Effects of paraprotein heavy and light chain types and free light chain load on survival in myeloma: an analysis of patients receiving conventional-dose chemotherapy in Medical Research Council UK multiple myeloma trials

While investigating 2592 patients enrolled in multicenter myeloma trials, we found light chain–only (LCO) patients had worse median survival times (1.9 years) than patients with IgA and IgG paraproteins (2.3 and 2.5 years, respectively) (P < .001). However, IgA and IgG patients with levels of LC excretion similar to those of LCO patients also had poor survival times because of renal failure, resulting in worse survival during induction therapy and at relapse with no difference in progression-free survival between LCO and IgG patients. LC excretion was higher for λ than for κ types, but there was no difference in survival between the 2 LC types when stratified for level of LC excretion, indicating that care of renal function is vital to improving the survival of any patient with LC excretion. LCO patients were younger (P = .001), had worse performance status (P = .001), and had more lytic lesions (P < .001), perhaps reflecting late and missed diagnoses in younger and older LCO patients, respectively. No differences were observed between IgA and IgG patients in presentation characteristics, response, or survival from disease progression. The worse survival of IgA patients was attributed to shorter progression-free survival (median, 1.2 vs 1.6 years; P < .001), which is important for maintenance therapy.

Isotypic and allotypic analysis with monoclonal antibodies and jacalin of 309 serum monoclonal IgA from French and Japanese myeloma patients

The subclass and allotype distribution of serum monoclonal IgA from myeloma patients was determined by ELISA with monoclonal antibodies in two French and one Japanese laboratory. In addition, the French sera were tested for their reactivity with the lectin jacalin. No significant difference in the isotypic distribution between French and Japanese series could be demonstrated: kappa/lambda ratios were 0.99 and 1.17, and the IgA1 subclass accounted for 93.9% and 91% of cases in the French and Japanese studies, respectively. Five out of 7 myeloma IgA2 from Japan and only one of the 12 IgA2 from France belonged to the A2m(2) allotype (P less than 0.01). All 219 IgA1 tested reacted with jacalin by immunoelectrophoresis (IEP), although with variable intensities. Among IgA2 proteins, only one (of the A2m(1) allotype) yielded a precipitating line with jacalin by IEP. Molecular analysis demonstrated that this protein was an IgA1-IgA2 hybrid bearing most of the A2m(1) epitopes.

Electrophoretic properties of human IgG and its subclasses on sodium dodecyl-sulfate-polyacrylamide gel electrophoresis and immunoblots

Unreduced human immunoglobulin G (IgG) which was not aggregated showed anomalous apparent molecular masses on sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). It migrated mainly as three distinct bands with apparent molecular masses from 190 to 240 kDa on gels containing 8% polyacrylamide, when denatured at 37 degrees C. Generation of this banding pattern has two reasons: (a) the pattern is a superposition of bands originating from the four IgG subclasses that differ in molecular masses and structures; and (b) the complexity of the band pattern is further increased, because IgG myeloma proteins of the IgG1 and IgG2 subclass migrated as doublets, while IgG3 and IgG4 formed primarily one band with slightly different apparent molecular masses. These properties were independent of the type of light chain in all myeloma proteins studied. Generation of doublets suggests heterogeneities of monoclonal proteins. The two separable protein populations from IgG1 differ in their susceptibility to reduction. Reduction at 37 degrees C cleaved the larger into heavy and light chain, while it generated heavy chain dimer and light chain from the smaller species. Hence, it is possible that monoclonal IgG1 are comprised of at least two subpopulations of molecules with different S-S bonds. Doublet formation of IgG2 remains unexplained, since both species were equally sensitive to reduction. Knowledge on the anomalous properties of IgG on SDS-PAGE is a prerequisite to run immunoblots from unreduced cellular antigens without confounding cell-associated IgG with cellular antigens.

Subclass distribution of human myeloma proteins as determined with monoclonal antibodies

Subclasses of 176 IgG and 62 IgA myeloma proteins were determined by indirect ELISA with monoclonal antibodies, as well as by an immunoblotting technique (for monoclonal IgG) and by immunoelectrophoresis against the lectin jacalin (for IgA). The subclass distribution of monoclonal IgG did not reflect mean normal serum levels of the correspondent isotypes, with an over-representation of IgG1 and IgG4 and an under-representation of IgG2 and IgG3 in myeloma. Similarly, IgA2 myeloma were clearly under-represented.

Immunoelectrophoretic investigations in 55 patients with systemic amyloidosis

Among 55 amyloidoses, the detection of a monoclonal protein (MP) led to the selection of 15 primary and 3 myeloma-associated types of amyloidosis. Therefore the presence of a MP gives evidence for an immunocytic amyloidosis. The lambda-light-chain nature of MP and the abundant production of free light-chains are two of the factors predisposing to the production of amyloid deposits (AL) in the course of immunocyte dyscrasias.

Two-dimensional electrophoresis of immunoglobulin myeloma proteins in the absence of denaturing agents

Human sera from myeloma patients were subjected to two-dimensional electrophoresis. Heterogeneity in molecular weight and in isoelectric point of the myeloma proteins were demonstrated on the protein map. The patterns of five major immunoglobulin classes differed from each other, implying that the five classes of myeloma immu,oglobulin can be distinguished by examining the two-dimensional electrophoretic patterns. Sugar content analysis suggested that differences in sialic acid content may be one of the origins of the heterogeneity of myeloma proteins observed in isoelectric focusing.

