scholarly journals Bilateral Pleural Effusions due to Pulmonary Amyloidosis as the Presenting Manifestation of Multiple Myeloma

2012 ◽  
Vol 4 (1) ◽  
pp. e2012010
Author(s):  
Abhishek Agarwal ◽  
Sandeep Singla ◽  
Meghana Bansal ◽  
Bijay Nair
Keyword(s):  
Multiple Myeloma ◽  
Hematologic Malignancy ◽  
Multiorgan Failure ◽  
Pleural Effusions ◽  
Imaging Studies ◽  
Multiple Myeloma Patient ◽  
Pulmonary Amyloidosis ◽  
Undetermined Etiology ◽  
High Index Of Suspicion ◽  
Work Up

Multiple myeloma is a hematologic malignancy of plasma cell origin. Pleural effusion may develop in the setting of myeloma due to various reasons but is extremely uncommon as a presenting symptom.  A 69-year-old Caucasian man presented with pleural effusions of undetermined etiology after extensive work up, and multiple failed pleurodesis. Lung biopsy revealed pulmonary amyloidosis and led to the diagnosis of multiple myeloma. Patient was started on chemotherapy but died within 6 weeks of his diagnosis due to multiorgan failure. Pulmonary amyloidosis should be suspected as a cause of intractable pleural effusions, even in patient who do not have evidence of lung involvement on imaging studies or typical features of multiple myeloma. Pleural effusions due to amyloidosis are often refractory to treatment, and a high index of suspicion is required for early diagnosis and treatment.

scholarly journals Hemophagocytic lymphohistiocytosis in a patient with glioblastoma: a case report

CNS Oncology ◽  
2019 ◽  
Vol 8 (4) ◽  
pp. CNS45 ◽  
Author(s):  
Vaibhav Kumar ◽  
Patrick J Eulitt ◽  
Ana Bermudez ◽  
Simon Khagi
Keyword(s):  
Hemophagocytic Lymphohistiocytosis ◽  
Epstein Barr Virus ◽  
Hematologic Malignancy ◽  
Multiorgan Failure ◽  
Rare Condition ◽  
Solid Organ ◽  
Adult Onset ◽  
Barr Virus ◽  
Epstein Barr ◽  
High Index Of Suspicion

Adult onset hemophagocytic lymphohistiocytosis (HLH) is a rare condition, usually secondary to either a precipitating infective or hematologic malignancy. We present a case of Epstein–Barr virus associated HLH in a 55-year-old female receiving treatment for a glioblastoma (GBM). It is possible that HLH is under recognized, as patients with GBM often have features of a nonspecific systemic inflammatory response syndrome, multiorgan failure and cognitive decline. A high index of suspicion and increased awareness can help improve timeliness of diagnosis. Therapeutically, Epstein–Barr virus associated HLH in patients with solid organ malignancy poses significant challenges. An individualized, multidisciplinary approach is essential when managing adult-onset HLH and providers will need to be mindful of the high mortality rate despite treatment.

scholarly journals A case of bortezomib-associated thrombotic microangiopathy in a multiple myeloma patient

2019 ◽  
Vol 4 (1-2) ◽  
pp. 46-51
Author(s):  
Nuno Moreira Fonseca ◽  
Filipa Cardoso ◽  
Manuel Monteiro ◽  
Mário Góis ◽  
Helena Sousa ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Thrombotic Microangiopathy ◽  
First Generation ◽  
Kidney Biopsy ◽  
Drug Discontinuation ◽  
Pathophysiological Mechanism ◽  
Fatal Complication ◽  
Multiple Myeloma Patient ◽  
High Index Of Suspicion ◽  
Concurrent Medication

Bortezomib is a first-generation proteasome inhibitor used in the treatment of multiple myeloma. We present a case of a 70-year-old woman with multiple myeloma, who presented thrombotic microangiopathy with multi-organ involvement thrombotic microangiopathy (ocular, cardiac, and renal) after bortezomib initiation. A kidney biopsy confirmed the diagnosis of thrombotic microangiopathy. A temporal relation between bortezomib exposure and thrombotic microangiopathy onset was seen in the absence of other concurrent medication or disease known to cause thrombotic microangiopathy, and thrombotic microangiopathy was only resolved after drug discontinuation. The exact pathophysiological mechanism remains unknown. To our knowledge, this is the second biopsy-proven published case of bortezomib-associated thrombotic microangiopathy. Since bortezomib is extensively used for treating patients with multiple myeloma, prescribing clinicians should maintain a high index of suspicion of this potentially fatal complication.

scholarly journals Pattern of Use and Efficacy of Daratumumab-based Therapy in Patients With Multiple Myeloma in a Real-world Setting: a Single Institution Experience

2021 ◽  
Author(s):  
Danai Dima ◽  
Xiao Hu ◽  
Joshua Dower ◽  
Diana Zhang ◽  
Raymond Comenzo ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Real World ◽  
Plasma Cells ◽  
Hematologic Malignancy ◽  
Multiorgan Failure ◽  
Progression Free Survival ◽  
Single Institution ◽  
Free Survival ◽  
Hematologic Response ◽  
Real World Setting

