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—At the time the patient was initially seen in 1978, the differential diagnosis of Dr Bouvet's patient's condition should have included solitary secretory myeloma and benign monoclonal gammopathy. In 1980, the patient had had moderate bone pains. At that time, she probably had multiple myeloma with relatively low tumor burden. In January 1981, the patient had clear-cut roentgenographic and bone marrow evidence of multiple myeloma. It would have been important to have verified the absence of myeloma proteins in her urine at that time.
The salient feature of this patient's condition was the continued presence of two M spikes belonging to the same immunoglobulin subclass throughout the clinical course and a decrease in only one of the two M spikes in face of clinical and laboratory evidence of large tumor burden of multiple myeloma in January 1981.
In this case, the decrease in one of the two M spikes was
Sahasrabudhe D, Parker JC. Decreasing M Spike With Increasing Tumor Burden in Multiple Myeloma-Reply. Arch Intern Med. 1982;142(6):1241. doi:10.1001/archinte.1982.00340190201040