He QL, Meng SS, Yang JN, Wang HC, Li YM, Li YX, Lin XH. Immunoglobulin D-λ/λ biclonal multiple myeloma: A case report. World J Clin Cases 2021; 9(11): 2576-2583 [PMID: 33889623 DOI: 10.12998/wjcc.v9.i11.2576]
Corresponding Author of This Article
Xu-Hong Lin, MD, Associate Professor, Department of Clinical Laboratory, Translational Medicine Center, Huaihe Hospital of Henan University, No. 115 Ximen Street, Kaifeng 475000, Henan Province, China. 10220017@vip.henu.edu.cn
Research Domain of This Article
Medicine, General & Internal
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Qiao-Ling He, Shuang-Shuang Meng, Jing-Nan Yang, Yan-Min Li, Yu-Xia Li, Xu-Hong Lin, Department of Clinical Laboratory, Translational Medicine Center, Huaihe Hospital of Henan University, Kaifeng 475000, Henan Province, China
Hui-Chao Wang, Department of Nephrology, The First Affiliated Hospital of Henan University, Kaifeng 475000, Henan Province, China
Author contributions: He QL and Lin XH designed the report; Meng SS and Wang HC collected the patient’s clinical data; Li YM and Li YX took the pictures and prepared the data of serum electrophoresis, serum immunofixation electrophoresis, and flow cytometry; Wang HC and Yang JN took the pictures of bone marrow; He QL and Lin XH wrote the paper; all authors issued final approval for the version to be submitted.
Supported byNational Natural Science Foundation of China, No. 81500430 and No. U1304802; Science and Technology Planning Project of Henan Province, No. 192102310045, No. 182102310544, No. 182102310566, and No. 182102310573; and Henan Medical Science and Technology Tackling Project, No. 2018020320.
Informed consent statement: Consent was obtained from the relatives of the patient for publication of this report and any accompanying results.
Conflict-of-interest statement: The authors declare that they have no conflicts to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xu-Hong Lin, MD, Associate Professor, Department of Clinical Laboratory, Translational Medicine Center, Huaihe Hospital of Henan University, No. 115 Ximen Street, Kaifeng 475000, Henan Province, China. 10220017@vip.henu.edu.cn
Received: December 8, 2020 Peer-review started: December 8, 2020 First decision: December 30, 2020 Revised: January 11, 2021 Accepted: February 4, 2021 Article in press: February 4, 2021 Published online: April 16, 2021 Processing time: 114 Days and 23.7 Hours
Abstract
BACKGROUND
Immunoglobulin D (IgD) multiple myeloma (MM) is a rare subtype of MM and commonly occurs in younger subjects but at a later stage of the International Staging System (ISS) when admitted. As a special type of IgD myeloma, IgD-λ/λ biclonal MM is rarer. Its serum protein electrophoresis and serum immuno-fixation electrophoresis (IFE) might find no anomalies even if the bone marrow (BM) examination is performed. Thus, it is easy to miss the diagnosis.
CASE SUMMARY
A 62-year-old man diagnosed as IgD-λ/λ myeloma (ISS stage III) was admitted with fatigue and weight loss. The physical examination suggested an anemic face, a few moist rales at the left lung base, and mild concave edema in both lower extremities. Laboratory examinations showed the elevated creatinine levels, β2-microglobulin, lactic dehydrogenase, and erythrocyte sedimentation rate, while the decreased neutrophils, granulocytes, and hemoglobin. In the serum protein electrophoresis, there appeared two inconspicuous M-spikes. Serum IFE indicated an over-representation of lambda light chain and yielded two monoclonal bands in λ region, but only one corresponding heavy chain band in the antisera to IgD region. The BM histology and BM cytology both supported the diagnosis of IgD-λ/λ myeloma.
CONCLUSION
This case highlights the differential clinical manifestations and laboratory findings of IgD-λ/λ myeloma to help minimize the chance of misdiagnosis.
Core Tip: Immunoglobulin D (IgD)-λ/λ myeloma is extremely rare and has a later International Staging System stage at diagnosis. The median survival time is shorter than that of other subtypes, and renal insufficiency is prone to occur at the time of diagnosis. Furthermore, the laboratory examination tends to consider IgD-λ/λ myeloma as other isotypes in that its serum immunofixation electrophoresis shows two bands in the λ region but no responding heavy chain band. Therefore, more complete serum immunofixation electrophoresis should be conducted to reduce the rate of missed diagnoses.
