**Author details**

Roman Hajek

maintenance therapy. Curability is possible only in patients with a low-risk based on gene expression profiles and cytogenetics based on experience from Total Therapy 3 treatment protocols in [30]. It is important to realize how many patients really have this chance. Of all MM patients, about 40% are involved in intensive treatments. Out of these patients, about 80% are low risk which means about 32% of entry number. To simplify the calculation, about 75% of these patients reach complete remission (24% of entry numbers), and up to 85-90% of these patients reach long-term complete remission (21% of entry numbers) with a chance of cura‐ bility at about 50-60% (10-12% of entry numbers) in [29,36,30]. Thus, based on available data, a qualified estimate would suggest that a chance for cure is possible for 10% of MM patients and 25% of patients who are able to undergo intensive treatments including myeloablation. These results changed natural course of the disease (Fig.2); moreover, they were impossible

myeloma

In 2012, we can announce MM to be a curable disease under favorable prognostic conditions at the time of diagnosis and using intensive therapy in about 10% of MM patients. Relapsed MM or disease progression is not curable using current treatment options with the exception of allogeneic transplants in some cases. Due to highly efficient drugs, especially proteasome inhibitors and immunomodulatory drugs, our current treatment options are such that we can

**DEATH IN COMPLETE REMISSION (>12 years)**

20 years ago.

**MGUS or smoldering myeloma**

**Figure 2.** Natural history of multiple myeloma can be changed

**M-protein (g/L)**

**11. Summary**

**20**

**50**

**100**

Clonal

8 Multiple Myeloma - A Quick Reflection on the Fast Progress

**Asymptomatic Symptomatic**

expansion MGUS Early

**ACTIVE MYELOMA**

**First-line therapy** 

Faculty of Medicine University Ostrava and Faculty Hospital Ostrava, Czech Republic

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**Chapter 2**

**Monoclonal Immunoglobulin**

Vassiliki Karalis, Dimitrios Maltezas,

http://dx.doi.org/10.5772/55855

**1. Introduction**

Marie-Christine Kyrtsonis, Efstathios Koulieris, Vassiliki Bartzis, Ilias Pessah, Eftychia Nikolaou,

Panayiotis Panayiotidis and Stephen J. Harding

Secretion of monoclonal immunoglobulins (M-Ig) may be associated with several malignant conditions, also called M-protein, paraprotein, or M-component they are produced by an abnormally expanded single (''mono-'') clone of plasma cells in an amount that can be detected in serum, urine, or rarely in other body fluids [1]. The M-Ig can be an intact immunoglobulin (Ig) (containing both heavy and light chains), or light chains in the absence of heavy chain (encountered in light chain myeloma, light chain deposition disease, AL amyloidosis), or rarely

All intact Igs have the same structure, made up of mirror imaged identical light and heavy chains. There are five classes of heavy chain, γ, α, μ, δ and ε with two classes of light chain κ and λ. Igs are secreted by terminally differentiated B-lymphocytes and their normal function

During B-cell maturation, the rearrangement of Ig heavy and light chain genes takes place early in pre-B-cell development and ends in memory B-cells or Ig producing plasma cells that have a unique heavy and light chain gene rearrangement, thus being selected to recognize a given antigen. During, oncogenic events which occur randomly during this process, the B cell may acquire a survival advantage, and proliferate into identical (clonal) daughter B-cells able to differentiate into Ig producing cells secreting a monoclonal component. With additional oncogenic events a mature B-cell neoplasm may develop, carrying the inherent ability to produce a monoclonal Ig. Multiple myeloma and Waldenstrom's macroglobulinaemia are

and reproduction in any medium, provided the original work is properly cited.

© 2013 Kyrtsonis et al.; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

heavy chains in the absence of light chains only (heavy chain disease).

is to act as antibodies recognizing a specific antigen.

architypical of Ig-secreting B-cell disorders.

Additional information is available at the end of the chapter

