The relationship between the type and amount of monoclonal immunoglobulin and the severity of anemic syndrome in patients with plasma cell neoplasms and other diseases with paraproteinemia

There is a signifi cant amount of scientifi c data on the clinical course, molecular biology, treatment options for plasma cell tumors and other disorders connected with the secretion of paraproteins. However, the analysis of the infl uence of specifi c clinical and laboratory signs and their combinations on disease progression and prognosis is less represented. The search for other indicators of disease progression is relevant, particularly the determination of the relationship between the type and level of monoclonal immunoglobulin secretion and the severity of the anemic syndrome, which is the focus of our work. Purpose. To determine the correlation between the type of secretion and the amount of monoclonal immunoglobulin in serum and urine with the severity of anemic syndrome in patients with paraproteinemic hemoblastoses (PН). To evaluate the secretion of pathological protein as a possible prognosis factor for the development of anemia in this category of patients. Material and methods. A retrospective analysis was conducted on data from 116 patients with plasma cell neoplasms and Waldenström’s macroglobulinemia. Of these, 104 (87.8%) were diagnosed with multiple myeloma. Eight (6.9%) patients were diagnosed with Waldenström’s macroglobulinemia, two (1.7%) with plasma cell leukemia, and one case each (0.8%) of solitary plasmacytoma and monoclonal gammopathy of undetermined signifi cance. Patients were divided into four groups based on hemoglobin levels: the fi rst group included patients with hemoglobin above 120 g/L, the second group consisted of patients with mild anemia (hemoglobin level from 119 to 100 g/L), the third included patients with moderate anemia (hemoglobin level 99– 80 g/L), and the fourth group comprised patients with severe anemia (hemoglobin level below 79 g/L). Paraproteins were determined in serum in all four groups: Gκ, Gλ, Aκ, Aλ, Mκ, Mλ, Dλ, BJκ, and BJλ proteins, as well as the excretion of BJκ and BJλ proteins in urine. Results. In most patients, paraproteins were detected in blood: Gκ (35.1%), Gλ (24.6%), and BJλ protein (14.9%); in urine: BJλ protein (14.9%) and BJκ (28.1%). The secretion of other types of paraproteins in blood was less frequent: Aκ (9.6%), Aλ (7%), Mκ (3.5%), Mλ (3.5%), Dλ (2.6%), BJκ (4.4%). The absolute majority consisted of patients with paraprotein in blood (Gκ and Gλ), BJλ protein in serum, and excretion of BJλ and BJκ proteins in urine. At the same time, the secretion of other types of paraproteins—Aκ, Aλ, Mκ, Mλ, Dλ, BJκ—was signifi cantly less frequently detected. Anemia of grade I was more frequently diagnosed—in the group with hemoglobin levels of 119–100 g/L, there were more patients (40; 35%). Grade II anemia (hemoglobin 99–80 g/L) was diagnosed in 33 (28%) patients, grade III in 13 (11%) patients. Hemoglobin levels above 120 g/L were found in 30 (26%) patients. No statistically signifi cant relationship was found between the type of paraprotein, its quantitative value in serum and urine, and the severity of anemia in any group. There was a certain correlation between the excretion of BJκ in urine and hemoglobin levels (χ2 = 10.94, p = 0.01 (< 0.05)). This is likely related to a higher number of patients with renal failure among those excreting BJκ in urine. Kidney damage was diagnosed in 18 (54%) out of 33 patients with BJκ excretion in urine. A statistically signifi cant relationship was identifi ed between the number of tumor cells in bone marrow and the severity of anemia, as well as between the level of β-2 microglobulin and the severity of anemia. Conclusions. It has been established that the type and quantitative level of secretion cannot be a prognostic factor for the severity of anemic syndrome in patients with PH. The study revealed a relationship between the severity of anemia and the amount of BJκ protein determined in urine. Since 54% of pati ents in t his group have renal insuffi ciency, we suggest that there is anemia of chronic disease caused by impaired erythropoietin production due to kidney damage. A correlation has also been identifi ed between the severity of anemia and the infi ltration of tumor cells in the bone marrow, which confi rms that the leading cause of anemia in patients with plasma cell disorders is the infi ltration of the bone marrow by tumor cells and their negative impact on erythropoiesis

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