Contribution of new immunoglobulin-derived biomarkers in plasma cell dyscrasias and lymphoproliferative disorders

Figure 3 Heavy chain fluctuations in the course of a immunoglobulin A multiple myeloma patient. An immunoglobulin (Ig)Aκ multiple myeloma patient achieved stringent complete remission (sCR) after second line treatment with velcade-Dexamethasone. At relapse, he was retreated with velcade-Dex. A second response by serum protein electrophoresis (SPE) was recorded after 8 d but the patient continued to clinically decline and bone marrow aspirations showed considerable plasma cell infiltration. The IgAκ/IgAλ ratio normalised at sCR, became abnormal -- relapse and increasingly abnormal during the second clinical relapse in contrast to the SPE results. Total IgA (blue line), IgA normal range (upper limit, blue dashed line), monoclonal protein by SPE densitometry (black line), IgAκ/IgAλ ratio (red line) and IgAκ/IgAλ ratio normal range (upper limit, red dashed line).