietic stem cell transplantation (HSCT) survival in patients with myeloma.Results:The basic clinical type of immunofixation electrophoresis was as follows: 19 cases (55.88%) of IgG, 7 cases (20.59%) of IgA, 6 cases (17.65%) of IgM, and 2 cases (5.88%) of light chain type. Outcomes: 13 cases (38.24%) of CR, 12 cases (35.29%) of VGPR, 9 cases (26.47%) of PR, and 25 cases (73.53%) of the overall response rate (CR+VGPR). Compared with IgG, CR, VGPR and PR of IgA, IgM and light chain had statistically significant differences in outcome (p<0.05), and CR+VGPR of patients with IgG was higher than that of patients with IgA, IgM and light chain type (p<0.05). Two of the 34 patients were lost to follow-up. The log-rank analysis showed that the survival rate of patients with CR+VGPR was higher than that of patients with PR (p<0.05). Patients with IgA, IgM, and light chain type had an increased number of prognostic death compared with those with IgG (p<0.05).Conclusion:Patients with IgG type myeloma are superior to those with IgA, IgM and light chain type in terms of the prognosis of hematopoietic stem cell transplantation, which has a certain clinical reference value.
Highlights
Multiple myeloma is a malignant proliferation of plasma cells in bone marrow in which clonal plasma cells in the bone marrow proliferate abnormally and secrete monoclonal immunoglobulins or fragments thereof, causing damage to the corresponding organs or tissues and exacerbating the disease process
It is a treatment regimen combined with autologous hematopoietic stem cell therapy based on traditional chemotherapy regimens, such as melphalan plus prednisone, vincristine plus adriamycin plus dexamethasone, which is characterized by addressing the various problems of traditional treatments such as strong dose dependence and bone marrow clearance, and improving the clinical outcome and survival rate of patients.[13,14]
Patients with IgG type myeloma are prone to a decline in organism immunity, leading to infection and aggravating the disease progression, those with IgA-type are susceptible to hypercalcemia and hypercholesterolemia, while those with IgM and light chain type are prone to renal dysfunction.[16,17,18]
Summary
Multiple myeloma is a malignant proliferation of plasma cells in bone marrow in which clonal plasma cells in the bone marrow proliferate abnormally and secrete monoclonal immunoglobulins or fragments thereof, causing damage to the corresponding organs or tissues and exacerbating the disease process. Pak J Med Sci January - February 2022 Vol 38 No 1 www.pjms.org.pk 315 tologous hematopoietic stem cell transplantation, second-generation proteasome inhibitors, immunomodulators, and monoclonal antibodies targeting surface proteins, have been used in the treatment of multiple myeloma.[3] With these approaches, the prognosis of patients can be greatly improved, some patients respond poorly to treatment, and almost all patients will relapse.[4] it is of great importance to explore the factors affecting the prognosis and to carry out an early intervention. In this study, urine immunofixation electrophoresis was utilized to detect Ig typing in patients with myeloma after hematopoietic stem cell transplantation, so as to explore the relationship between Ig typing and prognosis.
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