A case of IgA-lambda multiple myeloma with hyperviscosity syndrome treated with chemotherapy in combination with plasma exchange therapy

Abstract

A 71-year-old female presented to our hospital with anemia and rouleaux formation of red blood cells on a blood test with fundus hemorrhage. Serum immunoelectrophoresis revealed IgA-λ type monoclonal proteinemia. We identified immature plasma cells and some with two nuclei without proliferation on bone marrow biopsy. She had a history of Sjögren syndrome persisting for about 15 years to date, and her IgG levels were very high. Her blood was markedly viscous, and we diagnosed her with IgA-λ type multiple myeloma and hyperviscosity syndrome. She underwent plasma exchange for the hyperviscosity syndrome, and we confirmed the decrease of immunoglobulin levels before chemotherapy. About two weeks later, we performed double filtration plasmapheresis for the rebound of immunoglobulin. IgA-λ type multiple myeloma with hyperviscosity syndrome is rare, and we successfully administered chemotherapy by conducting plasma exchange and DFPP in advance, avoiding the exacerbation of hyperviscosity syndrome.