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Multiple myeloma with monoclonal immunoglobulin g and immunoglobulin d of lambda type exhibiting under treatment a shift from mainly immunoglobulin g to mainly immunoglobulin d



Multiple myeloma with monoclonal immunoglobulin g and immunoglobulin d of lambda type exhibiting under treatment a shift from mainly immunoglobulin g to mainly immunoglobulin d



Immunology 55(1): 45-58



A patient with multiple myeloma who initially presented with a predominant igG.lambda. and a minor IgD.lambda. paraprotein pattern, is described. After chemotherapy, levels of the IgD.lambda. protein increased and the IgG.lambda. levels decreased. The following results were obtained when serum IgD was predominant. In the bone marrow, there were 3 plasma cell populations: a major one containing only .delta. chains, a minor one containing only .gamma. chains, and another minor one containing both .delta. and .gamma. chains. All these plasma cell populations contained .lambda. chains. Stimulation of circulating mononuclear cells with pokeweed mitogen (PWM) achieved differentiation of circulating B lymphocytes into plasma cells; 30% with only cytoplasmic .delta.lambda. chains and 10% with only cytoplasmic .gamma.lambda. chains. These IgG-containing plasma cells showed cytoplasmic reactivity with rabbit antiserum raised aganist monoclonal IgD which was shown to contain specificities recognizing both .delta. chains and idiotypic determinants present in both serum IgD.lambda. and IgG.lambda. Circulating B lymphocytes were monoclonal; almost all expressed surface .delta.lambda. chains, and a small proportion of them expressed both .delta.gamma. and .lambda. chains. High levels of IgD were detected in the supernatants of all cultures, but high concentrations of IgG were only detected in those from PWM-stimulated cultures with very low levels of IgM and IgA. These findings suggest that plasma cells producing either IgD or IgG were derived from a common B cell clone. Double paraproteinemia exhibiting a shift in Ig production from IgG to IgD has not been previously described.

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