CASE REPORT article
Front. Oncol.
Sec. Hematologic Malignancies
This article is part of the Research TopicMultiple Myeloma Treatment: On the Brink of Prime TimeView all 3 articles
Daratumumab Monotherapy in a Patient with Kappa Light Chain Multiple Myeloma and Decompensated Cirrhosis: A Case Report on Diagnostic and Therapeutic Challenges
Provisionally accepted
- 1Department of Gastroenterology, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- 2Affiliated Hospital of Zunyi Medical University Department of Gastroenterology, Zunyi, China
- 3Affiliated Hospital of Zunyi Medical University, Zunyi, China
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Background: Multiple myeloma (MM) rarely presents as decompensated liver cirrhosis, posing a significant diagnostic challenge that can lead to misdiagnosis and delayed treatment. We report a case of kappa-light chain multiple myeloma (κ-LCMM) initially managed as end-stage liver disease to highlight the diagnostic pathway and a successful, organ-reversing therapeutic outcome. Case presentation: We report the case of a 67-year-old male who presented with decompensated liver cirrhosis and refractory ascites as the initial manifestation of multiple myeloma. Serum free light chain assay revealed a kappa level of 47,309.88 mg/L, and bone marrow biopsy confirmed kappa-light chain multiple myeloma with 60% plasma cell infiltration. A profound clinical response, including reversal of hepato-renal dysfunction, was observed following targeted monotherapy with daratumumab. Conclusions: This case underscores the critical importance of including plasma cell dyscrasias in the differential diagnosis of unexplained cirrhosis, particularly when accompanied by decreased immunoglobulin levels. The serum free light chain assay is an essential tool for facilitating a timely diagnosis. Furthermore, our findings suggest that daratumumab monotherapy can be a safe and highly effective therapeutic strategy for achieving deep, durable responses and reversing severe organ damage in patients with multiple myeloma.
Keywords: Multiple Myeloma, Liver Cirrhosis, light chain deposition, serum Free Light Chain, Daratumumab, case report
Received: 01 Sep 2025; Accepted: 27 Nov 2025.
Copyright: © 2025 Yang, liu, zhou, Zhang, yang and wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: hong wang
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