OncohematologyOncohematologyОнкогематология1818-83462413-4023Publishing House ABV Press89810.17650/1818-8346-2024-19-1-56-69DIAGNOSTIC OPPORTUNITIES AND TREATMENT ADVANCESВОЗМОЖНОСТИ ДИАГНОСТИКИ И УСПЕХИ ЛЕЧЕНИЯMonoclonal immunoglobulin as a prognostic factor for the severity of bone damage in paraproteinemic hemoblastoses and Waldenström’s macroglobulinemiaМоноклональный иммуноглобулин – прогностический фактор тяжести остеодеструктивного синдрома при парапротеинемических гемобластозах и макроглобулинемии Вальденстремаhttps://orcid.org/0000-0001-5216-8321PisarevskayaO. N.ПисаревскаяО. Н.
Russian Federation

Ol’ga Nikolaevna Pisarevskaya

3 Gospital’naya Ploshchad’, Moscow 105094

Ольга Николаевна Писаревская 

105094 Москва, Госпитальная пл., 3

sefeta@rambler.ruhttps://orcid.org/0000-0003-1329-8689AlekseevS. A.АлексеевС. А.
Russian Federation

3 Gospital’naya Ploshchad’, Moscow 105094

105094 Москва, Госпитальная пл., 3

https://orcid.org/0000-0002-1309-7265RukavitsynO. A.РукавицынО. А.
Russian Federation

3 Gospital’naya Ploshchad’, Moscow 105094

105094 Москва, Госпитальная пл., 3

Main Military Clinical Hospital named after academician N.N. Burdenko, Ministry of Defense of RussiaФГБУ «Главный военный клинический госпиталь им. акад. Н.Н. Бурденко» Минобороны России2701202419156692601202426012024https://oncohematology.abvpress.ru/ongm/article/view/898

Aim. Identify risk factors for the development of osteodestructive syndrome. To determine the relationship between the types of secreted monoclonal immunoglobulin (paraprotein) and the severity of osteodestructive syndrome in patients with paraproteinemic hemoblastoses (PH) and Waldenström’s macroglobulinemia (WM).

Materials and methods. A retrospective analysis of data from 116 patients with PH and WM was performed. 104 patients (89.6 %) were diagnosed with multiple myeloma. Less commonly observed were WM (in 8 patients – 6.9 %), plasma cell leukemia (in 2 patients – 1.8 %), solitary plasmacytoma and monoclonal gammopathy of unknown significance were diagnosed in one case (0.9 %) each. According to the severity of osteodestructive syndrome, all patients were divided into 4 groups. The first group (0) included patients who did not have osteodestructive changes in the bones. In patients of the second group, a mild degree (I) osteodestructive process was observed, and in patients from the third and fourth groups – moderate (II) and severe (III) degrees, respectively. All patients underwent protein electrophoresis followed by immunofixation to determine the type of paraprotein and its concentration in serum and urine.

Results. In the majority of patients, paraproteins were detected in the blood – Gκ (35.1 %), Gλ (24.6 %), Bence Jones protein λ-type (BJλ) (14.9 %); in urine – BJλ protein (14.9 %) and Bence Jones protein κ-type (BJκ) (28.1 %). Secretion of other types of paraproteins in the blood was less frequently detected – Aκ (9.6 %), Aλ (7.0 %), Mκ (3.5 %), Mλ (3.5 %), Dλ (2.6 %), BJκ (4.4 %). Osteodestructive syndrome of I and II severity was diagnosed in 43 (37.1 %) and 40 (34.5 %) patients, respectively; lytic destruction of III degree was less frequently detected in 20 (17.2 %) patients, in 13 (11.2 %) patients osteodestruction was not detected (degree 0). It was noted that a higher degree of destruction (II, III) was observed in patients with multiple myeloma occurring with paraproteinemia Dλ and BJλ in the blood, as well as hypercalcemia. Osteodestructive syndrome of the lowest degree (0, I) was diagnosed in patients with the secretion of monoclonal proteins Ak and Mλ. There was no statistically significant relationship between the type of secretion of paraproteins Gκ, Gλ, Aλ, Mκ, BJκ in the blood, as well as proteins BJκ and BJλ in the urine and the severity of the osteodestructive process.

Conclusion. The results obtained in the study make it possible to identify risk groups, and parameters such as the type of paraprotein, the concentration of calcium in the blood serum can be considered as prognostic factors when assessing the severity of osteodestructive syndrome in patients with PH and WM.

Цель исследования – выявить факторы риска развития остеодеструктивного синдрома. Определить взаимосвязь между типом секретируемого моноклонального иммуноглобулина (парапротеина) и степенью тяжести остеодеструктивного синдрома у пациентов с парапротеинемическими гемобластозами (ПГ) и макроглобулинемией Вальденстрема (МВ).

Материалы и методы. Проведен ретроспективный анализ данных 116 пациентов с ПГ и МВ. У 104 (89,6 %) больных диагностирована множественная миелома. Реже наблюдались МВ (у 8 (6,8 %) больных), плазмоклеточный лейкоз (у 2 (1,8 %)), солитарная плазмоцитома и моноклональная гаммапатия неясного значения (по 1 (0,9 %) случаю). По степени тяжести остеодеструктивного синдрома все пациенты были распределены на 4 группы. В 1‑ю группу включены больные, не имеющие остеодеструктивных изменений в костях (0 степень). У пациентов 2‑й группы наблюдался остеодеструктивный процесс легкой (I) степени, у больных 3‑й и 4‑й групп – средней (II) и тяжелой (III) степеней соответственно. Всем пациентам был выполнен электрофорез белка с последующей иммунофиксацией в целях определения типа парапротеина и его концентрации в сыворотке крови и моче.

Результаты. У большинства пациентов в крови определялись парапротеины – Gκ (35,1 %), Gλ (24,6 %), белок БенсДжонса λ-типа (BJλ) (14,9 %); в моче – белок BJλ (14,9 %) и белок Бенс-Джонса κ-типа (BJκ) (28,1 %). Реже определялась секреция в крови парапротеинов других типов – Аκ (9,6 %), Aλ (7,0 %), Мκ (3,5 %), Мλ (3,5 %), Dλ (2,6 %), BJκ (4,4 %). Остеодеструктивный синдром I и II степеней тяжести диагностирован у 43 (37,1 %) и 40 (34,5 %) больных соответственно, реже выявлялась литическая деструкция III степени – у 20 (17,2 %) больных, у 13 (11,2 %) больных остеодеструкции не определялись (0 степень). Более высокая степень деструкции (II, III) наблюдалась у больных множественной миеломой, протекающей с парапротеинемией Dλ и BJλ в крови, а также с гиперкальциемией. Остеодеструктивный синдром более низкой степени (0, I) диагностирован у больных с секрецией моноклональных белков Аκ и Mλ. Статистически значимой взаимосвязи между типом секреции парапротеинов Gκ, Gλ, Aλ, Mκ, BJκ в крови, а также белков BJκ и BJλ в моче и cтепенью тяжести остеодеструктивного процесса не получено.

Заключение. Тип секретируемого парапротеина и гиперкальциемия могут рассматриваться как факторы прогноза при оценке степени тяжести остеодеструктивного синдрома у больных ПГ и МВ.

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