DISCUSSION

Paraproteinemia, or monoclonal gammopathy, is the presence of excessive amounts of paraprotein or a single monoclonal gammaglobulin in the blood. It usually occurs as a part of an underlying immunoproliferative disorder, such as leukemia, lymphoma, or plasma cell dyscrasia. Serum paraprotein levels in lymphoma patients are usually low and commonly associated with low grade lymphomas. Detection of monoclonal paraprotein using SPEP with quantitation of Igs and IFX should be included in the staging of lymphoma patients, as the presence of monoclonal gammopathy may influence prognostic stratification of these patients. Serum-free light chain assay is also a useful technique and may represent a significant prognostic marker for the detection of bulk and residual disease, both before and after treatment [3]. Further studies should be conducted to correlate the survival of these patients with the quantity and type of paraproteins and any requirement of a specific chemotherapeutic drug combination for improving overall survival. High M protein sometimes can lead to mislabeling of a case as plasma cell dyscrasia, delaying appropriate investigation. High paraprotein levels must not dissuade one from suspecting an underlying lymphoma, especially when relevant investigation for plasma cell dyscrasia is non-contributory