Spectrum of monoclonal light-chain gammopathy in a tertiary care hospital

Abstract

Background: Monoclonal light chain gammopathies are uncommon subsets of plasma cell disorders which usually present as diagnostic challenge. Materials and Methods: Twenty cases of monoclonal light-chain gammopathy were identified after screening 150 plasma cell disorders at a tertiary care referral center of North India and were analyzed for clinical profile and treatment outcomes. Results: Out of 20 cases of monoclonal light-chain gammopathy, 65% (13/20) were light-chain multiple myeloma (LCMM) type, 20% (4/20) were light-chain deposition disease (LCDD) type, and 15% (3/20) had primary amyloidosis (AL). Renal failure (65% of cases) was the most common presentation. All the patients with LCDD presented with renal failure (4/4) while as 61% of LCMM (8/13) and 33% of AL (1/3) presented with renal failure. Five patients presented with anemia and all were LCMM type. Two patients presented with lytic bone lesions (LCMM type) and one patient presented with plasmacytoma (LCMM). Overall response rate after 4 cycles of induction therapy was 92.3% in LCMM group, 100% in LCDD group, and 33.33% in AL group (excluding one patient who expired before the start of treatment). LCMM showed 23% partial remission (PR), 30.77% very good PR, 38.46% complete response (CR), and 5% no response (NR). LCDD showed PR 75% and CR 25%. AL showed PR 33.33% and NR 5%. Conclusions: Renal failure is a common presentation of monoclonal light chain gammopathies, and it should alert the treating physician for the underlying uncommon plasma cell disorder.

Keywords

• Acute renal failure
• monoclonal light chain gammopathy
• plasma cell disorder