Low IgE monoclonal gammopathy level in serum highlights 20-yr survival in a case of IgE multiple myeloma.
This report describes the diagnosis, follow-up, and problems measuring serum immunoglobulin E (IgE) levels in a case of IgE myeloma with 20-yr survival. Serum and urine protein electrophoresis, immunofixation, and the N Latex IgE test were used to characterize the monoclonal proteins. The diagnosis of multiple myeloma in a 56-yr-old man was based on 5.4 g/24 h of monoclonal free lambda chain in urine and bone marrow findings of 23.5% plasma cells (19% mature and 4.5% atypical). IgE lambda monoclonal protein in serum measured 506,000 microg/L (210 833 IU/mL). The lack of other clinical findings of multiple myeloma places this case in the category of 'smoldering or indolent myeloma'. Measurement of serum IgE levels was complicated by the need to predilute serum to avoid antigen excess. Following chemotherapy, the patient went into clinical remission, eventually dying of complications of emphysema. This case expands the recognized clinical spectrum of IgE multiple myeloma.
Hayes
Michael J
MJ
Department of Pathology, The University of Michigan, Ann Arbor, MI, USA.
Carey
John L
JL
Krauss
John C
JC
Hedstrom
Deborah L
DL
Gulbranson
Ronald L
RL
Keren
David F
DF
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001797:Blood Protein Electrophoresis / Q000379:methods; D004646:Emphysema / Q000150:complications; D017809:Fatal Outcome; D005500:Follow-Up Studies; D006801:Humans; D006942:Hypergammaglobulinemia / Q000097:blood* / Q000652:urine; D007073:Immunoglobulin E / Q000097:blood* / Q000652:urine; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy; D010265:Paraproteinemias / Q000097:blood* / Q000175:diagnosis* / Q000652:urine; D013995:Time
D007073:Immunoglobulin E