The Association between Multiple Myeloma and Ankylosing Spondylitis: A Report of Two Cases

Hyung-Il Moon; Hyoung-Jin Chang; Ji-Eun Kim; Hoon-Young Ko; Soe-Hee Ann; Chang-Ki Min

doi:10.5045/kjh.2009.44.3.182

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

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

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

Case Report

Korean J Hematol 2009;44(3):182-187.

Published online: 20 September 2009

DOI: https://doi.org/10.5045/kjh.2009.44.3.182

The Association between Multiple Myeloma and Ankylosing Spondylitis: A Report of Two Cases

Hyung-Il Moon, M.D., Hyoung-Jin Chang, M.D., Ji-Eun Kim, M.D., Hoon-Young Ko, M.D., Soe-Hee Ann, M.D., Chang-Ki Min, M.D.

Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to：Chang-Ki Min, M.D. Division of Hematology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea 505, Banpo-dong, Seocho-gu, Seoul 137-701, Korea Tel: ＋82-2-2258-6053, Fax: ＋82-2-599-3589 E-mail: ckmin@catholic.ac.kr

Received 21 May 2009 Revised 11 September 2009 Accepted 11 September 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Multiple myeloma, Monoclonal gammopathy of undetermined significance, Ankylosing spondylitis, Inflammation, Tumor

References

1. Kyle RA, Rajkumar SV. Multiple myeloma. N Engl J Med. 2004; 351:1860–73.

2. Rajkumar SV. MGUS and smoldering multiple myeloma: update on pathogenesis, natural history, and management. Hematology Am Soc Hematol Educ Program. 2006. 340–5.

3. Rajkumar SV, Lacy MQ, Kyle RA. Monoclonal gammopathy of undetermined significance and smoldering multiple myeloma. Blood Rev. 2007; 21:255–65.

4. Riedel DA, Pottern LM. The epidemiology of multiple myeloma. Hematol Oncol Clin North Am. 1992; 6:225–47.

5. Brown LM, Gridley G, Check D, Landgren O. Risk of multiple myeloma and monoclonal gammopathy of undetermined significance among white and black male United States veterans with prior autoimmune, infectious, inflammatory, and allergic disorders. Blood. 2008; 111:3388–94.

6. Allavena P, Garlanda C, Borrello MG, Sica A, Mantovani A. Pathways connecting inflammation and cancer. Curr Opin Genet Dev. 2008; 18:3–10.

7. Cowling P, Ebringer R, Ebringer A. Association of inflammation with raised serum IgA in ankylosing spondylitis. Ann Rheum Dis. 1980; 39:545–9.

8. O'Neill TW, Harrison BJ, Yin AL, Holt PJ. Ankylosing spondylitis associated with IgA lambda chain myeloma. Br J Rheumatol. 1997; 36:401–2.

9. Lam SM, Ho HH, Dunn P, Luo SF. Association of ankylosing spondylitis with IgA-multiple myeloma: report of a case and pathogenetic considerations. Taiwan Yi Xue Hui Za Zhi. 1989; 88:726–8.

10. Beachy PA, Karhadkar SS, Berman DM. Mending and malignancy. Nature. 2004; 431:402.

11. Kim YN, Lee HE, Lee SH, et al. Ankylosing spondylitis associated with plasmacytoma: a case report. J Korean Rheum Assoc. 2005; 12:240–4.

12. Renier G, Renier JC, Gardembas-Pain M, Chevailler A, Boasson M, Hurez D. Ankylosing spondylitis and monoclonal gammopathies. Ann Rheum Dis. 1992; 51:951–4.

13. Blanc AP, Gastaut JA, Sebahoun G, Carcassonne Y. Association for ankylosing spondylarthritis multiple myeloma. A case history (author's transl). Sem Hop. 1979; 55:1335–7.

14. Gualandi M, Trotta F, Faggioli M, Vanini A, Tassinari MC. Association of non-secreting myeloma and ankylosing spondylitis. Considerations on a clinical case. Minerva Med. 1981; 72:2631–7.

15. Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008; 454:436–44.

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.

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.

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.

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
Reference	Year	Sex	Age at onset of Ankylosing spondylitis	Age at diagnosis of Monoclonal gammopathy	HLA-B27	Diagnosis	Isotype	Amount (g/L)	Bone marrow aspiration	ESR (mm/h)	CRP (mg/L)	Comments
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.

TOOLS

Similar articles