Prognostic value of unrelated atypical serum immunofixation patterns during Multiple Myeloma therapy
© Guimaraes et al.; licensee BioMed Central Ltd. 2012
Received: 30 March 2012
Accepted: 23 April 2012
Published: 26 June 2012
Autologous stem cell transplantation (ASCT) is the gold standard therapy for suitable multiple myeloma (MM) patients after induction with high dose therapy. To date, the evidence of a reliable marker of prognosis in these cases remains scarce. Our aim was to evaluate appearance of unrelated atypical serum immunofixation patterns (ASIPs) as a marker of prognosis in MM patients submitted to ASCT. We retrospectively analysed data from 65 patients. Interestingly, we observed that presence of ASIPs was associated with longer progression-free survival and longer overall survival. Our results suggested that presence of ASIPs could be a novel marker of good prognosis in MM patients submitted to ASCT.
KeywordsMultiple myeloma Autologous stem cell transplantation Marker of prognosis Serum immunofixation patterns
Letter to the editor
Multiple myeloma (MM) is a plasma cell neoplasia characterized by abnormal production of monoclonal immunoglobulin detectable in serum and/or urine . However, no reliable markers for prognosis in MM patients submitted to autologous stem cell transplantation (ASCT) are available. The appearance of unrelated atypical serum immunofixation patterns (ASIPs) is a well-recognized event after ASCT in MM with a prevalence ranging from 10 % to 73 % [2–4] and a marked reduction of the malignant plasma cell clone in presence of ASIPs has been described . Interpretation of ASIPs appearance during MM therapy have been challenging for clinicians . Although the real value of ASIPs after ASCT remains controversial, it might be an undervalued surrogate marker for prognosis.
Our aim was to evaluate the appearance of ASIPs on serum immunofixation (IEF) as a prognosis marker in MM. Patients with MM, less than 65 years old and without comorbidities that underwent ASCT were included. Staging of disease followed the Salmon-Durie and International Staging System (ISS) and number of ASCT per patient was recorded. Immunotypes were determined by IEF (HYDRASYS® agarose gel electrophoresis). ASIPs was defined as the appearance of new mono or oligoclonal immunoglobulin protein bands (with either light or heavy chain components). Patients were stratified according to the presence or absence of ASIPs. Overall survival (OS) and progression-free survival (PFS) were calculated using Kaplan-Mayer method and comparisons between groups were made using log-rank test. Chi-square test for categorical variables and Kruskal-Wallis test for continuous variables were used. Analysis of Covariance (ANCOVA) was performed. A p value of 0.05 was considered significant.
Clinical parameters after ASCT according to presence or absence of ASIPs on serum IEF
Presence of ASIPs
(n = 42)
Absence of ASIPs
(n = 23)
Age at dx (years)
58 ± 5
54 ± 7a
1 ASCT (n)
2 ASCT (n)
11 (26.2 %)
31 (73.8 %)
11 (47.8 %)
12 (52.2 %)
5 (11.9 %)
7 (16.7 %)
5 (21.7 %)
23 (54.8 %)
13 (56.5 %)
2 (4.8 %)
1 (4.3 %)
5 (11.9 %)
4 (17.4 %)
8 (19.0 %)
3 (13.0 %)
22 (52.4 %)
15 (65.2 %)
12 (28.6 %)
5 (21.7 %)
29 (69.0 %)
18 (78.3 %)
13 (31.0 %)
14 (60.9 %)b
We concluded that presence of unrelated atypical serum immunofixation patterns could be a possible laboratory marker of good prognosis in MM patients after ACST. Further studies are needed to confirm our results.
Autologous stem cell transplantation
atypical serum immunofixation patterns
International Staging System
overall survival, PFS: Progression-free survival.
We kindly acknowledge Durval Campos Costa MD PhD for his critical review of the final manuscript.
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