Monoclonal gammopathy

Monoclonal gammopathy is defined by the presence of a monoclonal immunoglobulin in plasma, urine, or both that is produced most often by clonal plasma cells and less commonly by B lymphocytes.

Clonal proliferation of B lymphocytes seen in B cell type llymphomas, B cell type leukemias, and clonal plasma cell proliferation seen in multiple myeloma and monoclonal gammopathy of undetermined significance.

Classification of monoclonal gammopathy is based on the presence of a colonial mass and end organ damage.

When a minimal tumor  burden is met, treatment is indicated when organ function becomes affected.

Proliferating monoclonal cells secrete immunoglobulin which can be detected in the blood or urine as a monoclonal immunoglobulin, M protein.

Frequently associated with secretion of light chain component of the immunoglobulin molecule kappa or lambda light chains, in addition to intact immunoglobulin, suggesting dysregulation of the normal antibody synthetic pathway.

Neoplastic cells may lose the ability to synthesize normal heavy chain component of the immunoglobulin molecule and secrete only Kappa or lambda light chains.

Clinical spectrum of monoclonal gammopathy includes malignant processes such as multiple myeloma, Waldenström’s macroglobulinemia, non-malignant paraprotein related disorders, including light chain amyloidosis, and premalignant plasma cell dyscrasias monoclonal gammopathy of undetermined significance.