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Biclonal gammopathy in Myeloma
Biclonal gammopathy in myeloma is rare but it does happen. Biclonal gammopathy or double m-bands or two m-spikes indicates two plasma clones when the usual myeloma patient demonstrates on m-spike with a single plasma clone.
What is bi-clonal myeloma?
I noticed several differences in the video above vs the studies linked below which leads me to believe that oncology doesn’t fully understand biclonal gammopathy in myeloma.
However, the important thing to me is that both types of myeloma are treated the same way. And most importantly, NDMM patients who are diagnosed with biclonal gammopathy in myeloma should read about the cure vs. control debate in myeloma treatment.
As a long-term myeloma patient who lives with a host of long-term side effects from aggressive therapies that did little for my MM, I feel strongly about NDMM patients understanding this important philosophical issue.
Email me at David.PeopleBeatingCancer@gmail.com with questions about managing MM.
Good luck,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Plasma cell myeloma with double M bands on Serum protein electrophoresis: A diagnostic conundrum?
“Plasma cell myeloma (PCM) is a monoclonal gammopathy (MGM) characterized by proliferation of abnormal clone of plasma cells infiltrating the bone marrow with consequent end organ damage.
The clonal plasma cells secrete a single clone of immunoglobulins (Ig) leading to presence of M-protein in the serum and/or urine. The M-protein is appreciated as a discrete band on serum protein electrophoresis (SPE) in the gamma globulin region, also called the M-band.
Biclonal gammopathy (BGM) occurs due to neoplastic transformation of a plasma cell clone undergoing Ig class switching or due to an independent neoplastic transformation event yielding proliferation of unrelated plasma cell clones, therefore resulting in two distinct M-bands on SPE.
It is, however, vital to distinguish a true BGM from an apparent one (MGM presenting with two distinct bands on SPE) so as to make an accurate diagnosis. Hereby, we report a case of a 61-year-old man, diagnosed with PCM and presenting with two discrete bands on SPE (simulating a BGM) which turned out to be monoclonal in nature…
Rarely, PCM can present with two distinct M-bands on SPE arising due to BGM.[2]BGM can result from either a proliferation of two clones of plasma cells with each producing an unrelated monoclonal spike or from the production of two monoclonal spikes by a single clone of plasma cells. Patients with BGMs can express para-proteins with different HC isotypes, different LC isotypes, or HCs and LCs of different isotypes.[6] The latter situation represents true BGMs, arising from 2 or more plasma cell clones.[4,6] BGMs may also be transitory; observed at presentation or anytime during the course of the disease or, rarely after therapy.[2]This phenomenon is explained by the recovery of normal immunoglobulin production from healthy plasma cells…”
Biclonal gammopathy
BACKGROUND:
Biclonal gammopathies are characterized by the production of two distinct monoclonal proteins. It is defined as the presence of two distinct M bands in serum protein electrophoresis. Biclonal myeloma accounted for approximately 1% of newly diagnosed cases of multiple myeloma…
RESULTS:
The median age was 65 years, there were 10 males and 3 females.
- Eleven patients had multiple myeloma,
- one had plasmacytoma,
- and one had monoclonal gammopathy of undetermined significance (MGUS).
Twelve patients had biclonal gammopathy at diagnosis and one developed biclonal gammopathy at relapse.
Immunofixation showed-
- IgG/IgA in seven cases,
- IgA/IgG in four,
- and IgG/IgG in two patients.
The patient with MGUS is on follow at 44 months and one with plasmacytoma received radical radiotherapy and alive at 45 months. Ten patients with myeloma received systemic treatment, eight are alive with survival ranging from 44 to 110 months, and four patients are alive more than 5 years.
CONCLUSION:
Biclonal gammopathies are rare characterized by the presence of two distinct monoclonal proteins. The most frequent combination was IgG/IgA. Treatment of biclonal gammopathy is similar to monoclonal gammopathy with comparable outcomes. During follow-up, both paraproteins have to be addressed…
Biclonal gammopathy in myeloma Biclonal gammopathy in myeloma Biclonal gammopathy in myeloma