Studies in multiple myeloma

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Clinical investigation of multiple myeloma has provided the answers to many questions concerning the natural history of multiple myeloma. However, many other questions have been raised, such as the relationship between elevations of serum and urinary proteins and the type of neoplastic cells producing them. With the introduction of sophisticated immunologic techniques, it was discovered that the tumor cells produced several chemically distinct types of proteins related structurally to whole or fragmentary gamma globulin molecules. Data on these “myeloma” proteins (M-proteins) and their relationship to the manifestations and course of the disease are the basis of this report.

Materials and methods

The material for this study was collected from the clinical records and laboratory reports of patients with monoclonal gammopathy evaluated in the Immunology Laboratory of the Cleveland Clinic from 1965 to 1972. Immunoelectrophoresis and, in most instances, quantitative immunoglobulin determinations were performed.

Of the 126 cases of monoclonal gammopathy evaluated, 98 patients had multiple myeloma (Table 1). There were too few patients with IgD myeloma for meaningful analysis, but the general features of the two cases will be presented. The two patients in whom no M-protein was identified have been seen only recently and sufficient data are not available for analysis.

The parameters tabulated included age and sex, clinical diagnosis and date of diagnosis, length of follow-up, hemoglobin level, skeletal survey, bone marrow evaluation, serum and urinary protein electrophoresis, serum and urinary protein Immunoelectrophoresis, and quantitative levels of immunoglobulin. Most patients were treated with melphalan alone or in combination . . .



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