Multiple myeloma associated with systemic lupus erythematosus

A case of systemic lupus erythematosus (SLE) complicated by multiple myeloma is presented. The lupus diagnosis was established together with the diagnosis of myeloma but the symptoms had commenced a few years before. The putative mechanisms underlying this unusual combination are discussed.     

Bortezomib‐Induced Lupus Erythematosus Tumidus

This paper reports on an exceptional case of lupus erythematosus tumidus induced by bortezomib during the treatment of multiple myeloma.     

Hemostatic Abnormalities in Multiple Myeloma Patients

Background: Multiple myeloma (MM) is a neoplastic plasma cell disorder characterized by clonal proliferation of plasma cells in the bone marrow. Diverse hemostatic abnormalities have been reported in patients with myeloma which predispose to bleeding and also thrombosis. Methods: Complete blood count, biochemical parameters and parameters of hemostasis i.e. platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), factor VIII assay results, plasma fibrinogen, D-dimer and lupus anticoagulant, were assessed in 29 MM patients and 30 age matched controls. Results: The most frequent abnormal screening parameter was APTT. Of the six indicative of a bleeding tendency i.e. thrombocytopenia, prolonged PT, APTT, TT, reduced plasma fibrinogen and factor VIII, at least one was abnormal in 8 (27.6%) patients. Of the four prothrombotic markers, lupus anticoagulant, D-dimer, elevated factor VIII and plasma fibrinogen, one or more marker was present in 24 (82.7%). D-dimer was the most common prothrombotic marker, being elevated in 22 (75.9%) patients. One or more laboratory parameter of hemostasis was abnormal in all 29 (100%) patients. Though thrombotic complications are reported to be less frequent as compared to hemorrhagic manifestations, one or more marker of thrombosis was present in 24 (82.7%) patients. Conclusion: This study provided laboratory evidence of hemostatic dysfunction which may be associated with thrombotic or bleeding complications at diagnosis in all MM patients. Hence, screening for these abnormalities at the time of diagnosis should help improved prognosis in such cases.     

The prolonged activated partial thromboplastin time at diagnosis indicates less favorable prognosis in IgA myeloma

BACKGROUND: The impact of coagulopathy on survival of patients with myeloma has not been studied in detail. We aimed to assess the correlation between activated partial thromboplastin time/prothrombin time at diagnosis and overall survival in myeloma patients. METHODS: Data including activated partial thromboplastin time and prothrombin time obtained before treatment and at the time of diagnosis of multiple myeloma (excluding monoclonal gammopathy of undetermined significance, POEMS syndrome, IgM myeloma and myeloma with amyloidosis) collected from 222 patients were analyzed. RESULTS: Twenty-one patients (9.5%) had prolonged activated partial thromboplastin time (nine with prolonged a activated partial thromboplastin time alone, 12 with both prolonged activated partial thromboplastin time and prothrombin time) and 10 (4.5%) had prolonged prothrombin time alone. Coagulopathy occurred only in patients with IgA and IgG myeloma but not light-chain disease. Prolonged activated partial thromboplastin time was an independent prognostic factor in IgA and IgG myeloma (median survival = 12.7 months, P = 0.004), while prolonged prothrombin time alone had no impact on survival. Subgroup analysis revealed that prolonged activated partial thromboplastin time indicated less favorable survival in IgA myeloma (P = 0.001), but not the IgG myeloma (P = 0.341). This observation still holds true in IgA myeloma with Durie-Salmon stage II or III (P = 0.002). CONCLUSIONS: The presence of prolonged activated partial thromboplastin time at diagnosis is a prognostic factor indicating poor outcome in the IgA myeloma.     

Multiple Myeloma and Atopic Eczema in an Adult

Multiple myeloma is the fourteenth cause of cancer-related death. The symptoms of myeloma are mostly nonspecific, and there is significant delay between the first symptoms and diagnosis of myeloma. Atopic eczema is a common chronic inflammatory skin disease associated with dysregulation of the immune system. It generally develops in early childhood but can also occur in adults. Eczema is associated with a variety of hematological and solid malignancies, and possibly multiple myeloma. We report a patient with eczema that developed 5 years before the diagnosis of multiple myeloma but was mistaken for psoriasis.Key Words: Multiple myeloma, Atopic eczema, Early symptoms, Diagnostic criteria     

Multiple myeloma associated with immune thrombocytopenic purpura

Thrombocytopenia in patients with multiple myeloma is usually due to chemotherapy or marrow replacement with myeloma cells. Two patients with multiple myeloma who fulfilled criteria for the diagnosis of immune thrombocytopenic purpura are presented. The etiologic and therapeutic implications of this unusual association are discussed.     

