Is there a certain type of myeloma patient who would be more likely to develop amyloidosis?

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Is there a certain type of myeloma patient who would be more likely to develop amyloidosis?

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so so all myeloma patients can develop amyloidosis. We do see amyloid to a higher degree in patients with an elevated free light chain component to their illness, either a free kappa or a free lambda That circulates in the blood, and even more so with the lambda chains as opposed to the of chains.

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So patients with a free lambda element to their myeloma are a little bit more risk of developing amyloidosis. However, all myeloma patients are at risk, so we don't want to narrow our degree of concern to just a subset of myeloma. We really want to be thinking about this for all myeloma patients, but these are some categories of higher risk.

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So whether there's a certain type of multiple myeloma patient who would be more likely to develop amyloidosis, It's an interesting question.

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The short answer is probably not.

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But there are certain things that we see in amyloidosis that are a little bit different from multiple myeloma, at least from a biological perspective. And what I mean by that is that, as we all know in multiple myeloma, one of the standard tests that we do on bone marrow biopsy is genetics, basically not genetics, of course, that you get from your parents and pass onto children, rather genetics

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that exist exclusively in those myeloma cells.

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And we do those tests. So cytogenetics and fish, which has been talked about of course in other lectures

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we do those tests routinely as part of the workup for multiple myeloma for prognostic purposes.

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And one relatively common finding is this one called t 11 14. So translocation of chromosomes 11 and 14 where basically a piece of chromosome 11, and a piece of chromosome 14 gets switched.

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So this is a relatively common finding in multiple myeloma

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that we see probably in about 20% of patients with multiple myeloma. And interestingly in amyloidosis, it's much more common. So closer to 50%. We don't know exactly why that is,

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that specific chromosomal translocation is overrepresented in amyloidosis.

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So clearly there is something about that translocation that more often causes people to develop amyloidosis.

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But beyond that,

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we don't really understand much about it. So lots of research being done on that topic currently.

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not definitely. One interesting thing

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one of the chromosome abnormalities that we see in multiple myeloma, the 11 14 translocation is actually

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3 to 4 times as common in al amyloidosis.

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I'm not sure that that's the same thing as saying that myeloma patients with that translocation are more likely to develop amyloid. But it is an interesting finding.

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I think the patients is the subset of myeloma patients that

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you have to at least consider

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amyloid and are ones who have peripheral neuropathy

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at the time of diagnosis

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or that isn't explained by the the therapy that they've had or patients who have heavy amounts of protein in their urine

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that isn't

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Bence-

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jones or light chain protein, but rather high amounts of albumin in there. And thinking about those those particular symptoms, if you screened patients with those, you would be more likely to identify a patient with amyloidosis.