The purpose of our study was to determine the prevalence of types of heavy and free lung (k, λ) chains of immunoglobulins among patients with multiple myeloma.

MATERIALS AND METHODS:

The total group included 115 patients; of them 24 of them are of kirghiz nationality and 91 patients of the Russian-speaking population residents of Kirghizia. Of them, from 2004 to 2016 years with multiple myeloma patients 43 of them 4 kirghiz nationality and 39 patients Russian-speaking population residents of Kirghizia were examined at the St. Petersburg Research Institute of Epidemiology and Microbiology named L.Pasteur, the St. Petersburg Clinical Hospital of the Russian Academy of Sciences, the Eurasian Center of oncohematology, immunology and therapy, citizens of the Kirghiz Republic. The total of women 43 and men 72, the age of the patients ranged from 33 to 90 years.

The diagnosis of MM was based on standard criteria including a classical triad: plasma cells in the bone marrow of at least 10%, bone lesions of varying degrees - from osteoporosis to osteolysis, monoclonal protein in the blood and / or urine.. At each patient took into account clinical and laboratory indicators, immunochemical variants production of immunoglobulins types of heavy and light chains. Patients were distributed to the stages of the current according to Durie B.G.M., Salmon S.E and the International Multiple Myeloma Staging System (ISS, 2005).

In the immunology laboratory of the National Center for Cardiology and Therapy of the Ministry of Health of the Kirghiz Republic, city Bishkek,  typing in blood serum  - 115 patients, of which 24 kirghiz nationality and 91 patients Russian-speaking population residents of Kirghizia, on immunoglobulin's IgA, IgM, IgG and on  indications on IgD, IgE.

From March 1995 to November 1999, in the laboratory of hybrid technologies of CNIRRI FASR, Russia, St. Petersburg, investigated at 51 patients with MM in the blood serum of the free lung k and λ chains, where more often s revealed among kirghiz population IgAк-chain, IgG1κ-chain, IgG2 λ-chain and in one patient at a repeated study a biclonal tumor (IgAκ-chains and IgE) was confirmed. Avia transportation and delivery of analyzes (blood serum) to the laboratory of hybrid technologies CNIRRI FASR, Russia, St. Petersburg was conducted in mini-refrigerated containers at minus 10 degrees.

DEFINITION IMMUNOGLOBULINS TYPES OF HEAVY AND FREE EASY CHAINS IN THE SERUM BLOOD:

The immunoglobulins were typed methods in a direct solid-phase immune -enzyme analysis. Paraproteins were immobilized on a solid phase sera diluted 1:105 and 1: 106 on 0.1 m carbonate-bicarbonate buffers pH 9.5. Heavy chain isotypes and light chain types of myeloma immunoglobulins were determined using conjugant's of monoclonal antibodies (MCAT) with horseradish peroxides.   Typing was conducted in the laboratory of immunology at the Kirghiz Research Institute of Cardiology and Therapy in city Bishkek and in the laboratory of the hybrid technology CNIRRI FASR, St. Petersburg, the Ministry of Health of Russia.

 RESULTS AND DISCUSSION:

The results of our studies in a comparative analysis among patients with MM of kirghiz nationality and MM patients of Russian-speaking population of Kirghizia residents showed that the variant of IgA or A-myeloma among men of kirghiz nationality was more often revealed in 57%, among women - in 29%, among women of Russian-speaking population of residents Kirghizia - in 14% of the cases and among the men of the Russian-speaking population of Kirghizia, were not detected at our observation. Several less common is the type of IgD, type IgE, and in unit cases the biclonal tumor in patients with MM of kirghiz nationality. On prevalence of the frequency of detection in patients with MM of kirghiz nationality, high immunoglobulin titers were more often detected types of IgG1-κ chain and IgG2-λ chain and type of IgAk-chain. Detection of myeloma IgAk-chain among patients MM kirghiz nationality in 55-58%.  And in the dynamics of observation, the clinical current is more malignant,  in  for the most part, in  high risk of disease progression with A-myeloma, IgD, IgE and biclonal tumor (IgA IgE). Characterized with pronounced anemic, ossalgic syndrome, spontaneous fractures of flat bones, connection of infectious complications, an increase in the number of plasma cells in the bone marrow, chronic renal failure, where patients needed timely selection and conduct of chemotherapy programs. For the timely selection of treatment tactics among patients of kirghiz nationality at rare forms of immunoglobulins such as IgE and IgD, biclonal tumor (IgA IgE) and IgA-myeloma with chronic renal insufficiency and with a high risk of unfavorable course of the disease, at the availability HLA of a compatible healthy donor is necessary to spend out transplantation of hematopoietic stem cells.

Thus, significant important value at the multiple myeloma has a immunochemical variant and function renals in the determining flow of the disease. And considering the prevalence of rare forms of immunoglobulins, the determination of the types of heavy and free light chains of immunoglobulin's, is also of great diagnostic importance and is one of the criteria affecting the prognosis of the disease in multiple myeloma.

The work is submitted to the International Scientific Conference « FUNDAMENTAL AND APPLIED RESEARCH IN MEDICINE »,   October, 20-26, 2017 in the Netherlands (Amsterdam), came to the editorial office оn 07.08.2017

2. Variants of multiple myeloma such as types IgAk-chain, IgD-chain, IgE and biclonal tumors of the type (IgAk, IgE) are more often detected among patients with multiple myeloma of kirghiz nationality

3. Patients multiple myeloma with immunochemical variants of the IgAk-chain, IgDλ-chain, IgE and biclonal tumors of the type (IgAk, IgE)often with at high risk of adverse current of the disease.

4. In primary patients with multiple myeloma, when detecting rare forms with high titers of immunoglobulins and the content of free light chains with increased k and λ chains, has a important influence in prognosis of the disease.