A 72-year-old woman with multiple myeloma on lenalidomide maintenance develops a new IgG M-protein of 0.4 g/dL, different isotype from her original IgA myeloma. Bone marrow biopsy confirms a second plasma cell clone. This scenario best represents:
- A Lenalidomide-associated secondary primary malignancy
- B Oligoclonal bands of immune reconstitution — a benign finding ✓
- C Progression of the original clone with isotype switching
- D Myeloma relapse requiring daratumumab-based salvage
Explanation
Oligoclonal bands during and after treatment for multiple myeloma represent recovery of polyclonal immunoglobulin production and immune reconstitution. These are monoclonal-appearing bands of different isotype/paraprotein from the original clone, often seen during or after autologous SCT or immunomodulatory therapy. They are transient, benign, and should not be mistaken for disease progression. They occur in up to 30–40% of patients on lenalidomide maintenance post-ASCT. Distinguishing oligoclonal reconstitution from true progression requires monitoring of the original M-protein and clinical context.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.