An Overview of Light Chain Multiple Myeloma: Clinical Characteristics and Rarities, Management Strategies, and Disease Monitoring

Light chain multiple myeloma (LCMM) constitutes approximately 15% of patients with multiple myeloma (MM). It has a poorer prognosis when compared to immunoglobulin (Ig) G or IgA variant. We performed a comprehensive literature search on LCMM and identified a total of 390 articles. After a detailed s...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2018-08, Vol.10 (8), p.e3148-e3148
Main Authors: Rafae, Abdul, Malik, Mustafa N, Abu Zar, Muhammad, Durer, Seren, Durer, Ceren
Format: Article
Language:English
Subjects:
Age
Anemia
Bone diseases
Bone marrow
Hematology
Immunoglobulins
Inhibitor drugs
Internal Medicine
Light
Medical prognosis
Multiple myeloma
NMR
Nuclear magnetic resonance
Oncology
Pain
Patients
Proteins
Targeted cancer therapy
Urine
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Summary:Light chain multiple myeloma (LCMM) constitutes approximately 15% of patients with multiple myeloma (MM). It has a poorer prognosis when compared to immunoglobulin (Ig) G or IgA variant. We performed a comprehensive literature search on LCMM and identified a total of 390 articles. After a detailed screening, six studies involving a total of 1054 LCMM patients were included. A literature review revealed bone pain and renal failure as the most common initial sign and symptoms while extramedullary disease (EMD) was acquired later during the progression of the disease. Bortezomib has shown superior efficacy in LCMM patients over nonbortezomib regimens as demonstrated by better overall response rate (95.5% vs. 60%), progression-free survival (PFS) (25% vs. 9% at two years), and overall survival (OS) (24% vs. 9% at five years). Moreover, better PFS was seen, when bortezomib was used in combination with bendamustine compared to dexamethasone (95% vs. 25% at two years). Similarly, better OS (90% at two years) was observed with bortezomib in combination with bendamustine. Monitoring of disease should include serum free light chain levels, as literature review revealed that serum assays were more sensitive in indicating the disease and predicting PFS and OS as compared to urine assays. We provide presentation patterns, clinical rarities, management strategies including their efficacy, and disease monitoring in patients with LCMM in our review paper.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.3148