O'Connor M L, Rice D T, Buss D H, Muss H B
Department of Pathology, Wake Forest University, Bowman Gray School of Medicine, Winston-Salem, NC 27157.
Cancer. 1991 Aug 1;68(3):611-6. doi: 10.1002/1097-0142(19910801)68:3<611::aid-cncr2820680328>3.0.co;2-5.
The authors report a case, perhaps the first, of immunoglobulin D (IgD) benign monoclonal gammopathy. The patient, a 48-year-old black woman, initially had a 500 mg/dl IgD-lambda M-spike, hypercalcemia, and anemia. There was no bone pain, lytic bone lesions, or evidence of renal failure. The bone marrow showed 2.8% plasma cells with a diffuse (not nodular) IgD plasmacytosis and strong lambda predominance. Only trace amounts of free lambda light chains could be demonstrated by immunoelectrophoresis in serum and concentrated urine. The anemia responded quickly to iron therapy. Chemotherapy was not initiated. Over the 6+ years of follow-up, the patient has had no progression of clinical disease attributable to her IgD monoclonal gammopathy. The IgD M-spike has steadily decreased.
作者报告了一例可能是首例免疫球蛋白D（IgD）良性单克隆丙种球蛋白病的病例。该患者为一名48岁的黑人女性，最初IgD-λM蛋白峰为500mg/dl，伴有高钙血症和贫血。无骨痛、溶骨性骨病变或肾衰竭证据。骨髓显示2.8%的浆细胞，呈弥漫性（而非结节性）IgD浆细胞增多，且λ链明显占优势。免疫电泳在血清和浓缩尿中仅可检测到微量游离λ轻链。贫血对铁剂治疗反应迅速。未开始化疗。在6年多的随访中，患者未出现因IgD单克隆丙种球蛋白病导致的临床疾病进展。IgD M蛋白峰持续下降。
