[AustinLisa]

CVID and having a monoclonal protein - a connection?

by AustinLisa on Thu Aug 23, 2012 10:51 pm

I need help with figuring out this mess. So, I have a monoclonal protein - IgG lambda, but no measurable spike. I also have low IgG, IgA, and IgM. I also have low kappa and lambda free light chains, and I have an abnormally low kappa/lambda ratio.

Due to my low IgG, IgA, and IgM (hypogammaglobulinemia), and being sick a lot, and having lupus, I was sent to an immunologist. He did vaccine response tests – gave me pre test, gave me pneumonia vaccine, and drew response 4 weeks later. I had no response.

His office called today and said I have common variable immunodeficiency (CVID) and need to start IVIG infusions. He said that the monoclonal protein problems are definitely not his area and he'll leave that to my oncologist, but the other problem is his area, and I need IVIG.

So, how is this all connected? Could CVID be causing the monoclonal protein and abnormal (low) kappa-lambda ratio? Could the monoclonal protein problem be causing the CVID? Do I still need to be going to MD Anderson for testing and diagnosis? Are they not connected at all?

[Dr. Peter Voorhees]

Re: CVID and having a monoclonal protein - a connection?

by Dr. Peter Voorhees on Fri Aug 24, 2012 6:34 am

Lupus and common variable immunodeficiency (CVID) do go hand in hand. CVID is associated with hypo­gamma­globulinemia. If you are having recurrent infections, IVIG is the right thing to do. You have a low level M-spike, IgG lambda, and the lambda light chains made by these plasma cells has made your ratio low.

Patients with rheumatologic conditions (like lupus) have higher rates of MGUS. Based on what information you have provided, MGUS seems like the most likely diagnosis. However, con­sulta­tion with someone with expertise in MGUS and multiple myeloma is worthwhile, especially given the other medical issues that will make interpretation of these diagnostic tests more challenging. The M protein is likely not causing the CVID.

Good luck!

Pete V.