Aksungar Fehime Benli, Ayer Mesut, Serteser Mustafa, Coskun Abdurrahman, Unsal Ibrahim
Department of Biochemistry, Acibadem Labmed Clinical Laboratories, Istanbul, Turkey Department of Biochemistry, Acibadem University School of Medicine, Istanbul, Turkey
Department of Haematology, Haseki Education and Research Hospital, Istanbul, Turkey.
Ann Clin Biochem. 2014 Sep;51(Pt 5):606-10. doi: 10.1177/0004563213512801. Epub 2013 Dec 20.
Multiple myeloma (MM) is a plasma cell dyscrasia characterized by the malignant proliferation of a plasma cell clone that produces a monoclonal immunoglobulin. Diagnosis and management of patients with monoclonal gammopathies depend on accurate identification and characterization of monoclonal proteins. We present a 67-year-old male patient with anaemia, weakness and weight loss for six months. His physical examination was normal with no fever, and no bone lesions were present in the imaging studies. Laboratory investigations revealed low haemoglobin and albumin concentrations with high total protein and beta 2-microglobulin concentrations. Capillary zone electrophoresis with immunosubtraction method revealed a triclonal pattern of M-protein (IgG κ + IgG λ + IgA κ) which was not prominent with immunofixation electrophoresis. After bone marrow biopsy, MM with triclonal gammopathy was diagnosed and autologous stem cell transplantation was performed. Six months later, again a triclonal M-protein was detected by immunosubtraction method, and a relapse was confirmed with a second bone marrow biopsy. The occurrence of monoclonal and biclonal gammopathies can often be seen upon diagnosis in plasma cell dyscrasias and lymphoproliferative disorders, but triclonal paraproteins are very rare and their clinical significance is unknown. In this particular patient, triclonality was detected by an alternative method called immunosubtraction by capillary electrophoresis. The patient was resistant to therapy suggesting that more than one monoclonal M protein may be a negative prognostic factor, and with new technologies and methods, the number of patients with different monoclonal patterns may increase.
多发性骨髓瘤（MM）是一种浆细胞发育异常疾病，其特征为产生单克隆免疫球蛋白的浆细胞克隆恶性增殖。单克隆丙种球蛋白病患者的诊断和管理取决于单克隆蛋白的准确识别和特征描述。我们报告一名67岁男性患者，有6个月的贫血、乏力和体重减轻症状。他的体格检查正常，无发热，影像学检查未发现骨病变。实验室检查显示血红蛋白和白蛋白浓度低，总蛋白和β2-微球蛋白浓度高。采用免疫扣除法的毛细管区带电泳显示M蛋白呈三克隆模式（IgG κ+IgG λ+IgA κ），免疫固定电泳显示不明显。骨髓活检后，诊断为伴有三克隆丙种球蛋白病的MM，并进行了自体干细胞移植。6个月后，免疫扣除法再次检测到三克隆M蛋白，第二次骨髓活检证实复发。单克隆和双克隆丙种球蛋白病在浆细胞发育异常和淋巴增殖性疾病诊断时较为常见，但三克隆副蛋白非常罕见，其临床意义尚不清楚。在该特定患者中，通过一种称为毛细管电泳免疫扣除的替代方法检测到三克隆性。该患者对治疗耐药，提示不止一种单克隆M蛋白可能是不良预后因素，随着新技术和方法的出现，具有不同单克隆模式的患者数量可能会增加。
