Correlation of abnormal immunoglobulin with clinical features of myeloma.

Physical and chemical characteristics of the abnormal immunoglobulin as well as the immunoglobulin type are important determinants of the clinical features and prognosis in myeloma. A review of 270 cases of myeloma studied by the Acute Leukemia Group B showed that survival was adversely affected by azotemia. The presence of Bence Jones proteinuria adversely influenced survival even in patients who were not initially azotemic. The presence of lambda-type Bence Jones proteinuria resulted in greatly shortened survival in contrast to kappa-type Bence Jones proteinuria in the absence, or presence, of a serum IgG M-protein. The adverse effect of lambda-type Bence Jones protein could not be demonstrated in patients with IgA myeloma. Patients with IgA myeloma were found to have a noticeably shorter survival than those with IgG myeloma.