Diagnostic significance

Normal plasma cells most often produce balanced amounts of heavy and light chains. In contrast, malignant plasma cells often secrete free LC. Hence, the presence of significant amounts of BJP (^0.3 g l"1 of urine) is indicative of malignancy. Minute amounts of BJP detected after 1000 x concentration of proteins present in urine in physiologic concen trations are also mostly observed in malignant diseases. In myeloma, BJP are found as the only monoclonal Ig in about 20% of cases. In IgD myeloma (of the A. type in 9 out of 10 cases), there is usually a large output of BJP, whereas the serum monoclonal IgD is often present in small amounts. Hence, the finding of an apparently isolated X BJP should lead to a search for IgD myeloma. Bence Jones proteins may be observed in B cell lymphomas and leukemias, in small amounts in virtually every patient with Waldenstrom macroglobulinemia, and in about 50% of cases of |x heavy chain disease.

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