The risk of renal disease is increased in lambda myeloma with bone marrow amyloid deposits
Piotr Kozlowski1, Scott Montgomery2, Rahel Befekadu3
1Department of Medicine, School of Medical Sciences, Örebro University, Örebro, Sweden.
Background:
Light chain amyloidosis (AL) is a rare deposition disease and is present in 10-15% of patients with myeloma (MM). In contrast to symptomatic AL in MM, presence of bone marrow (BM) amyloid deposits (AD) in MM is not connected to kidney damage. Renal AD but not BM-AD occur mostly in MM with lambda paraprotein (lambda MM).
Methods:
We investigated amyloid presence in BM clots taken at diagnosis in 84 patients with symptomatic MM and compared disease characteristics in MM with kappa paraprotein (kappa MM)/lambda MM with and without BM-AD.
Results:
Lambda MM with BM-AD was compared with kappa MM without BM-AD, kappa MM with BM-AD, and lambda MM without BM-AD: lambda MM with BM-AD patients had a significantly higher mean creatinine level (4.23 mg/dL vs 1.69, 1.14, and 1.28 mg/dL, respectively) and a higher proportion presented with severe kidney failure (6/11 [55%] vs 6/32 [19%], 1/22 [5%], and 3/19 [16%], respectively). Proteinuria was more common in lambda MM with BM-AD patients compared with kappa MM without BM-AD patients (8/11 [73%] vs 5/32 [16%], respectively).
Conclusion:
Kidney damage was more common in lambda MM with BM-AD indicating presence of renal AD.
Insights
Light chain amyloidosis (AL) in multiple myeloma (MM) patients with bone marrow amyloid deposits (BM-AD) is linked to kidney damage, especially in lambda MM. This suggests the presence of renal amyloid deposits (AD) in these cases.
Area of Science:
- Hematology
- Nephrology
- Oncology
Background:
- Light chain amyloidosis (AL) is a rare condition associated with multiple myeloma (MM).
- Amyloid deposits (AD) in the bone marrow (BM) of MM patients are not typically linked to kidney damage.
- Renal AD, unlike BM-AD, are more frequently observed in MM with lambda paraprotein (lambda MM).
Purpose of the Study:
- To investigate the association between bone marrow amyloid deposits (BM-AD) and kidney damage in patients with symptomatic multiple myeloma (MM).
- To compare disease characteristics in MM patients with kappa or lambda paraprotein, with or without BM-AD.
Main Methods:
- Analysis of bone marrow clots from 84 symptomatic multiple myeloma patients at diagnosis.
- Comparison of disease characteristics, including kidney function markers, between different MM subgroups based on paraprotein type and BM-AD presence.
Main Results:
- Lambda MM patients with BM-AD showed significantly higher mean creatinine levels (4.23 mg/dL) compared to other groups (1.14-1.69 mg/dL).
- A higher proportion of lambda MM with BM-AD patients experienced severe kidney failure (55%) versus other groups (5-19%).
- Proteinuria was more prevalent in lambda MM with BM-AD patients (73%) compared to kappa MM without BM-AD (16%).
Conclusions:
- Kidney damage is more common in lambda multiple myeloma patients with bone marrow amyloid deposits.
- The findings suggest the presence of renal amyloid deposits in lambda MM patients with BM-AD.
- This highlights the clinical significance of assessing BM-AD in MM for predicting renal involvement.
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