IgD-λ+λ双克隆多发性骨髓瘤2例报道

Mutiple Myeloma with Double Clones of IgD-λ+λ:Two Cases Report

目的提高对IgD-λ+λ双克隆型多发性骨髓瘤的认识和诊治水平,避免漏诊和误诊.方法回顾分析昆明医科大学第二附属医院2014年1月至2016年11月收治的2例IgD-λ+λ双克隆型多发性骨髓瘤并复习相关文献.结果研究观察期间昆明医科大学第二附属医院收治初诊MM患者共79例,本组2例患者,1例男性,45岁;1例女性,51岁,分型均为IgD-λ+λ,分期均为Ⅲ期B组.临床表现有贫血、骨痛、肾功能不全、消瘦乏力.血钙、LDH均有不同程度升高,免疫球蛋白IgG、IgA、IgM均出现降低,均经免疫固定电泳发现2条单克隆M蛋白区带,明确诊断为IgD-λ+λ双克隆型MM.其中1例接受4个疗程VADT方案,后疗效评估PR,随访目前仍存活;另外1例因经济原因未接受治疗出院.结论 IgD-λ+λ双克隆型MM临床罕见,对该疾病临床特点、实验室特点、诊断、治疗转归及预后方面目前尚缺乏较为深刻一致的认识,尚需更多临床病例总结分析.

Objective To improve the recognition level, diagnostic therapeutic level of IgD-λ＋λ typemutiple myeloma, and also reduce the rate of missed diagnosis and misdiagnosis. Methods We retrospectivelyreported and analyzed two cases double clones of IgD-λ＋λ type multiple myelomadiagnosed in our hospital fromJanuary to November in 2014. Results There were 79 cases of multiple myeloma patients during observing time. Twopatients in this study, male one was 45 years old while the female one 51 years old when they first came to bediagnosed. Both of them were diagnosed of double clones of IgD-λ＋λ stage III B group. Clinical manifestationincluded anemia, ostealgia, renal failure, thin and weak. Serum calcium and LDH levels were increased indifferent degree. The levels of immune globulin IgG, IgA, IgM were decreased and immunofixation electrophresisshowed two monoclonal zone. Then they were both diagnosed IgD-λ＋λ type mutiple myelom. One patient reachedPR after four courses VADT chemotherapy and now is still alive. Another one didn＇t accept any treatment because ofpoverty. Conclusions The double clones IgD-λ＋λ type multiple myelomais is a kind of rare plasma celldisorder, sicientists now haven＇t reached a profond understanding about its clinical features, laboratory featuresdiagnositic criteria and therapeutic prognosis. More clinical cases are needed to summarize and analyze in the futurestudy.