**4. Conclusions**

ized by the disappearance of symptoms, of monoclonal serum IgM (by IF), and of monoclonal lymphoplasmacytes from all infiltrated sites, partial response by a serum IgM decrease by 50% or more while progressive disease (PD) by IgM increase; likewise, relapse after response is characterized by IgM increase [94]. With regard to staging and prognosis, serum IgM levels were included into currently used international prognostic staging system for WM (IPSS-WM) that co-evaluated 5 parameters: age above 65 years, haemoglobin below 11,5 g/dL, platelet

There are so far only preliminary results on the contribution of the new Ig-based biomarkers (sFLC and HLC) levels in WM patients at diagnosis. It was shown that sFLC may be increased and, in such cases, correlate with markers of disease activity, such as increased β2M, anemia [96] and low serum albumin levels. Patients with elevated sFLC presented shorter time to treatment [97] and adverse outcome [98]. Increased HLC-IgM were also found correlated with markers of disease activity such as bone marrow infiltration of more than 50% and low serum

Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in the Western world and presents a large range of clinical manifestations and a variable outcome. More than two thirds of the patients are asymptomatic at the time of diagnosis and may not require treatment for months or even years. For prognostic purposes, traditional Rai and Binet clinical staging systems are still in use but they do not apply perfectly in modern years. For patients needing treatment, underlying molecular alterations are important predictors of response; however, for the majority of CLL patients, life expectancy largely depends on time to first

It was shown that increased sFLC is the most common paraprotein observed in CLL, being found in almost half of the cases and that sFLCR abnormalities are present in a significant

More recently, increased polyclonal sFLC were also found to constitute an adverse marker for time to first treatment in CLL [103]. This finding was confirmed by Morabito et al that evaluated the sum of κ and λ sFLC levels and found that the prognostic impact of sFLC (κ + λ) value above 60.6 mg/mL was superior compared to FLCR and built a model based on four variables, namely sFLC (κ + λ) more than 60.6 mg/mL, Binet staging, ZAP-70, and cytogenetics and

In the other PCD, Ig contribution to diagnosis, prognosis and monitoring is restricted to bone solitary plasmacytoma and mainly concerns sFLC quantification that was shown predictive of evolution to MM [104]. With regards to B-cell non Hodgkin's lymphomas, abnormal Ig secretion, as observed mostly by the new Ig-based biomarkers (sFLC and HLC) levels, the clinical significance of which remains for the time being, under investigation [105], although increasing evidence of sFLCs prognostic role are emerging in these diseases [106;107].

proportion of patients and identify those at risk of progressive disease [101;102].

albumin levels while high HLCR correlated with shorter time to treatment [98;99].

treatment [100], so reliable markers for time to treatment are needed.

separated 4 patients' groups with different time to treatment [50].

*3.5.6. Other plasma cell dyscrasias & B-cell non Hodgkin's llymphomas*

/L, β2-microglobulin above 3mg/L and IgM above 7 g/dL [95].

counts below or equal to 100×109

28 Multiple Myeloma - A Quick Reflection on the Fast Progress

*3.5.5. Chronic llymphocytic leukemia*

Paraprotein presence is the hallmark of monoclonality. Knowledge of biologic mechanisms that lead to monoclonality has allowed understanding of malignant B-cell origin and B-cell neoplasms pathophysiology. New methods for the precise detection and quantification of monoclonal Ig have opened interesting clinical applications concerning patients diagnosis, monitoring and prognostication.
