English 
Italian CASI CLINICI – Case Reports
Volume:
Biochimica Clinica 2018; 42(1) e01-e04
Pubblicato on-line:
August 2, 2017
DOI:
10.19186/BC_2017.036
Mieloma multiplo IgD lambda: “switch” isotipico immunoglobulinico dopo trapianto autologo
AUTORI
1Dipartimento di Medicina Molecolare e Biotecnologie Mediche, 2Dipartimento Assistenziale Integrato di Medicina di Laboratorio, 3Dipartimento di Medicina Clinica e Chirurgia, 4Unità Operativa Complessa di Ematologia, Università Federico II di Napoli
ABSTRACT
IgD lambda multiple myeloma: immunoglobulin isotype switch after autologous stem cell transplantation
IgD multiple myeloma (MM) is a rare disease affecting less than 2% of patients with MM, and it is frequently characterized by an aggressive course. It is usually associated with low monoclonal protein levels, so adequate diagnostic procedures have to be performed in order to identify the involved monoclonal component (MC). We present a case of a 38-year-old man with acute kidney disease caused by an IgD lambda MM. Diagnosis was achieved by serum protein electrophoresis and immunofixation with anti IgD and IgE antisera. After autologous stem cell transplantations (ASCT) the patient developed a MC different from the original isotype, followed by an oligoclonal bands (OB) pattern. Recently, the occurrence of MC and OB unrelated to the original clone has been proven to be an important favorable prognostic factor in patients with MM who undergo ASCT. The role of the protein laboratory at diagnosis and during follow up of MM patients is highlighted.