Journal List > Korean J Hematol > v.44(3) > 1032831

Moon, Chang, Kim, Ko, Ann, and Min: The Association between Multiple Myeloma and Ankylosing Spondylitis: A Report of Two Cases

Abstract

Multiple myeloma is a malignant disease of plasma cells, whereas ankylosing spondylitis is a chronic inflammatory disease of axial joints. The relationship between the two diseases is uncertain, but chronic inflammation could trigger multiple myeloma. The authors report the cases of two ankylosing spondylitis patients with a disease duration of more than 20 years, that subsequently developed IgA kappa and IgG lambda chain myeloma, respectively, and discuss the possible pathogenetic relationship between these diseases.

References

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Fig. 1.
(A) Serum protein electrophoresis (Left) showed a sharp peak in the gamma globulin region. The gamma globulin region composed 37.5% of total (8.92 g/dL). Immunofixation electrophoresis (IFE, Right) showed a mono-clonal IgA, κ band. (B) Serum protein electrophoresis (Left) showed a prominent M-peak (39.9% of total protein, 8.78 g/ dL), whereas immunofixation electrophoresis (IFE, Right) showed a monoclonal IgG, λ band.
kjh-44-182f1.tif
Fig. 2.
(A) Skull radiograph showing multiple variably sized punched-out lesions in the fronto-parietal area. (B) D-L spine AP LAT radiograph showing extensive ankylosis and syndesmophytes in the thoracic and upper lumbar spine.
kjh-44-182f2.tif
Fig. 3.
PET scan showing multifocal increased uptakes in vertebrae, pelvic bones, clavicles, rib cages, and both humeri and femurs. No changes in uptake were observed after dexamethasone treatment.
kjh-44-182f3.tif
Table 1.
A summary of data from previous reports concerning the association between ankylosing spondylitis and plasma cell disorders
Reference Year Sex Age at onset of Ankylosing spondylitis Age at diagnosis of Monoclonal gammopathy HLA-B27 Diagnosis Monoclonal Immunoglobulin Bone marrow aspiration ESR (mm/h) CRP (mg/L) Comments
Isotype Amount (g/L)
This report 2009 M 27 47 + Myeloma IgA κ 11.7 Plasma cells, 3.4% 120 16.88  
This report 2009 M 23 58 N.A MGUS IgG λ 28.8 Plasma cells, 12.3% 10 0.62  
O'Neill et al (8) 1997 F Many years ago 73 N.A Myeloma IgA λ 22 Plasma cells, 6% →14% (atypical) 98 N.A  
Lam et al (9) 1989 M 41 61 + Myeloma IgA κ 34.5 Plasma cells, 22% 162 N.A  
Renier et al (12) 1992 M 60 79 Waldenström's macroglobulinemia IgM κ >20 Plasma cells, 3% N.A N.A  
    M 45 71 N.A MGUS IgM κ <5 Normal N.A N.A  
    M Many years ago 72 + BMG IgG λ <5 Normal N.A N.A Post infection monoclonal gammopathy
    F 37 37 MGUS IgG λ >20 Plasma cells, 2% N.A N.A  
    M Many years ago 78 N.A MGUS IgG λ <5 N.A N.A N.A  
    F 32 57 + BMG IgG κ <5 N.A N.A N.A Monoclonal gammopathy after hepatitis
    M 20 58 MGUS IgG λ 20 Plasma cells, 33% (atypical) N.A N.A  
Blanc et al (13) 1979 M 33 49 N.A Myeloma IgA κ 12.8 N.A N.A N.A  
Gualandi et al(14) 1981 M N.A N.A Myeloma IgA κ 5 N.A N.A N.A  

Abbreviations: MGUS, monoclonal gammopathy of undetermined significance; BMG, benign monoclonal gammopathy; N.A, not available.

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