2026-10-14T11:20:56Z https://api.figshare.com/v2/oai

oai:figshare.com:article/33942019 2026-09-19T09:45:41Z category_7 portal_147 item_type_3 month_year_09_2026

Supplemental material for: Progression of IgA-κ Monoclonal Gammopathy to Symptomatic Multiple Myeloma During Nivolumab Therapy for Melanoma: A Case Report figshare admin karger (2628495) Sarah Hajj Chehade (25075593) Ayman Moubayed (25075594) Ahmad Saad (4815198) Dany Nassar (322786) Fadi El Karak (25075596) Medicine Medicine <p dir="ltr">Introduction: Immune checkpoint inhibitors can alter systemic immune regulation, but their relationship to the evolution of pre-existing plasma-cell clones remains uncertain. We report progression of a longstanding IgA-κ monoclonal gammopathy to symptomatic multiple myeloma during adjuvant nivolumab therapy for melanoma.</p><p dir="ltr">Case presentation: A 70-year-old man had a beta-region electrophoretic peak documented in 2017 and an IgA-κ monoclonal component identified in 2020. He remained clinically stable in 2021, although plasma-cell-specific surveillance was incomplete thereafter. In 2023, he underwent excision of a right plantar ulcerated superficial-spreading melanoma (Breslow thickness 14 mm) with satellite disease and one positive sentinel lymph node, classified as pT4b pN2c cM0, stage IIIC. Adjuvant nivolumab 240 mg every 2 weeks began on February 20, 2024; three doses were administered. During treatment, he developed progressive back pain, fatigue, impaired mobility, and confusion. On April 30, 2024, hemoglobin was 7.7 g/dL, creatinine 2.65 mg/dL, calcium 15.2 mg/dL, and IgA 1,970 mg/dL. Imaging demonstrated vertebral compression fractures and diffuse skeletal abnormalities. Bone marrow core biopsy showed 40% κ-restricted CD138-positive plasma cells with aberrant CD56 expression. Nivolumab was discontinued, and bortezomib, cyclophosphamide, and dexamethasone were initiated. IgA decreased to approximately 510 mg/dL by October 2024, although persistent κ excess remained on later testing.</p><p dir="ltr">Conclusion: The chronology raises the hypothesis that PD-1 blockade may have accelerated an already evolving plasma-cell clone, but the pre-treatment anemia, incomplete surveillance, and absence of baseline marrow and free-light-chain data preclude causal attribution. Baseline characterization and continued hematologic monitoring may be appropriate when checkpoint inhibitors are given to patients with known monoclonal gammopathies.</p> 2026-09-19T09:45:41Z Dataset Dataset 10.6084/m9.figshare.33942019.v1 https://figshare.com/articles/dataset/Supplemental_material_for_Progression_of_IgA-_Monoclonal_Gammopathy_to_Symptomatic_Multiple_Myeloma_During_Nivolumab_Therapy_for_Melanoma_A_Case_Report/33942019 CC BY 4.0