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, Rarely, SPEP shows the simultaneous presence of two distinct M-bands (found in 3%–4% of multiple myeloma cases). ,, , However, it may sometimes occur in the β- or α-globulin regions instead, especially when the M-protein is of IgM or IgA isotype. The M-protein is amenable to detection by serum protein electrophoresis (SPEP) as a single discrete band (M-band), mostly in the γ-globulin region. , They are usually associated with multiple myeloma, monoclonal gammopathy of unknown significance, and Waldenstrom's macroglobulinemia though their presence in other pathologies, namely, cryoglobulinemia, primary amyloidosis, leukemias, lymphomas, etc., has also been described. Monoclonal gammopathies are hematological disorders characterized by high levels of an immunologically homogeneous immunoglobulin (known as monoclonal protein or M-protein or paraprotein), produced by a rapidly and abnormally proliferating clone of B-lymphocytes and/or plasma cells.
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Monoclonal gammopathy with double M-bands: An atypical presentation on serum protein electrophoresis simulating biclonal gammopathy.
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How to cite this URL: Bora K, Das U, Barman B, Ruram AA. Keywords: Double gammopathy, IgA, M-component, multiple myeloma, polymer How to cite this article: Bora K, Das U, Barman B, Ruram AA. Further, we discuss how true and apparent biclonality can be distinguished by inexpensive analytical techniques in resource-constrained settings. This peculiar presentation of double M-bands in monoclonal gammopathy was attributed to polymeric forms of IgA by systematic workup. Here, we describe an atypical case of IgA-λ multiple myeloma, where double M-bands (one in β- and the other in γ-globulin region) were found during SPEP simulating biclonal gammopathy, although it was monoclonal in nature. Rarely, two M-bands appear simultaneously at different positions during SPEP – a condition known as biclonal gammopathy, which is a result of clonal expansion of two different neoplastic cell lines. The M-protein can be evaluated by serum protein electrophoresis (SPEP), which yields a single discrete band (M-band), usually in the γ-globulin region. Monoclonal gammopathies, such as multiple myeloma, typically exhibit high levels of a monoclonal immunoglobulin (M-protein), produced by a clone of abnormally proliferating B-lymphocytes and/or plasma cells. Kaustubh Bora 1, Umesh Das 2, Bhupen Barman 3, Alice Abraham Ruram 4ġ ICMR-Regional Medical Research Centre, North East Region, Dibrugarh, Assam Department of Biochemistry, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India 2 Department of Medical Oncology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India 3 Department of Internal Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India 4 Department of Biochemistry, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, IndiaĬlick here for correspondence address and email Date of Web Publication Monoclonal gammopathy with double M-bands: An atypical presentation on serum protein electrophoresis simulating biclonal gammopathy