IgD myeloma: clinical, biological and laboratory features

The study of IgD myeloma remains a challenging field. In terms of the initial detection of the IgD paraprotein, great care must be exercised in the interpretation of electrophoresis patterns and immunoglobulin profiles. Laboratory staff have a very important role to play in this, as it is likely that many IgD myeloma cases are uncovered following the involvement of laboratory staff. They must help to ensure that suggestive electrophoresis and immunoglobulin levels are properly investigated and that Bence Jones myeloma is not diagnosed without excluding the presence of an IgD paraprotein. In clinical terms, IgD myeloma remains a rare but aggressive tumour affecting younger people and with presenting features that include most of those common to all myeloma cases. However, renal problems, amyloidosis and the occurrence of Bence Jones lambda light chain proteinuria complicate matters to a far greater extent than in most other forms of the disease. There are now increasing numbers of case reports describing patients with associative symptoms and only time will tell whether these relationships are predictive or useful in nature. It is important however, given the rarity of the condition, that these cases continue to be reported. There do not appear to be any treatment regimes that are specifically tailored for IgD myeloma and the response to chemotherapy does not seem to differ from other forms of the disease. However, the management of any associated renal failure will always remain a challenge, I suspect. The progress being made in the treatment of myeloma as a whole, is bound to have a positive impact on the treatment of IgD myeloma.