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Case Reports in Hematology
Volume 2015 (2015), Article ID 809840, 5 pages
Case Report

Light Chain Escape in 3 Cases: Evidence of Intraclonal Heterogeneity in Multiple Myeloma from a Single Institution in Poland

1Institute of Hematology and Transfusion Medicine, Ulica Indiry Gandhi 14, 02-776 Warsaw, Poland
2The Binding Site Group Ltd., 8 Calthorpe Road, Birmingham B151QT, UK

Received 16 September 2015; Revised 3 December 2015; Accepted 7 December 2015

Academic Editor: Marie-Christine Kyrtsonis

Copyright © 2015 Maria Kraj et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


We report three cases of light chain escape (LCE) at a single institution in Poland, including an interesting case of biclonal monoclonal gammopathy of undetermined significance (MGUS) that satisfied the criteria for progression to light chain multiple myeloma (LCMM) with a rapid rise in serum free light chain (FLC) levels, following steroidal treatment for simultaneous temporal artery inflammation and polymyalgia rheumatica (PMR). In the three cases discussed, progression of the disease by light chain escape was associated with rapid and severe renal impairment, highlighting the necessity for prompt detection of such free light chain-only producing clones in order to prevent the possible development of irreversible end-organ damage. Interestingly, monitoring of these three patients by serum free light chain assay (sFLC) and retrospective heavy/light chain analysis (HLC) detected this clonal evolution prior to clinical relapse and suggests that these assays represent important additional tools for more accurate monitoring of multiple myeloma patients.