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IgD Non-Secreting Multiple Myeloma

by Matt on Sat May 15, 2010 10:30 pm

I have been confused regarding my sub-type of multiple myeloma since I was diagnosed in April of 2009. There were no M Proteins detected in my blood or urine. I also tested negative for light chains. The following, however, is a direct quote from my cytogenetic test: "Additional tests show that neoplastic plasma cells contain IgD heavy chain."

The UCLA Dept. of Pathology calls what I have Non-Secretory IgD plasma cell Myeloma. A researcher who gave me a second opinion, however, says that what I have is simply Non-Secretory Myeloma. I am confused but apparently a bunch of people a whole lot smarter than me are too. The doctor who did my stem cell transplant said he had never encountered my sub-type. My local oncologist jokes that she is just going to take me to ASH next fall, put me on display and let the experts try and come to a consensus.

Have you ever heard of this? Is it relevant as far as putting me in a prognostic category?

Matt
Name: Matt Linden
Who do you know with myeloma?: Myself
When were you/they diagnosed?: April 2009
Age at diagnosis: 44

Re: IgD Non-Secreting Multiple Myeloma

by Dr. Craig Hofmeister on Sat May 15, 2010 11:23 pm

Well I have a handful of IgD myeloma patients, but I don't understand if you are that.
Has anyone checked your serum IgD level?
If you have all sorts of records but you want to keep it confidential, please email me your records to craig.hofmeister@osumc.edu.
Dr. Craig Hofmeister
Multiple Myeloma Clinic, The Ohio State University

Dr. Craig Hofmeister
Name: Craig C. Hofmeister, M.D.

Re: IgD Non-Secreting Multiple Myeloma

by Matt on Sun May 16, 2010 4:17 pm

I searched a bunch of my records and can't find the serum IgD levels. All I know is that no monoclonal proteins were detected by immunofixation in my urine or serum.

Here are the exact quotes from the cytogenetic reports:

"Bone marrow shows almost total replacement by abnormal plasma cells. Nodules of plasma cells are seen. Many plasma cells demonstrate atypical features including large size, a high nuclear to cytoplasmic ratio, centrally located nuclei and visible nucleoli. Flow cytometric anyalysis of bone marrow demonstrates abnormal plasma cells expressing CD38, CD138 and CD56, and negative for cytoplasmic light chain. Rare cases of plasma cell myeloma can be negative for light chain. Serum protein electrophoresis is negative. Additional tests show that neoplastic plasma cells contain IgD heavy chain. The findings are consistent with a non-secretory IgD plasma cell myeloma."

There was a second pathological report done with the same slides a week later.

"Bone Marrow Biopsy and Aspirate Smear:
-- Hypercellular marrow most consistent with IgD Plasma cell myeloma involving over 90% of the marrow.
-- BARTL Grade 2
-- Plasma cells are positive for CD138, CD38, CD56, and IgD
-- No light chains were detected, see comment:

Comment: This is a patient with mophlogic and immunophenotypic evidence of multiple myeloma, however, an interesting point is that no cytoplasmic light chains were not (sic) detected by flow ctometry and immunohistochemistry. These cells reveal IgD heavy chain restridction.

Karyotypic analysis revealed no evidence of abnormal acquired changes.

FISH study revealed del Chr. 13 and extra signal IgH (14q32)

The patient clinically presents with multiple bonyh lesions. Overall morphology immunophenotypic and cyto genetic findings are consistent with IgD myeloma, non-secretory type (absence of light chain in the flow cytometry or immunohistochemistry."


Please not in absence of light chain secretion a possibility of a rare delta heavy Chain Disease cannot be completely ruled out. Clinicval correlation, repeat serum studies for IFE, SPE, Quantification of IgD and light chains suggested."

Matt
Name: Matt Linden
Who do you know with myeloma?: Myself
When were you/they diagnosed?: April 2009
Age at diagnosis: 44

Re: IgD Non-Secreting Multiple Myeloma

by Dr. Craig Hofmeister on Mon May 17, 2010 5:41 pm

Okay, now this was helpful. So if your serum immunofixation, 24hr urine immunofixation, and results of your serum free light chains are all negative, then yes, you do have non-secretory myeloma. That in itself is generally not a good thing, but more important is that your karyotype was normal and the FISH came back without definite high risk features (deletion of the p53 gene or the translocation between chromosomes 14 and 16). Overall it would be difficult for folks to say that you belonged to a high risk category but having non-secretory myeloma unfortunately requires that your disease be followed primarily by bone marrow biopsy and that's obviously quite painful.
Dr. Craig Hofmeister
Multiple Myeloma Clinic, The Ohio State University

Dr. Craig Hofmeister
Name: Craig C. Hofmeister, M.D.


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