Efficacy of plasmapheresis on a patient with Bence Jones λ-type plasma cell leukemia

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A seventy-two-year old female had chest pain since October 1981. In July 1982, she was admitted for congestive heart failure. In October 1982, compression fractures of vertebrae on Th12 and L1, and Bence Jones protein in the urine were found. She was transferred to our hospital for further examination about multiple myeloma in November 1982. Her laboratory data included mild normocytic normochromic anemia, leukocytes 9, 600/cmm, plasma cells 34% in peripheral blood, total protein 4.5g/dl, decreased all classes of immunoglobulins, BUN 99mg/dl, and creatinine 6.9mg/dl. Her serum and urine showed M-bow only against anti-λ antiserum in immunoelectrophoresis. She was diagnosed as Bence Jones λ type plasma cell leukemia associated with renal failure. Her renal function was gradually improved after chemotherapy and plasmapheresis were started. After a month her renal function became worse, but the response to further treatments including chemotherapy and plasmapheresis could not be obtained. She was died of renal failure on 19th December 1982. In autopsy specimen, many tubular casts and Bence Jones λ type proteins in tubular epithelial cells were found. Bence Jones proteins were purified from patient's urine by ammonium sulfate precipitation method followed by DEAE column chromatography. This purified λ type Bence Jones proteins were used as a standard marker in the measurement of λ type free light chains in the patient's serum. Patient's serum free light chains were serially measured during her clinical course, and were markedly decreased after initial treatment. We discussed about the negative role of Bence Jones proteins on renal function in multiple myeloma. Plasmapheresis treatment along with chemotherapy shows beneficial effect on renal function mainly by removing free light chains from the serum in the patient with Bence Jones type multiple myeloma.
日本臨床免疫学会の論文

Efficacy of plasmapheresis on a patient with Bence Jones λ-type plasma cell leukemia

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