IgM multiple myeloma: diagnostic difficulties and results of bortezomib treatment – case report

The IgM paraprotein secretion is most frequently associated with Waldenström’s macroglobulinemia. In very rare cases it may also occur in multiple myeloma. The diagnostic and therapeutic process of a 84 year old male suffering from IgM multiple myeloma is described, including difficulties in establishing this diagnosis. Due to infectious complications, after the first cycle of melphalan– prednisone–bortezomib treatment, melphalan was stopped, subsequently, bortezomib and prednisone doses were also reduced. Two treatment interruptions have occurred. Despite reduced treatment intensity, the patient was in very good partial remission, while the toxicity profile was acceptable. IgM multiple myeloma should be included in the differential diagnosis of IgM paraproteinemia, also when osteolytic lesions and translocation 11:14 are not detected. Bortezomib-based therapy can be effective in elderly patients (also in those suffering from cardiac insufficiency), even when dose reduction is required.