Multiple myeloma. Clinical correlation of immunoglobulin changes with therapy. A report of 23 cases

Twenty-three patients with multiple myeloma were studied. They were grouped according to their clinical response and changes in myeloma globulin in the serum or urine while under chemotherapy. Sixteen responded favorably with clinical improvement and marked reduction in the respective M-globulins. Four did not respond and showed progression of disease, and three had short-lived clinical response with essentially unchanged myeloma-globulin values. Patients with renal insufficiency showed simultaneous improvement of uremia and M-globulins in response to chemotherapy. Three patients had solitary plasmacytomas when first seen, and dissemination occurred later in one. Combination of alkylating agents with steroids appeared to give faster, longer-lasting and more satisfactory clinical remissions, although the bone marrow may remain essentially unchanged. Radiation therapy was the most effective agent against localized pain (without altering the M-globulin) when used alone. Twenty-two of the 23 patients already had a significant decrease in IgM at the time multiple myeloma was diagnosed. A diminution in IgM can be considered of diagnostic significance although the mechanism for this reduction is not known. It has been felt to involve a feed-back mechanism, where one immunoglobulin elevation results in a subsequent diminution in the other immunoglobulins.