The risk of renal disease is increased in lambda myeloma with bone marrow amyloid deposits

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The risk of renal disease is increased in lambda myeloma with bone marrow amyloid deposits Piotr Kozlowski,1 Scott Montgomery,2–4 Rahel Befekadu,5 Victoria Hahn-Strömberg6 1Department of Medicine, School of Medical Sciences, Örebro University, Örebro, Sweden; 2Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden; 3Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; 4Department of Epidemiology and Public Health, University College London, London, UK; 5Department of Transfusion Medicine, School of Medical Sciences, Örebro University, Örebro, Sweden; 6Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden Background: Light chain amyloidosis (AL) is a rare deposition disease and is present in 10–15% of patients with myeloma (MM). In contrast to symptomatic AL in MM, presence of bone marrow (BM) amyloid deposits (AD) in MM is not connected to kidney damage. Renal AD but not BM-AD occur mostly in MM with lambda paraprotein (lambda MM). Methods: We investigated amyloid presence in BM clots taken at diagnosis in 84 patients with symptomatic MM and compared disease characteristics in MM with kappa paraprotein (kappa MM)/lambda MM with and without BM-AD. Results: Lambda MM with BM-AD was compared with kappa MM without BM-AD, kappa MM with BM-AD, and lambda MM without BM-AD: lambda MM with BM-AD patients had a significantly higher mean creatinine level (4.23 mg/dL vs 1.69, 1.14, and 1.28 mg/dL, respectively) and a higher proportion presented with severe kidney failure (6/11 [55%] vs 6/32 [19%], 1/22 [5%], and 3/19 [16%], respectively). Proteinuria was more common in lambda MM with BM-AD patients compared with kappa MM without BM-AD patients (8/11 [73%] vs 5/32 [16%], respectively). Conclusion: Kidney damage was more common in lambda MM with BM-AD indicating presence of renal AD. Keywords: plasma cells, neoplasms, amyloidosis, renal insufficiency, proteinuria

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