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[IgD-lambda type multiple myeloma associated with IgG-kappa type benign monoclonal gammopathy]
H Shimada1, S Nishinarita, Y Kishigami
1First Department of Internal Medicine, Nihon University School of Medicine.
Summary
This study reports a case of IgD-lambda multiple myeloma with coexisting IgG-kappa benign monoclonal gammopathy. Chemotherapy effectively reduced IgD-lambda levels, indicating partial remission of multiple myeloma.
Area of Science:
- Hematology
- Oncology
- Nephrology
Background:
- Multiple myeloma is a plasma cell malignancy characterized by monoclonal protein production.
- Coexistence of multiple myeloma and benign monoclonal gammopathy presents diagnostic and therapeutic challenges.
Observation:
- A 76-year-old male presented with lumbago, chest pain, and chronic renal failure.
- Laboratory findings revealed hypergammaglobulinemia with distinct IgD-lambda and IgG-kappa M-proteins, and lambda-type Bence Jones proteinuria.
- Bone marrow examination showed atypical plasma cell proliferation (43%), and skeletal X-rays revealed osteoporosis.
Findings:
- The patient was diagnosed with IgD-lambda multiple myeloma and IgG-kappa benign monoclonal gammopathy.
- Combination chemotherapy (melphalan, prednisolone) and hemodialysis were initiated.
- Treatment led to a significant decrease in IgD-lambda M-protein, while IgG-kappa M-protein remained stable, demonstrating differential response.
Implications:
- This case highlights the importance of differentiating between malignant and benign monoclonal gammopathies, even when coexisting.
- The differential response of the two M-proteins to chemotherapy provides insights into disease behavior.
- Despite succumbing to congestive heart failure, the patient achieved a 16-month partial remission of multiple myeloma, underscoring treatment efficacy.