Waldenstrom's MacroglobulinemiaHuman monoclonal macroglobulins with antibody activity☆,☆☆,★
Section snippets
Materials and methods
Analysis was carried out on sera from 172 patients with monoclonal macroglobulinemia collected between 1970 to 2002 (12 from 1970 to 1979, 17 from 1980 to 1989, 53 from 1990 to 1995, 75 from 1996 to 2000, nine in 2001, and six in 2002). Sera were stored at −20°C until 1 to 20 days before assay. Clinical data were determined by retrospective chart review. The study protocol was approved by the Institutional Review Board, Baylor University Medical Center, Dallas, TX.
Results
Mean age of the patients was 67 years (range, 31 to 96). There were 90 men and 82 women. Of the original 172 patient sera, one could not be verified as containing monoclonal macroglobulin and was excluded. The remaining 171 had monoclonal macroglobulins by IFE. Quantitative serum IgM levels varied between 70 and 6,800 mg/dL, with a mean level of 1,409. Some patients did not have a definable M-protein on SPE because of polyclonal hypergammaglobulinemia or low serum IgM levels. Biclonal
Discussion
The presence of antibody activity in serum from a patient with monoclonal gammopathy does not necessarily indicate that the M-protein possesses the activity. Criteria to establish that monoclonal immunoglobulins are antibodies have been discussed.1, 5, 6, 7, 8, 9, 10, 11 That some monoclonal macroglobulins and myeloma proteins satisfy these criteria has been documented for more than three decades. Most of the antigens identified have been of autologous or bacterial origin (Table 4).1, 24, 25, 26
Acknowledgements
We thank Drs Rana Saad and George Netto for performing the hepatitis C RNA determinations.
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Cold Agglutinin-Mediated Autoimmune Hemolytic Anemia
2015, Hematology/Oncology Clinics of North AmericaCitation Excerpt :These normally occurring CA are polyclonal and are found in low titers, usually below 64 and rarely exceeding 256.6,8 In 172 consecutive individuals with monoclonal immunoglobulin (Ig)M in serum, on the other hand, significant CA activity was found in 8.5% with titers between 512 and 65,500, and all individuals with detectable CA had hemolysis.9 Thus, monoclonal CA are generally far more pathogenic than polyclonal CA.
Cold agglutinin disease
2013, BloodCitation Excerpt :After test findings suggest CAD, the antibody titer and thermal activity should be determined.3 The latter is essential to prevent overdiagnosis, because most agglutinins are clinically insignificant; one study showed only 14 (8%) of 172 patients with cold agglutinins displaying clinically significant activity.51 The titer level is less concordant with disease activity because hemolysis occurs with levels as low as <1:325; however, most consider titer levels greater than 1:512 as clinically significant.2,52
Pathogenesis and morbidity of autoantibody syndromes in Waldenstrom's macroglobulinemia
2011, Clinical Lymphoma, Myeloma and LeukemiaCitation Excerpt :Patients with MC and hepatitis C thus have monoclonal gammopathies. The gammopathies constitute a spectrum of clonal B-cell expansion that extends from preneoplastic to overt non-Hodgkin lymphoma.3,9,10 Approximately 10% of patients develop lymphoma, especially WM. Both the cryoglobulin and the lymphoma may decrease after interferon and rituximab treatment.13–15
Heating up cold agglutinins
2010, Blood
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Supported in part by the Edward and Ruth Wilkof Foundation, the Robert Schanbaum Memorial Fund, and the James E. Nauss Cancer Research Fund.
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Address reprint requests to Marvin J. Stone, MD, Baylor-Sammons Cancer Center, 3500 Gaston Ave, Dallas, TX 75246.
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0093-7754/03/3002-0042$30.00/0