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Clinical Chemistry 48: 1805-1811, 2002;
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(Clinical Chemistry. 2002;48:1805-1811.)
© 2002 American Association for Clinical Chemistry, Inc.

Case Report

Trimolecular Complexes of {lambda} Light Chain Dimers in Serum of a Patient with Multiple Myeloma

Roshini S. Abraham1, M. Cristine Charlesworth2,4, Barbara A.L. Owen3, Linda M. Benson4, Jerry A. Katzmann1, Craig B. Reeder5 and Robert A. Kyle1,6a

1 Division of Clinical Biochemistry and Immunology,
2 Department of Biochemistry and Molecular Biology,
3 Department of Molecular Pharmacology and Experimental Therapeutics,
4 Mayo Proteomics Research Center, and
5 Division of Hematology, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ 85259.

6 Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905.

aAddress correspondence to this author at: Division of Clinical Biochemistry and Immunology, 920 Hilton, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905. Fax 507-266-4088; e-mail kyle.robert{at}mayo.edu.

Background: Patients with multiple myeloma often have Bence Jones proteins composed of free monoclonal light chains of the {kappa} or {lambda} type in their urine. Usually, these light chains exist as monomeric or dimeric forms, but rarely, larger molecules, such as tetramers, have been reported in the serum.

Methods and Results: We report the presence of trimeric complexes of {lambda} light chain dimers in a patient who was diagnosed with a free {lambda} light chain multiple myeloma 2 years earlier and subsequently underwent a stem cell transplant. Recently, the patient presented with a large serum M-spike (23 g/L) by protein electrophoresis. The spike consisted of monoclonal {lambda} light chains without a heavy chain. The urine contained only 8 mg of {lambda} light chain in a 24-h specimen. Quantitative analysis of the serum and urinary free light chains (FLCs) indicated the probability of larger aggregates of FLCs. Size-exclusion chromatography, electrophoresis, analytical ultracentrifugation, and mass spectrometric studies of the serum revealed almost exclusively the presence of trimolecular aggregates of {lambda} light chain dimers without other multimeric species.

Conclusion: Monoclonal {lambda} light chains may present as hexameric aggregates that cannot be cleared by renal excretion.




The following articles in journals at HighWire Press have cited this article:


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I. Herzum, H. Renz, and H. G. Wahl
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J. R. Tate, D. Gill, R. Cobcroft, and P. E. Hickman
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R. S. Abraham, S. M. Geyer, T. L. Price-Troska, C. Allmer, R. A. Kyle, M. A. Gertz, and R. Fonseca
Immunoglobulin light chain variable (V) region genes influence clinical presentation and outcome in light chain-associated amyloidosis (AL)
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