Differential binding of IgA proteins of different subclasses and allotypes to Staphylococcal protein A

The binding of myeloma proteins of known subclass and allotype to staphylococcal protein A has been studied using affinity chromatography with Protein A-Sepharose CL-4B. Three IgA1 proteins did not show any binding, whereas two IgA2 A2m(1) and one IgA2 A2m(2) proteins were found to bind to the column.

Serological distinciton of heavy chain variable regions (VH subgroups) of mouse immunoglobulins. I. Common VH determinants on the heavy chains of mouse myeloma proteins having different binding sites

16 of more than 100 mouse myeloma proteins, including 3 proteins of the IgG2a class and 13 of the IgA class, were shown to have a similar heavy chain variable region (VH) antigen(s) (U10-173). The proteins bearing these antigenic determinants (U10-173+ proteins) represented at least five different ligand-binding specificities. These findings, taken togeter with available sequence data for VH regions of U10-173+ proteins, have led us to conclude that U10-173 defines a small number of related VH subgroups. The ability to detect VH subgroups in mice by serological means, as has been done in humans also, promises new and useful kinds of VH markers for immunologic study.

Serological detection of variable region (Vh) subgroups of Ig heavy chains

Serological test systems were established for determining the heavy-chain variable region (Vh) subgroups of immunoglobulin heavy chains. Myeloma proteins with known Vh subgroups based on amino acid sequence were utilized as the primary basis of reference for analysis by hemagglutination and hemagglutination inhibition. Good agreement between the chemical and serological typing was obtained and nonoverlapping systems established for the three major Vh subgroups. In a survey of 167 myeloma proteins, all except two were exclusively positive in one of the three systems. The two exceptions may represent a fourth subgroup. There was an overall incidence ratio of 1:2:3 for VhI:VhII:VhIII subgroups. Some differences in the overall ratios were encountered within the immunoglobulin classes. Certain advantages of the serological typing antisera were discussed with special emphasis on their use for studies of Vh antigens on the membranes of lymphocytes.

Binding properties of immunoglobulin combining sites specific for terminal or nonterminal antigenic determinants in dextran

Binding constants of the dextran-reactive BALB/c mouse IgA myeloma proteins W3129 and QUPC 52 have been determined for each member of the isomaltose series of oligosaccharides and for methyl alphaDglucoside. Protein W3129 has maximum complementarity for isomaltopentaose (IM5) deltaf degrees = 7,180 cal/mol) with 55-60% of the total binding energy directed against methylalphaDglucoside. Protein QUPC 52 gives maximum binding with isomaltohexaose (IM6) (deltaF degrees = -5,340 cal/mol) and has about 70% of its total binding energy for isomaltotriose (IM3), but at most only 5% for isomaltose (IM2) or methyl alphaDglucoside. Protein W3129 precipitates with branched dextrans high in alpha (1 yields 6) linkages and reacts with but does not precipitate a synthetic alpha (1 yields 6)-linked linear dextran. Protein QUPC 52 precipitates both branched and linear dextrans. Thus, the immunodominant group for protein W3129 is mimicked by methyl alphaDglucoside and this protein reacts exclusively at the terminal nonreducing ends of alpha (1 yields 6)-linked dextran chains. Protein QUPC 52 has an immunodominant group which is expressed by IM3 but not smaller oligosaccharides and this protein can react at nonterminal locations along alpha (1 yields 6)-linked dextran chains. Precipitation of linear dextran seems to be a valid although not quantitative assay for antidextrans with nonterminal specificity. Quantitative precipitin reactions with branched and linear dextrans suggest that alpha (1 yields 6)-specific human antidextrans are mixtures of molecules having terminal and nonterminal specificities and that the fraction of each type can vary among individuals. Rabbit antisera against IM3 or IM6 coupled to bovine serum albumin also appear to contain antibodies with nonterminal specificity for dextran chains although a large fraction has terminal specificity. Low molecular weight clinical dextran N-150N (congruent to 60,000) reacted more like linear dextran than like its parent native-branched dextran B512. This is thought to result from an abundance of nonterminal determinants in clinical dextran N-150N but a very small number of functional terminal determinants per molecule. An appreciation of terminal and nonterminal specificities and of the different immunodominant structures in isomaltosyl chains has proven to be of a great value in understanding the immunochemical reactions of dextrans. Moreover, certain previous findings with fructosan-reactive mouse myeloma proteins and human antilevans (55, 84) also suggest terminal and nonterminal specificities for levan chains.

A new mouse immunoglobulin: IgG3

A new subclass of mouse IgG for which we propose the name IgG3 has been shown to have a mol wt of 150,000 consistent with an L(2)H(2) structure, and is present in normal mouse serum at a concentration of 0.1-0.2 mg/ml. Its molecular weight, low carbohydrate content, glycopeptide analysis, and C-terminal analysis are all typical of the IgG class. The intact protein had a strong tendency to form noncovalent aggregates with itself which were dissociable in acid. Upon papain digestion an Fab fragment of 47,000 mole wt was generated along with an Fc fragment which was insoluble at neutral pH. As for its biology, the protein did not fix complement, was not cytophilic for gammaG2 receptor sites on macrophages, and did not show passive cutaneous anaphylaxis. It was very efficiently transported across the placenta so that its concentration in the newborn was twice that in the serum of the mother, compared to the concentration of IgG1 and IgG2 proteins which were only present at one-third the concentration of that found in the serum of the mother. The Fc fragment of this protein reacted with and was solubilized by the staphylococcal A protein which also precipitated the intact immunoglobulin. In addition, the myeloma protein which was the prototype for this gammaG subclass exhibited binding activity for levan which was localized to the Fab fragment.