Scientific Letters
Vol. 18 No. 1 (2026): Mediterranean Journal of Hematology and Infectious Diseases

Multiple myeloma diagnosed by CT-guided rib biopsy after a hemodilute bone marrow aspirate, in a patient with a biclonal pattern on serum protein electrophoresis

Multiple Myeloma diagnosed with CT-guided rib biopsy

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Published: June 30, 2026
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Authors

A 54-year-old man of Albanian ethnicity presented with widespread osteolytic disease and a biclonal pattern on serum protein electrophoresis (SPEP), with markedly elevated IgG (3251 mg/dL), severe immunoparesis, and a markedly abnormal kappa/lambda free light chain ratio. 

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Citations

[1] Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014;15:e538–e548.
[2] Greipp PR, San Miguel J, Durie BG, Crowley JJ, Barlogie B, Bladé J, et al. International staging system for multiple myeloma. J Clin Oncol. 2005;23:3412–3420.
[3] Houbaida Y, Del Giudice ML, Galimberti S, Buda G. How first-line therapy is changing in transplant-eligible multiple myeloma patients. Mediterr J Hematol Infect Dis. 2025;17:e2025026. doi:10.4084/MJHID.2025.026.
[4] Voorhees PM, Kaufman JL, Laubach J, Sborov DW, Reeves B, Rodriguez C, et al. Daratumumab, lenalidomide, bortezomib, and dexamethasone for transplant-eligible newly diagnosed multiple myeloma: the GRIFFIN trial. Blood. 2020;136:936–945.
[5] Kyle RA, Robinson RA, Katzmann JA. The clinical aspects of biclonal gammopathies: review of 57 cases. Am J Med. 1981;71:999–1008.
[6] Mullikin TC, Rajkumar SV, Dispenzieri A, Buadi FK, Lacy MQ, Lin Y, et al. Clinical characteristics and outcomes in biclonal gammopathies. Am J Hematol. 2016;91:473–475.
[7] Palumbo A, Avet-Loiseau H, Oliva S, Lokhorst HM, Goldschmidt H, Rosinol L, et al. Revised International Staging System for multiple myeloma: a report from International Myeloma Working Group. J Clin Oncol. 2015;33:2863–2869.
[8] Martino EA, Mele G, Morabito F, Gentile M, Vigna E. Refining high-risk multiple myeloma: advancements in genomic, clinical, and prognostic criteria. Mediterr J Hematol Infect Dis. 2025;17:e2025006. doi:10.4084/MJHID.2025.006.
[9] Morè S, Corvatta L, Manieri VM, Morsia E, Poloni A, Offidani M. Novelties on multiple myeloma from the main 2024 hematology conferences. Mediterr J Hematol Infect Dis. 2025;17:e2025027. doi:10.4084/MJHID.2025.027.
[10] Dimopoulos MA, Moreau P, Terpos E, Mateos MV, Zweegman S, Cook G, et al. Multiple myeloma: EHA-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2021;32:309–322.

Ethics Approval

Multiple myeloma, Biclonal Myeloma
Arjeta Cyrbja, Spitali Rajonal Durres, Albania

Hematology Department, 

Clinical hematologist

 
Shaqir Qerama, Our Lady of Good Council Hospital, Tirana, Albania

Hematology department

Clinical hematologist

How to Cite



“Multiple myeloma diagnosed by CT-guided rib biopsy after a hemodilute bone marrow aspirate, in a patient with a biclonal pattern on serum protein electrophoresis: Multiple Myeloma diagnosed with CT-guided rib biopsy” (2026) Mediterranean Journal of Hematology and Infectious Diseases, 18(1), p. e2026061. doi:10.4084/MJHID.2026.061.