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Monoclonal elevations of IgG, IgA, IgD, and IgE characterize multiple myeloma. Low levels of IgM occur in multiple myeloma and some types of leukemia. Hemoglobin levels drop further. In multiple myeloma, the level of one type may be high while the others are low. The levels of these immunoglobulins are measured to see if any are abnormally high or low. The IgA and IgM levels remained extremely low at 7 mg/dL. High Immunoglobulin M. There are two types of IgM antibodies: natural and immune [1, 3]. Non-IgM monoclonal gammopathy of undetermined significance (MGUS) A high number of myeloma cells are present. X-rays may show several areas of bone damage. The body produces immune IgM antibodies in response to intruders (antigens). Smoldering Multiple Myeloma. Monoclonal elevations of IgG, IgA, IgD, and IgE characterize multiple myeloma. The 'low', 'normal' and 'high' ranges vary with age, and are also lab-specific. It is the best test for detecting and measuring the abnormal monoclonal protein level associated with myeloma. Polyclonal serum IgM level identifies a subgroup of multiple myeloma patients with low-risk clinicobiological features and superior survival Leuk Res . Serum protein electrophoresis (SPEP): This test measures the levels of various proteins in the blood. Multiple myeloma (MM) is a plasma cell malignancy that is recognized for immune system disturbances primarily affecting normal immune globulin (antibody) production with resultant frequent morbidity and mortality. Selective IgM deficiency (SIgMD) is a rare immune disorder in which a person has no immunoglobulin M (IgM) antibodies, or too little IgM, with normal levels of IgG and IgA antibodies. There are several different types of antibodies in the blood: IgA, IgD, IgE, IgG, and IgM. Monoclonal gammopathies of all types may lead to a spike in the gamma globulin zone seen on serum protein electrophoresis. After IgD MM was first reported by Rowe and Fahey [5] in 1965, multiple studies have reported an IgD MM prevalence of approximately 1% to 2% of myeloma patients, [2,6-9] whereas IgE is rare, with fewer than 50 cases reported in the literature. Monoclonal elevations of IgM occur in macroglobulinemia. but after 2 months it plummeted to 204 mg/dL (Figure 1). However, a reasonable normal range is 45-250mg/dl. Electrophoresis. [10] Another study found an IgD MM incidence of 6% in myeloma patients younger than 40 years. 2014 Jun;38(6):666-72. doi: 10.1016/j.leukres.2014.02.009. In a study with 493 British patients diagnosed with multiple myeloma, the SFLC was evaluated for 17 of these patients and concluded that the SFLC number was more indicative of response to therapy than was the involved immunoglobulin number (such as levels of IgG, IgA, etc). Decreased immunoglobulin levels are found in patients with congenital deficiencies. Monoclonal elevations of IgM occur in macroglobulinemia. Both criteria must be met: Serum monoclonal protein (IgG or IgA) 30g/L or urinary monoclonal protein 500mg per 24h and/or clonal bone marrow plasma cells 10-60%. Most laboratory tests for Multiple Myeloma provide indirect information about the amount of tumor present, by measuring proteins that are secreted by the tumor into the blood and/or the urine. IgM levels eventually decline as the body starts producing more IgG antibodies . [11] Therefore, when a person does not have enough IgM, the body may have difficulty fighting infections. That is why IgM levels tend to increase during the initial phase of infections. Elevations of IgG, IgA, and IgM may be due to polyclonal immunoglobulin production. IgM is the first antibody the immune system makes to fight a new infection. Monoclonal immunoglobulin and blood calcium levels may increase. Monoclonal gammopathies of all types may lead to a spike in the gamma globulin zone seen on serum protein electrophoresis. Stage 2: A moderate number of myeloma cells are present. Diagnosis and Tests. Stage 3: This is the final stage of multiple myeloma. Absence of myeloma-defining events or amyloidosis. For example, if a patient has IgG myeloma, the IgG level will be high, and the IgA and IgM levels will be low.

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