Case study of intracerebral plasmacytoma as an initial presentation of multiple myeloma

Cerebral involvement is an uncommon complication of multiple myeloma. We report on a 64-year-old man hospitalized for a partial seizure. MRI showed two intracerebral lesions, which proved to be plasmacytomas. After complete staging, we retained the diagnosis of immunoglobulin G lambda-type multiple myeloma with CNS involvement. Cytogenetic analysis of plasma cells detected a deletion in the p53 gene at 17p13.1. Despite cranial radiotherapy and systemic chemotherapy, the patient's disease progressed rapidly and he died five months after diagnosis. What makes this case unusual is that overt multiple myeloma had been absent before cerebral involvement was discovered. It confirms the extremely poor prognosis of patients with CNS myeloma even in the presence of aggressive treatment. Cytogenetic abnormalities could be a marker of chromosomal and genetic instability, conferring to multiple myeloma a more aggressive profile.     

Prognostic significance of plasma cell morphology in multiple myeloma

The effect of bone marrow plasma cell morphology at diagnosis on survival time was evaluated in 139 patients with multiple myeloma. According to the morphological classification scheme the patients were categorized as mature (30 patients), immature (76 patients) or plasmablastic (33 patients). The plasmablastic group had an estimated median survival (Kaplan-Meier method) of 10.9 months, compared with 32.2 months for immature and 60 months for mature types (P = 0.0000). The prognostic value of a morphologic classification in multiple myeloma was further demonstrated by means of a multivariate linear regression analysis of survival data. Expected survival was calculated using clinical features and morphologic subtypes. The estimated survival time for plasmablastic myeloma was shorter by 51.4 months and for immature myeloma patients by 35 months, compared with mature myeloma patients with similar clinical characteristics. Plasma cell morphology at diagnosis is an important predictor of survival duration in patients with multiple myeloma.     

Breast cancer and synchronous multiple myeloma as a diagnostic challenge: Case report and review of literature

Multiple myeloma is a hematological malignancy, which sometimes creates difficulties in diagnosis, based on the presence of monoclonal protein in serum/urine and plasmocyte infiltration in the bone marrow, and on the other hand, synchronous cancers are also a diagnostic challenge. We present a case report of a patient with concurrent breast cancer and multiple myeloma.A 68-year-old woman was admitted to the hospital with diagnosis of left breast cancer in first stage of the disease. In the past, she had had several episodes of thrombocytopenia, leucocytosis, and mild anaemia, which were followed by hematologist in outpatient setting. She was operated and started adjuvant chemotherapy. During treatment, episodes of hematological abnormalities were observed. After completion of the chemotherapy for breast cancer, the patient was observed and short time after that multiple myeloma was diagnosed as a synchronous cancer. Patient was first treated for breast cancer, then subsequently for multiple myeloma (2 lines therapy: CTD and VMP). We describe diagnostic problems with multiple myeloma; however, they could be caused by curation of breast cancer, which might have supressed the proliferation of plasmocytes and could delay the diagnosis. All symptoms of multiple myeloma were interpreted as a secondary effect of chemotherapy. Review of the literature shows the clinical approaches in such situations.     

IgM multiple myeloma: report of four cases and review of the literature

The differential diagnosis between multiple myeloma (MM) and Waldenstr?m's macroglobulinemia (WM) is generally well defined. Consistent with a diagnosis of MM is the presence of a non-IgM monoclonal gammopathy associated to multiple osteolytic lesions and plasma cell infiltration of the bone marrow. Characteristic of WM is the presence of an IgM monoclonal gammopathy associated to lymphoadenopathy, hepatosplenomegaly, anemia and hyperviscosity syndrome in the presence of a monoclonal lymphoplasmacytoid proliferation in the bone marrow. Nonetheless, few cases of IgM myeloma have been reported that display clinico-pathologic features intermediate between MM and WM. Here, this study describes four of 317 (1.2%) patients with an IgM monoclonal gammopathy in whom the morphologic and clinical features were consistent with a diagnosis of IgM myeloma.     

Multiple myeloma masquerading as metastatic breast cancer

Two women are described in whom, on the basis of prior therapy for breast cancer and the presence of painful, lytic bone lesions, an initial diagnosis of metastatic breast cancer was made. Further evaluation established the diagnosis of multiple myeloma in both patients. Neither had evidence of recurrent breast cancer. These cases indicate that women with a history of breast cancer in whom lytic bone lesions develop without evidence of extraskeletal metastases should have the diagnosis of multiple myeloma excluded.     

多学科协作诊疗多颅神经受累的浆母细胞型骨髓瘤1 例

浆母细胞型骨髓瘤是骨髓瘤中较少见的病理类型,需要与其他镜下表现类似的疾病相鉴别。中枢神经系统受累是骨髓瘤较为罕见的并发症,由于受累部位的特殊性,其治疗选择尤为重要。本研究介绍1 例多颅神经受累的浆母细胞型骨髓瘤病例,其诊断较为困难,通过多学科协作的方式最终明确诊断,为后续选择合适的治疗方案奠定了基础。     

Imaging of myeloma bone disease--implications for staging, prognosis and follow-up

Among all imaging modalities, magnetic resonance imaging provides the most useful information about the accurate staging of solitary bone plasmacytoma, the prediction of progression of asymptomatic multiple myeloma and the prognosis of symptomatic multiple myeloma. Furthermore, magnetic resonance imaging contributes to the differential diagnosis of compression fractures in patients with myeloma and can be used for assessment of response to treatment.     

