Akademik Veri Yönetim Sistemi
19th International Myeloma Society Annual Meeting, California, Amerika Birleşik Devletleri, 25 - 27 Ağustos 2022, sa.166, ss.126
Introduction: Free light chain escape (FLE) is a rare phenomenon
seen in 3% of multiple myeloma patients. It is characterized by
rise of involved free light chain levels without involved heavy
chain component. It often accompanies extramedullary disease
progression or rapid renal impairment. Here we present four case
with FLE. Methods: Patient data has been obtained from patient
fi les. Results: Case A: 52-year-old female patient is referred after
pathologic fracture due to plasmacytoma. IgGλ myeloma R-ISS
stage III is diagnosed and treatment is started immediately with
weekly bortezomib+cyclophosphamide+dexamethasone (VCD).In the last day of the fi rst course it was observed that her general
condition deteriorated; anemia, hypercalcemia, and a slightly
higher creatinine level is detected. At the same time, free λ light
chain escape is observed. She received carfi lzomib and underwent
autologous stem cell transplant (SCT) but relapsed and died in 7
months after SCT. Case B: A 46-year-old male patient was evaluated
in June 2010 with complaints of low back pain and fatigue and and
was diagnosed IgAλ MM R-ISS: I. The patient has a history of two
autologous SCTs (in 2011 and 2018). After his second transplant he
was started on lenalidomide maintenance with VGPR. He presented
with back pain in July 2020. Magnetic resonance imaging revealed
a mass lesion with signifi cant compression of the spinal cord and
FLE is observed. He underwent allogeneic SCT. Case C: 56-year-old
female patient is referred with mild anemia and hypercalcemia and
diagnosed with IgGκ multiple myeloma R-ISS: II. She underwent
autologous SCT after VCD. Relapsed after 8 months and received
carfi lzomib+lenalidomide+dexamethasone(CarLenDex) with no
response and she progressed with many cervical lymph nodes and
left pleural effusion. FLE has been detected simultaneously. She died
after several months. Case D: 60 year-old patient has been diagnosed
with IgGλ ISS: 2 myeloma. He underwent 2 autologous SCTs in
2013 and 2019. del17p and 1q Gain has been observed after his
second relapse. He received CarLenDex and PomDex sequentially
with short durations of response (PR). FLE was detected under
PomDex treatment and he presented with worsening anemia and
acute kidney injury one month later. Conclusions: Our cases show
that in during the treatment of myeloma, a clone that may be
selected which can lead to light chain escape and disease progression.
This progression is usually sudden and requires close monitoring
of serum free light chain levels to detect. Also light chain escape
can accompany extramedullary/extraosseous disease progression or
rapid renal impairment. Serum free light chain follow-up during
treatment could be useful in identifying this phenomenon even
when FLC ratio seems stable for a while. We suggest monitoring free
light chain levels in addition to heavy chain levels during treatment
and follow-up of myeloma patients.