title: [IgD-lambda type multiple myeloma associated with IgG-kappa type benign monoclonal gammopathy].
abstract: A 76-year-old man was admitted to Kisen hospital because of lumbago and chest pain. Laboratory examinations revealed a chronic renal failure with marked elevation of the serum BUN (48.8 mg/dl) and creatinine levels (8.2 mg/dl). The serum electrophoresis demonstrated a hypergammaglobulinemia with M peaks. An immunoelectrophoresis demonstrated monoclonal IgD-lambda and IgG-kappa proteins in the serum, and lambda-type Bence Jones protein in the urine (0.4 g/day). Bone marrow smears revealed an abnormal proliferation of atypical plasma cells (43%). A systemic X-ray examination of the skeletal system showed systemic osteoporosis without punched out lesion. The patient was diagnosed as having IgD-lambda type multiple myeloma and IgG-kappa type benign monoclonal gammopathy by quantifying concentration of two M proteins (1,160 mg/dl in IgD, 1,179 mg/dl in IgG, respectively). A combination chemotherapy with melphalan and prednisolone was administered monthly for multiple myeloma, and hemodialysis for the renal failure was performed 3 times a week. A marked improvement of his laboratory findings including a diminution of the serum IgD-lambda M-protein was obtained. On the other hand, IgG-kappa M-protein level was unchanged. Two M-protein levels showed a different behavior after the combination chemotherapy. Although the patient died of congestive heart failure, the partial remission of multiple myeloma has been maintained for 16 months with chemotherapy.
authors.affiliation: First Department of Internal Medicine, Nihon University School of Medicine.
authors.forename: H
authors.initials: H
authors.lastname: Shimada
authors.forename: S
authors.initials: S
authors.lastname: Nishinarita
authors.forename: Y
authors.initials: Y
authors.lastname: Kishigami
authors.forename: T
authors.initials: T
authors.lastname: Hayama
authors.forename: U
authors.initials: U
authors.lastname: Sawada
authors.forename: T
authors.initials: T
authors.lastname: Horie
authors.forename: N
authors.initials: N
authors.lastname: Nakamura
authors.forename: M
authors.initials: M
authors.lastname: Kato
authors.forename: M
authors.initials: M
authors.lastname: Hirano
authors.forename: O
authors.initials: O
authors.lastname: Nakamura
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D006801:Humans; D007072:Immunoglobulin D / Q000097:blood*; D007145:Immunoglobulin kappa-Chains / Q000097:blood*; D007146:Immunoglobulin lambda-Chains / Q000097:blood*; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008998:Monoclonal Gammopathy of Undetermined Significance / Q000150:complications* / Q000276:immunology; D009101:Multiple Myeloma / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D011241:Prednisone / Q000008:administration & dosage
chemical_list: D007072:Immunoglobulin D; D007145:Immunoglobulin kappa-Chains; D007146:Immunoglobulin lambda-Chains; D008558:Melphalan; D011241:Prednisone