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[Transient monoclonal gammopathies. Study of 34 cases]
P Giraldo1, D Rubio-Félix, P Delgado
1Servicio Regional de Hematología y Hemoterapia, Hospital Miguel Servet, Zaragoza, España.
Purpose:
To evaluate the incidence of transitory monoclonal gammopathies (MG) defined as a narrow spike in serum electrophoresis disappearing after a variable period of time.
Material And Methods:
A follow up (1986-1992) in all the cases with "minimal" MG (< 10 g/L) to evaluate the transitory or permanent nature of the patients sera was performed along a 7-year period. Serum protein electrophoresis along with immunofixation electrophoresis were performed in order to identify and characterize the monoclonal components in all the cases.
Results:
Thirty four out of 592 monoclonal gammopathies (5.7% of the total and 8.6% of the non-myelomatous monoclonal components) fulfilled the criteria of transitory monoclonal gammopathies. There was predominance of adult patients (88.2%), females (64.7%) and subjects over 40 years of age (67.6%). The monoclonal component was small in all the cases (mean 4.5 g/L). After immunochemical characterization, IgG was found in 23 cases and IgM in 9; the light chain was Kappa in 25 and lambda in 7; two patients had 2 or 3 monoclonal components. In 31 of the 34 cases the associated pathology was infectious; this being neoplastic in 2 and hypersensitivity to drugs in the remaining patient. The infectious agents could be identified in 24 instances as mainly gram-negative bacteria.
Conclusions:
1) The appearance of a transitory monoclonal gammopathy is not an unusual finding. 2) This alteration does not have any prognostic significance. 3) The appearance of a small monoclonal component, especially in infectious diseases, should not elicit deeper studies.
Insights
Transitory monoclonal gammopathies (MG), a temporary protein electrophoresis spike, are not unusual and lack prognostic significance. These findings, often linked to infections, do not typically require further investigation.
Area of Science:
- Clinical chemistry
- Immunology
- Hematology
Context:
- Monoclonal gammopathies (MG) are characterized by the presence of a monoclonal protein in the serum.
- Transitory MG, defined by a narrow spike that disappears over time, is a less understood subtype.
- Understanding the incidence and nature of transitory MG is crucial for accurate diagnosis and patient management.
Purpose:
- To determine the incidence of transitory monoclonal gammopathies (MG).
- To characterize the clinical and immunochemical features of transitory MG.
- To evaluate the prognostic significance of transitory MG.
Summary:
- A 7-year follow-up study identified transitory MG in 5.7% of monoclonal gammopathy cases.
- Transitory MG predominantly affected adults, particularly females over 40, with small monoclonal components (mean 4.5 g/L).
- Infectious diseases, mainly gram-negative bacterial infections, were associated with 31 of 34 transitory MG cases.
Impact:
- Transitory monoclonal gammopathies are a common finding and do not indicate a poor prognosis.
- The presence of a small monoclonal component, especially in infectious conditions, does not warrant extensive diagnostic workup.
- This study clarifies the benign nature of transitory MG, potentially reducing unnecessary investigations and patient anxiety.