Lymphoma / Multiple Myeloma / or SLE?

Hi. As far as your present laboratory results are concerned especially with regards to the protein levels, non of these would fulfill the criteria for a multiple myeloma. Rituximab aims to deplete CD20 positive B cells that aims to decrease immunoglobulin production, and therefore improve the disease course of SLE. Repeating this treatment should require that your doctors establish first that the SLE is in activity which would include low platelets, hemolytic anemia, neurophsychiatric symptoms, renal damage (which can be reflected as low C3 levels). In your situation your C3 level is good, and you can ask the rheumatologist what will be his or her indication for treatment. With the presence of enlarged lymph nodes, lymphoma can indeed be considered but there are other disease entities that can explain this. Enlarged lymph nodes can be reactive nodes from acquired infections. SLE patients, especially those who are receiving immunosuppressive treatment may be really prone to acquire infections (viral or bacterial), and this angle should also be sought. I would agree in the plan to biopsy the node since this would really give us a lot of information. In summary, the lab picture may be unlikely to be myeloma, it is also suggested that you ask your rheumatologist regarding the exact indication for rituximab, and that the biopsy be pursued to rule out lymphoma. Regards and God bless.