Clinical Features

The data on IgD myeloma come from reports on a few cases and small series, two large reviews of the reported cases in the literature,87,88 and single-institution experience in 53 cases.89,90

The main clinical and laboratory features reported in four series of IgD myeloma including at least 20 patients are summarized in Table 84.5.87'88'89'90'91 The median age at presentation was 55-60 years, which is slightly younger than that in a general myeloma population. The initial presenting symptoms were not different from those reported in usual myeloma cases. In two series, a moderate lymph node enlargement, a rare finding in multiple myeloma, was present in about 10% of patients.88,90 Although one series had a low incidence of extramedullary plasma-cytoma,91 the reported incidence of extraosseous spread in IgD myeloma ranges from 19 to 63%.84,88,90 In one of the studies, 7 of 53 patients (13%) had extradural plasmacytomas at diagnosis.90 Amyloidosis was reported in 44% of patients at autopsy.87 In a single-institution series, however, the frequency of associated amyloidosis was 19%.90 IgD myeloma has been associated with a higher frequency of PCL.87,88,92 The incidence of renal failure is higher in IgD myeloma.87,88,90,91

The serum protein electrophoretic pattern differs in that only 60% of patients with IgD myeloma have an M-protein spike. Furthermore, the amount of the M protein rarely exceeds 2 g/dL.90 Almost all patients

Table 84.5 Immunoglobulin D myeloma: clinical and laboratory features in four series including at least 20 patientsa

Feature

Jancelewicz et al.87

Fibbe and Jansen91

Shimamoto et al.88

Bladé et al.90

No. of patients

0 0

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