PMC5771931_01
Case #1. IgGlambda 
MM in CR. The increasing serum IgG levels were identified as an increment either in both of the uHLC and iHLC levels (arrow case 1-1) or in the uHLC alone accompanying a decrement in the iHLC levels (arrow case 1-2) by the HLC assay. In both occasions, the HLC ratios were normal. These HLC data were interpreted as indicating a continued remission according to the diagram (Table 1). Case #2. IgGkappa 
MM in sCR. The increasing serum IgG levels were identified as an increment in both of the uHLC and iHLC levels (arrow case 2-1) by the HLC assay. The HLC ratio became normal (arrow case 2-3) and led to the identification of continued remission according to the diagram (Table 1). Each figure shows sequential changes in total serum IgG, iHLC, and uHLC concentrations (upper frame), FLC ratios (middle frame), and HLC ratios (lower frame).
CCR3-6-96-g001.jpg
PMC5771931_02_CCR3-6-96-g001.jpg
ccr31304-fig-0001
As observed in Figure 1, her serum IgG started to increase as indicated by the arrow case 2-1.
PMC5771931_02
Case #1. IgGlambda 
MM in CR. The increasing serum IgG levels were identified as an increment either in both of the uHLC and iHLC levels (arrow case 1-1) or in the uHLC alone accompanying a decrement in the iHLC levels (arrow case 1-2) by the HLC assay. In both occasions, the HLC ratios were normal. These HLC data were interpreted as indicating a continued remission according to the diagram (Table 1). Case #2. IgGkappa 
MM in sCR. The increasing serum IgG levels were identified as an increment in both of the uHLC and iHLC levels (arrow case 2-1) by the HLC assay. The HLC ratio became normal (arrow case 2-3) and led to the identification of continued remission according to the diagram (Table 1). Each figure shows sequential changes in total serum IgG, iHLC, and uHLC concentrations (upper frame), FLC ratios (middle frame), and HLC ratios (lower frame).
CCR3-6-96-g001.jpg
PMC5771931_02_CCR3-6-96-g001.jpg
ccr31304-fig-0001
As observed in Figure 1, her serum IgG started to increase as indicated by the arrow case 2-1.
PMC5771931_03
Case #3. IgGkappa 
MM in sCR. The increasing serum IgG levels were identified as an increment in both of the uHLC and iHLC levels (arrow case 3-1) by the HLC assay. The HLC ratios had been normal (arrow case 3-4) and would warrant the disease activity being in remission (Table 1). The normalization of the HLC ratio occurred before the normalization of the fluctuated FLC ratios (arrow case 3-4 vs. case 3-3). Case #4. Relapsed IgGkappa 
MM in progression. In spite of a normal FLC ratio, there developed an increasing serum IgG level which was identified as an increment in the iHLC accompanying a small decrement in the uHLC levels (arrow case 4-1) by the HLC assay. The HLC ratio became abnormal (arrow case 4-3) and led to the identification of relapse. The FLC ratio became abnormal (arrow case 4-2) later than the HLC ratios did (arrow case 4-3). See Figure 1 caption for sequencial changes.
CCR3-6-96-g002.jpg
PMC5771931_04_CCR3-6-96-g002.jpg
ccr31304-fig-0002
PMC5771931_04
Case #3. IgGkappa 
MM in sCR. The increasing serum IgG levels were identified as an increment in both of the uHLC and iHLC levels (arrow case 3-1) by the HLC assay. The HLC ratios had been normal (arrow case 3-4) and would warrant the disease activity being in remission (Table 1). The normalization of the HLC ratio occurred before the normalization of the fluctuated FLC ratios (arrow case 3-4 vs. case 3-3). Case #4. Relapsed IgGkappa 
MM in progression. In spite of a normal FLC ratio, there developed an increasing serum IgG level which was identified as an increment in the iHLC accompanying a small decrement in the uHLC levels (arrow case 4-1) by the HLC assay. The HLC ratio became abnormal (arrow case 4-3) and led to the identification of relapse. The FLC ratio became abnormal (arrow case 4-2) later than the HLC ratios did (arrow case 4-3). See Figure 1 caption for sequencial changes.
CCR3-6-96-g002.jpg
PMC5771931_04_CCR3-6-96-g002.jpg
ccr31304-fig-0002
PMC5771931_05
Case #5. Relapsed IgGkappa 
MM. Even in a VGPR state, a favorable response to KRd was detected by the HLC assay with a steep drop in the serum M-protein as well as the iHLC levels (arrow case 5-1). Case #6. IgGkappa 
MM in VGPR. An increase in M-protein was noted (arrow case 6-1), but the HLC assay identified it with a simultaneous increase in both of the iHLC and uHLC resulting in normal HLC ratio (arrow case 6-2). These HLC data would indicate a remission (Table 1). See Figure 1 caption for sequencial changes.
CCR3-6-96-g003.jpg
PMC5771931_06_CCR3-6-96-g003.jpg
ccr31304-fig-0003
Case #6 (Fig. 3): A 66-year-old male with IgGkappa symptomatic MM with past medical history of cerebral infarction with resultant left hemiplegia was treated with VMP (bortezomib-melphalan-prednisolone) and obtained a VGPR which was maintained with monthly bortezomib.
PMC5771931_06
Case #5. Relapsed IgGkappa 
MM. Even in a VGPR state, a favorable response to KRd was detected by the HLC assay with a steep drop in the serum M-protein as well as the iHLC levels (arrow case 5-1). Case #6. IgGkappa 
MM in VGPR. An increase in M-protein was noted (arrow case 6-1), but the HLC assay identified it with a simultaneous increase in both of the iHLC and uHLC resulting in normal HLC ratio (arrow case 6-2). These HLC data would indicate a remission (Table 1). See Figure 1 caption for sequencial changes.
CCR3-6-96-g003.jpg
PMC5771931_06_CCR3-6-96-g003.jpg
ccr31304-fig-0003
Case #6 (Fig. 3): A 66-year-old male with IgGkappa symptomatic MM with past medical history of cerebral infarction with resultant left hemiplegia was treated with VMP (bortezomib-melphalan-prednisolone) and obtained a VGPR which was maintained with monthly bortezomib.