Abstract
6739 Background: Levels of serum sIL-2R represents the total amount of activated T lymphocytes in tumor infiltrating lymphocytes of cancer tissues and metastatic organs. In most malignant diseases, elevated levels of serum sIL-2R are present, compare to normal control. Immunomodulatory effect of low dose IL-2 therapy on interferon (IFN), tumor necrosis factor (TNF) production in vivo and in vitro and on the expression of sIL-2R in HIV-M patients with IgM-laden myeloma cells and triclonal is unknown. Methods: We present a 63 year old female with stage II multiple myeloma (HIV-M), referred to our center with epistaxis, hypercoagulabe state, protein S deficiency, lupus anticoagulant and severe gastrointestinal distress (angulated transverse colon) and a serum viscosity of > 3.00 centipoises (cp). She was treated with immunomodulation therapy BPD (Biaxin, Pentoxifylline, Decadron). Prior to admission she was given plasmapheresis once but relapsed soon afterwards with a rising serum viscosity and bleeding. Her paraprotein parameters were reduced by 50% over ten weeks. We measured serum sIL-2R, C-rective protein (CRP), beta-2-microglobulin (B2M), IgG-kappa, IgG-lambda, IgM-kappa, before and throughout immunomodulation therapy. Her CD4+ count: 728/cumm: viral load:>100K. Highly antiretroviral therapy (HAART) was started. Results: The CRP level began decreasing with cessation of epistaxis. Triclonal parameters decreased steadily over 12 -24 weeks. The sIL-2R level was significantly reduced to normal levels after 24 weeks of immunomodlulation therapy but the beta-2- microglobulin levels remained elevated. Conclusions: The suppression with immunomodulation therapy of CRP gene transcription with manipulation of NF-Kb and IK-Kb with BPD and normalization of sIL-2R in HIV-M patients with early stage triclonal myeloma may have a direct independent effect on the prognostic factor in triclonal IgM-laden HIV-M patients. Serum sIL-2R levels may be a useful parameter for evaluating HIV-M disease stage and monitoring the disease progression during and post-treatment follow-up. No significant financial relationships to disclose.
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