Immunoglobulin D Multiple Myeloma: A Rare Variant

Area of Science:

• Hematology
• Oncology
• Immunology

Background:

• Immunoglobulin D multiple myeloma (IgD MM) is a rare subtype, accounting for <2% of multiple myeloma cases.
• IgD MM often presents with advanced disease, aggressive progression, and poorer survival rates compared to other myeloma types.
• Diagnostic challenges arise from typically undetectable or low M-protein levels on serum protein electrophoresis.

Observation:

• Patients with IgD MM frequently exhibit hypercalcemia, anemia, bone lesions, and renal failure.
• The rarity of IgD MM limits extensive clinical studies, with most data from small case series.
• A case of IgD kappa MM was incidentally diagnosed after a traumatic injury.

Findings:

• The reported case received bortezomib and dexamethasone (Vd), followed by bortezomib, dexamethasone, and lenalidomide (VRd).
• The patient successfully completed treatment cycles and underwent autologous hematopoietic stem cell transplantation (ASCT).
• Small studies suggest improved outcomes with high-dose chemotherapy and ASCT for IgD MM.

Implications:

• Understanding IgD MM's response to novel therapies like proteasome inhibitors and immunomodulatory agents is crucial.
• Despite treatment advancements, IgD MM's poor prognosis necessitates further research into effective therapeutic strategies.
• This case highlights the potential benefit of combination therapies and ASCT in managing IgD MM.