Persistent pretransplantation nonclinical clonotypic isotypes in blood, BM, and autografts, followed by a loss of nonclinical isotypes after transplantation and re-emergence of clonotypic IgM at the time of relapse.

Patient 2 was diagnosed in May 1997. She provided PBMC samples until January 1999. Her treatment consisted of 3 cycles of chemotherapy, followed by high-dose melphalan with autologous blood stem cell support in January 1998. Her disease was clinically stable until she relapsed in January 1999. She was not a candidate for further treatment, and she died in July 2000. Her clinical isotype was IgG. The clinical isotype was always detectable using strategy A. Nonclinical isotypes were only detected using strategy B. All samples were positive for strategy D. Mobilized blood had detectable clinical and nonclinical clonotypic isotypes, and the clinical isotype persisted postautologous transplantation. All samples to the right of the vertical line were taken after transplantation. M, mobilized blood autografts; R, relapse. Other abbreviations are as for Figure 2.