Plasma cell myeloma is known to cause expansion of a single clone of immunoglobulin (Ig) which results in the secretion of a unique homogeneous monoclonal protein (M component). However, there are cases which reported that it can also cause production of two different clones of these monoclonal M proteins. Although it is relatively very rare as the prevalence is only 2% of all plasma cell myeloma cases, the clinical features are said to be similar to monoclonal gammopathy. It is suggested that these biclonal gammopathy results from either one monoclonal cell clone in monoclonal gammopathy or two different monoclonal cell clones. Whichever the mechanism of the disease be, the response to treatment seems to be similar as compared to the monoclonal cases although some reports shows chemoresistant. Here, we report a rare case of plasma cell myeloma with IgG (lambda) and IgA (lambda) type of biclonal gammopathy, the clinical presentation, the haematological and biochemical markers as well as the response to the treatment.
A Rare Occurrence of Plasma Cell Myeloma with Biclonal Gammopathy
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Abstrak
Myeloma sel plasma telah diketahui menyebabkan pengeluaran immunoglobulin (Ig) monoklonal yang mengakibatkan rembesan protein monoklonal homogenus (komponen M) yang unik. Walaubagaimanapun, terdapat kes-kes melaporkan bahawa ia juga boleh menyebabkan pengeluaran dua klon protein M monoklonal yang berbeza. Walaupun ia agak jarang berlaku dan hanya 2% kes direkodkan daripada semua kes myeloma sel plasma, ciri-ciri klinikal adalah sama dengan mana-mana kes monoklonal tersebut. Berkemungkinan 2 klon protein M yang berbeza ini adalah hasil daripada klon yang sama atau dua klon sel monoklonal yang berbeza. Walau apa pun mekanisme penyakit ini, tindak-balas terhadap rawatan adalah sama dengan kes-kes monoklonal walaupun beberapa laporan menunjukkan rintangan terhadap rawatan boleh berlaku. Di sini, kami melaporkan satu kes myeloma sel plasma yang jarang direkodkan dimana kes ini menunjukkan penghasilan dua klon protein M yang berbeza iaitu IgG (lambda) dan IgA (lambda), ciri-ciri klinikal, ciri-ciri hematologi serta penanda biokimia dan tindak balas kepada rawatan.
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