Biclonal gammopathy – A single-center experience

BACKGROUND: Biclonal gammopathies are characterized by the production of two distinct monoclonal proteins. It is defined as the presence of two distinct M bands in serum protein electrophoresis. Biclonal myeloma accounted for approximately 1% of newly diagnosed cases of multiple myeloma. OBJECTIVE: The aims was to study the clinical characteristics and treatment outcomes of 13 patients with biclonal gammopathy treated at a tertiary cancer center. MATERIALS AND METHODS: The details of clinical presentation, diagnosis, treatment, and survival were noted from medical records. RESULTS: The median age was 65 years, there were 10 males and 3 females. Eleven patients had multiple myeloma, one had plasmacytoma, and one had monoclonal gammopathy of undetermined significance (MGUS). Twelve patients had biclonal gammopathy at diagnosis and one developed biclonal gammopathy at relapse. Immunofixation showed IgG/IgA in seven cases, IgA/IgG in four, and IgG/IgG in two patients. The patient with MGUS is on follow at 44 months and one with plasmacytoma received radical radiotherapy and alive at 45 months. Ten patients with myeloma received systemic treatment, eight are alive with survival ranging from 44 to 110 months, and four patients are alive more than 5 years. CONCLUSION: Biclonal gammopathies are rare characterized by the presence of two distinct monoclonal proteins. The most frequent combination was IgG/IgA. Treatment of biclonal gammopathy is similar to monoclonal gammopathy with comparable outcomes. During follow-up, both paraproteins have to be addressed.