A review of 74 patients with newly diagnosed multiple myeloma at a tertiary referral hospital in Nairobi,Kenya

Introduction

Multiple myeloma is a neoplastic disorder characterized by clonal proliferation of plasma cells. We aimed to carry out a retrospective audit to describe clinical and laboratory features of patients newly diagnosed with multiple myeloma.

Materials and Methods

Records of all patients initially diagnosed with multiple myeloma at the haematology clinic of Aga Khan University Hospital, Nairobi, from January 1, 1999 to December 31, 2011 were reviewed. Diagnosis of multiple myeloma was based on (1) increased numbers of abnormal, atypical or immature plasma cells in a bone marrow aspirate or trephine, (2) presence of monoclonal protein or free light chains in serum or urine and (3) bone lesions consistent with multiple myeloma.

Results

Seventy-four patients were diagnosed with multiple myeloma. The median age at diagnosis was 59 years. Males comprised 53%. The most common presenting complaints were bone pain in 56 (76%), recurrent infections in 11 (16%) and fatigue in 24 (33%) patients. Anaemia (Hb < 10 g/dl) was present at diagnosis in 47% of patients while 25 (34%) presented with hypercalcaemia (serum calcium > 2.6 mmol/l) and 38 patients (52%) had renal failure at diagnosis (serum creatinine > 110μmol/l). A monoclonal band was demonstrated in 56 patients (76%). Nine patients (12%) had light chain myeloma while only 4 patients had nonsecretory myeloma. One patient was found to have biclonal myeloma.

Conclusion

The median age of patients at diagnosis is lower than that reported in other populations [59 years versus 66–68 years] and may indicate a younger age of incidence of the pre-malignant monoclonal gammopathy of undetermined significance (MGUS) in African patients.     

Orbital multiple myeloma: Case report and review of computed tomography features

Orbital involvement at diagnosis in multiple myeloma is rare. Only a few a cases are reported with computed tomographic features. We report a case of orbital myeloma, and relevant medical reviews on computed tomography features are discussed.     

Cardiac tamponade in multiple myeloma – A pictorial case review of FDG PET/CT findings

Pericardial involvement of multiple myeloma is a rare and late‐stage complication, with only a few cases reported in the literature. PET/CT has demonstrated a growing role in the diagnosis and follow‐up of patients with multiple myeloma. We present a case of pericardial multiple myeloma in a patient with relapsed/refractory disease, showcasing previously unpublished FDG PET/CT findings.     

Anaplastic Myeloma

Anaplastic myeloma (AM) represents a rare variety of multiple myeloma (MM) with poor prognosis. One case with special interest is reported, which presented with manifestations due to the ex-tramedullary localization and arose in the absence of an initial diagnosis of MM. In addition, differential diagnosis was based on morphological and immunocytochemical findings while treatment with radio-chemotherapy had no effect on the extramedullary sites.     

Dural plasmacytoma as the initial presentation of multiple myeloma: A case report and review of the literature

Dural plasmacytoma is a type of multiple myeloma of the central nervous system. Our patient presented with symptoms of headache. Imaging findings suspected glioblastoma, whereas pathological findings revealed mucosa-associated lymphoid tissue lymphoma associating with plasma cell differentiation. Further in-depth studies confirmed a diagnosis of dural plasmacytoma. This case indicates that morphological variations may occur in the extramedullary involvement of CD20-positive multiple myeloma. The multidisciplinary team contributes to the diagnosis of hematological diseases.     

Histiocytic lymphoma of the ileocecal region after chemotherapy for multiple myeloma.

Histiocytic lymphoma of the ileocecal region developed in a patient with multiple myeloma following successful long-term alkylating agent therapy. Five and one-half years after the diagnosis of myeloma, while in remission on cyclophosphamide therapy, the patient experienced severe abdominal right lower quadrant pain due to a large cecal lymphoma. A right hemicolectomy was performed with relief of symptoms. However, 9 months later, while still asymptomatic, routine physical examination revealed a recurrent right lower quadrant tumor. Radiation therapy decreased the size of the mass, but five months later partial small bowel obstruction occurred because of recurrent lymphomatous infiltration. The patient died 7 years after the diagnosis of myeloma with extensive abdominal lymphoma. There was no evidence of recurrent myeloma after the initial remission on cyclophosphamide therapy. This patient adds to the growing literature of a second malignancy occurring after prolonged successful chemotherapy of a primary neoplasm.