Heavy Chain Disease, Mu Follow-up

  • Author: Ajeet Gajra, MD; Chief Editor: Emmanuel C Besa, MD   more...
 
Updated: Jan 2, 2010
 

Further Inpatient Care

Inpatient care is usually not required.

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Further Outpatient Care

  • Once the diagnosis of mu-HCD is established, any accompanying lymphoproliferative disorder should be treated. Typically, this involves chemotherapy administered in an outpatient setting.
  • If no overt lymphoproliferative disorder is found, the patient should be evaluated every few months to assess the abnormal protein. Reasonable follow-up intervals are every 3 months in the first year following diagnosis, every 4 months for the next year, and every 6 months thereafter. The patient should be evaluated earlier if symptoms occur. If the patient is symptomatic in any way, then radiologic assessment and other diagnostic procedures for lymphoproliferative disorders are essential.
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Complications

  • Possible complications include pathologic fracture secondary to osteolytic lesions.
  • Renal insufficiency occasionally is associated with mu-HCD. Etiologies include cast glomerulopathy, nodular glomerulosclerosis, and amyloidosis.
  • Positive results from a direct antiglobulin test have also been reported.
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Prognosis

The clinical course is variable, with survival ranging from 1 month to 11 years after the appearance of symptoms with a median survival of 24 months in the well studied cases. Reports of cures are described, primarily in the setting of a curable lymphoproliferative disorder. Because of its low incidence, no large series of patients treated in a systematic way at a single center has been reported.

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Contributor Information and Disclosures
Author

Ajeet Gajra, MD  Assistant Professor of Medicine, Director of Hematology/Oncology Fellowship Program, State University of New York Upstate Medical University; Consulting Staff, Department of Internal Medicine, Division of Hematology and Oncology, Veterans Affairs Medical Center

Ajeet Gajra, MD is a member of the following medical societies: American Association for Cancer Research, American College of Physicians-American Society of Internal Medicine, American Medical Association, and American Society of Hematology

Disclosure: Nothing to disclose.

Coauthor(s)

Sara J Grethlein, MD  Associate Dean for Graduate Medical Education, Professor, Department of Internal Medicine, Division of Hematology and Oncology, State University of New York Upstate Medical University

Sara J Grethlein, MD is a member of the following medical societies: American Society of Hematology

Disclosure: Nothing to disclose.

Specialty Editor Board

Paul Schick, MD  Emeritus Professor, Department of Internal Medicine, Thomas Jefferson University Medical College; Research Professor, Department of Internal Medicine, Drexel University College of Medicine; Adjunct Professor of Medicine, Lankenau Hospital, Wynnewood, PA

Paul Schick, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Society of Hematology, International Society on Thrombosis and Haemostasis, and New York Academy of Sciences

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Troy H Guthrie, Jr, MD  Director of Cancer Institute, Baptist Medical Center

Troy H Guthrie, Jr, MD is a member of the following medical societies: American Federation for Medical Research, American Medical Association, American Society of Hematology, Florida Medical Association, Medical Association of Georgia, and Southern Medical Association

Disclosure: Nothing to disclose.

Rajalaxmi McKenna, MD, FACP  Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems

Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis

Disclosure: Nothing to disclose.

Chief Editor

Emmanuel C Besa, MD  Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Thomas Jefferson University

Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, and New York Academy of Sciences

Disclosure: Nothing to disclose.

References

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  3. Mihaesco C, Ferrara P, Guillemot JC, et al. A new extra sequence at the amino terminal of a mu heavy chain disease protein (DAG). Mol Immunol. Aug 1990;27(8):771-6. [Medline].

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  14. Iwasaki T, Hamano T, Kobayashi K, Kakishita E. A case of mu-heavy chain disease: combined features of mu-chain disease and macroglobulinemia. Int J Hematol. Oct 1997;66(3):359-65. [Medline].

  15. Liapis H, Papadakis I, Nakopoulou L. Nodular glomerulosclerosis secondary to mu heavy chain deposits. Hum Pathol. Jan 2000;31(1):122-5. [Medline].

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  17. Wahner-Roedler DL, Kyle RA. Mu-heavy chain disease: presentation as a benign monoclonal gammopathy. Am J Hematol. May 1992;40(1):56-60. [Medline].

 
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