Apparent IS in 23 Patients
| Patient No. . | Time . | Isotype Change . | Maximum IS (g/dL) . | Duration (mo) . |
|---|---|---|---|---|
| 1 | pre–Tx-1 | Aλto Gκ | <0.1 | 1 |
| 2 | pre–Tx-1 | λ-freeto Gκ | 0.3 | 1 |
| 3 | post–Tx-1 | Gκ to Gκ + Gλ | 0.4 | 3 |
| 4 | post–Tx-1 | Gκ to Gκ + Gλ | 0.4 | 2 |
| 5 | post–Tx-1 | Aλ to Aλ + Gλ | 0.2 | 3 |
| 6 | post–Tx-1 | Aλ to Gλ | 0.2 | 3 |
| 7 | post–Tx-1 | Gκ to Gκ × 2 + Gλ + Mλ | 0.3 | 2 |
| 8 | post–Tx-1 | Gλ to Gλ + Mλ + Mκ | <0.1 | 2 |
| 9 | post–Tx-1 | Gλ to Gλ + Gκ | <0.1 | 3 |
| 10 | post–Tx-2 | Gλ + λ-free to κ-free | <0.1 | 3 |
| 11 | post–Tx-2 | λ-free to Gκ to Mλ | <0.1 | 6 |
| 12 | post–Tx-2 | Gκ to nil to Gκ + Gλ | <0.1 | 5 |
| 13 | post–Tx-2 | λ-free to nil to Gλ | 0.3 | 7+ |
| 14 | post–Tx-2 | λ-free to nil to Aκ + Gκ | <0.1 | 6 |
| 15 | post–Tx-2 | κ-free to Gκ + Gλ oligo to Gλ | <0.1 | 1+ |
| 16 | post–Tx-2 | Aλ to Gλ | <0.1 | 2 |
| 17 | post–Tx-2 | Aκ to Gκ oligo to poly to Gλ to Mλ to poly | <0.1 | 4 |
| 18 | post–Tx-2 | Gκ to Gκ + Mλ oligo to Mλ + Gκ oligo to poly | 0.4 | 3 |
| 19 | post–Tx-1 & 2 | Gλ to Gκ to Mκ | <0.1 | 8 |
| 20 | post–Tx-1 & 2 | κ-free to Mλ to Gκ oligo to Gλ to poly | 0.3 | 7 |
| 21 | post–Tx-1 & 2 | Gκ to Gκ + Gλ to Gκ + Gλ + Mλ | 0.5 | 9 |
| 22 | pre–Tx-1 and post–Tx-2 | κ-free to Gλ × 2 to poly to Mλ × 2 to Mλ | 0.4 | 4+ |
| 23 | pre–Tx-1 and post–Tx-2 | λ-free to Gκ × 2 to nil to Gκ + Gλ oligo to Gκ | 0.2 | 6+ |
| Patient No. . | Time . | Isotype Change . | Maximum IS (g/dL) . | Duration (mo) . |
|---|---|---|---|---|
| 1 | pre–Tx-1 | Aλto Gκ | <0.1 | 1 |
| 2 | pre–Tx-1 | λ-freeto Gκ | 0.3 | 1 |
| 3 | post–Tx-1 | Gκ to Gκ + Gλ | 0.4 | 3 |
| 4 | post–Tx-1 | Gκ to Gκ + Gλ | 0.4 | 2 |
| 5 | post–Tx-1 | Aλ to Aλ + Gλ | 0.2 | 3 |
| 6 | post–Tx-1 | Aλ to Gλ | 0.2 | 3 |
| 7 | post–Tx-1 | Gκ to Gκ × 2 + Gλ + Mλ | 0.3 | 2 |
| 8 | post–Tx-1 | Gλ to Gλ + Mλ + Mκ | <0.1 | 2 |
| 9 | post–Tx-1 | Gλ to Gλ + Gκ | <0.1 | 3 |
| 10 | post–Tx-2 | Gλ + λ-free to κ-free | <0.1 | 3 |
| 11 | post–Tx-2 | λ-free to Gκ to Mλ | <0.1 | 6 |
| 12 | post–Tx-2 | Gκ to nil to Gκ + Gλ | <0.1 | 5 |
| 13 | post–Tx-2 | λ-free to nil to Gλ | 0.3 | 7+ |
| 14 | post–Tx-2 | λ-free to nil to Aκ + Gκ | <0.1 | 6 |
| 15 | post–Tx-2 | κ-free to Gκ + Gλ oligo to Gλ | <0.1 | 1+ |
| 16 | post–Tx-2 | Aλ to Gλ | <0.1 | 2 |
| 17 | post–Tx-2 | Aκ to Gκ oligo to poly to Gλ to Mλ to poly | <0.1 | 4 |
| 18 | post–Tx-2 | Gκ to Gκ + Mλ oligo to Mλ + Gκ oligo to poly | 0.4 | 3 |
| 19 | post–Tx-1 & 2 | Gλ to Gκ to Mκ | <0.1 | 8 |
| 20 | post–Tx-1 & 2 | κ-free to Mλ to Gκ oligo to Gλ to poly | 0.3 | 7 |
| 21 | post–Tx-1 & 2 | Gκ to Gκ + Gλ to Gκ + Gλ + Mλ | 0.5 | 9 |
| 22 | pre–Tx-1 and post–Tx-2 | κ-free to Gλ × 2 to poly to Mλ × 2 to Mλ | 0.4 | 4+ |
| 23 | pre–Tx-1 and post–Tx-2 | λ-free to Gκ × 2 to nil to Gκ + Gλ oligo to Gκ | 0.2 | 6+ |
The single band Ig isotype and light chain are specified for each observation. Nil denotes absence of the Ig region, oligo denotes presence of oligoclonal protein bands, and poly the presence of a normal Ig pattern on IFE. Peak IS is the highest value obtained by quantification of the apparent isotype switch protein band. + indicates that the IS was present on the last follow-up sample. The paraprotein associated with the patient's MM is underlined. Two patients had IS before transplantation (Tx), 7 after Tx-1, 9 only after Tx-2, 3 after Tx-1 and Tx-2, and 2 pre–Tx-1 and post–Tx-2.