Biclonal gammopathies: rare presentations

Backgrounds: Biclonal gammopathies are defined as a clonal proliferation of plasma cells or B-lymphoid progenitors that produces two distinct M bands due to either proliferation of two separate clones of plasma cell, each producing an unrelated monoclonal Ig or it may result from a single clone of plasma cell producing two monoclonal proteins. Biclonal myeloma accounts for approximately 1% of newly diagnosed case of multiple myeloma. These neoplastic clones which secrete one type of M protein might undergo isotype switching resulting in secretion of another subtype of M protein by the same clones producing biclonal spikes. Clinical presentation and treatment are usually similar to that of monoclonal gammopathy with comparable survival outcome. Aim: To study rare cases of multiple myeloma with biclonal gammopathies where clinical data is still lacking in the literature. Methods:This is a retrospective study including 4 case of biclonal gammopathies Complete blood count along with routine Biochemical investigations were performed. Agarose gel protein electrophoresis was done on Helena Bioscience, Europe using SAS-MX SP-10 SB kit & serum Immunofixation Electrophoresis by SAS-MX IFE 10 SB kit. The results were analysed using Helena software platinum 6.0.100. B-2 Microglobulin, free light chain ratio and immunoglobulin profiles along with Bone marrow aspiration, Bone marrow Biopsy and Flow cytometery were done in all cases. Results: Ist case showed two M spike in gamma globulin region on SPE, Second case showed M-spike in Beta and gamma globulin region on SPE and IgA kappa and IgG kappa on IFE. Third case had two M-bands in gamma heavy chain with corresponding bands in kappa light chain region on IFE. Fourth case was with two separate peaks in gamma globulin region on SPE and 2 distinct bands as IgG kappa and IgG lambda on IFE. Conclusions: Biclonalitydetermined by presence of para-proteins is considered to represent clonal evolution and may therefore, be a determinant of disease prognosis. The etiology of bi-clonal gammopathy is not yet elucidated; therefore it is necessary to follow the evolution of the clones by more advanced research focused on the genetic study of these clones to better understand the physiopathology and clinical behavior of biclonal Gammopathies.