Abstract Purpose: Multiple myeloma (MM) is an incurable hematologic malignancy, caused by the accelerated growth of clonal plasma cells leading to severe multiorgan failure. Several novel agents have been recently approved for the treatment of this diseases, including daratumumab, a human IgG kappa monoclonal antibody that targets CD38 on the surface of plasma cells. The objective of this retrospective study is to explore the pattern of use, safety and efficacy of daratumumab-based therapy among patients with both newly diagnosed multiple myeloma (NDMM) and relapsed/refractory multiple myeloma (RRMM) in a real-world setting at a single institution. Methods: 57 patients with MM treated with daratumumab based therapy, from 11/16/2015 to 3/16/2020, were included in the study. Kaplan-Meier method was used to estimate time to hematologic response, as well as progression free survival (PFS) after daratumumab initiation. Log-rank tests were applied to compare PFS among subgroups. Results: The overall hematologic response (ORR) to daratumumab based-therapy was 82.5% and the median progression-free survival (PFS) was 23.5 months. The ORR and PFS among NDMM patients vs RRMM patients were 80% and not reached vs 84.8% and 22 months respectively. Importantly, subgroup analysis based on cytogenetic risks, demonstrated that patients with standard risk cytogenetics sustained a marginally significantly prolonged PFS (24.0 vs 10.0 months, p=0.065) compared to those with high/intermediate risk cytogenetics. When stratified by the treatment line (1st vs 2nd-3rd vs >3rd) and treatment pattern (dara monotherapy vs. combination with PI vs. IMiD vs. PI + IMiD), there were no significant differences in PFS. Daratumumab was generally well tolerated, with no discontinuations due to adverse events.Conclusion: Daratumumab-based therapy has significant efficacy and very good tolerability among MM patients, in a real-world setting.

Malignant Pericardial Effusion--An Uncommon Complication of Multiple Myeloma: Case Report

2005 ◽  
Vol 8 (2) ◽  
pp. 87 ◽  
Author(s):  
Louis E. Samuels ◽  
Philbert Y. Van ◽  
Douglas E Gladstone ◽  
Marian M. Haber
Keyword(s):  
Multiple Myeloma ◽  
Case Report ◽  
Plasma Cells ◽  
Pericardial Fluid ◽  
Pleural Effusions ◽  
Myeloma Patient ◽  
Multiple Myeloma Patient ◽  
Malignant Pericardial Effusion ◽  
Abnormal Accumulation ◽  
Uncommon Complication

Multiple myeloma is a condition usually associated with lesions of the skeleton. However, under rare circumstances, the malignant plasma cells may infiltrate the pericardium, resulting in an effusion. If left untreated, the abnormal accumulation of pericardial fluid will result in cardiac tamponade, requiring drainage. The following report describes a multiple myeloma patient who developed secondary pericardial and pleural effusions, which were surgically drained via a pleuropericardial window.

scholarly journals Case Report on Renal Failure Reversal in Lambda Chain Multiple Myeloma with Bortezomib and Dexamethasone

2014 ◽  
Vol 2014 ◽  
pp. 1-6
Author(s):  
Bhanu K. Patibandla ◽  
Akshita Narra ◽  
Ahmad A. Alwassia ◽  
Anthony Bartley ◽  
Gurprataap S. Sandhu ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Renal Failure ◽  
Prognostic Factors ◽  
Sinus Tachycardia ◽  
White Cell Count ◽  
Altered Mental Status ◽  
Elderly Individual ◽  
Imaging Studies ◽  
Renal Response ◽  
Work Up

Renal failure (RF) reversal in multiple myeloma (MM) is associated with an improved prognosis. Light chain myeloma, serum creatinine (SCr) > 4 mg/dL, extensive proteinuria, early infections, and certain renal biopsy findings are associated with lower rates of RF reversal. Our patient is a 67-year-old female with multiple poor prognostic factors for RF reversal who demonstrated a rapid renal response with bortezomib and dexamethasone (BD) regimen. She presented initially with altered mental status. On exam, she appeared lethargic and dehydrated and had generalized tenderness. She had been taking ibuprofen as needed for pain for a few weeks. Labs showed a white cell count—18,900/μL with no bandemia, hemoglobin 10.8 gm/dL, potassium—6.7 mEq/L, bicarbonate—15 mEq/L, blood urea nitrogen—62 mg/dL, SCr—5.6 mg/dL (baseline: 1.10), and corrected calcium—11.8 mg/dL. A rapid flu test was positive. Imaging studies were unremarkable. Her EKG showed sinus tachycardia and her urinalysis was unremarkable. The unexplained RF in an elderly individual in conjunction with hypercalcemia and anemia prompted a MM work-up; eventually, lambda variant MM was diagnosed. An immediate (4 days) renal response defined as 50% reduction in SCr was noticed after initiation of the BD regimen.

Impact of Natural Dietary Agents on Multiple Myeloma Prevention and Treatment: Molecular Insights and Potential for Clinical Translation

2020 ◽  
Vol 27 (2) ◽  
pp. 187-215 ◽  
Author(s):  
Lavinia Raimondi ◽  
Angela De Luca ◽  
Gianluca Giavaresi ◽  
Agnese Barone ◽  
Pierosandro Tagliaferri ◽  
...  
Keyword(s):  
Signal Transduction ◽  
Multiple Myeloma ◽  
Natural Products ◽  
Bone Disease ◽  
Molecular Mechanisms ◽  
Plasma Cells ◽  
Hematologic Malignancy ◽  
Signal Transduction Pathways ◽  
Pharmacologically Active ◽  
Dietary Agents

: Chemoprevention is based on the use of non-toxic, pharmacologically active agents to prevent tumor progression. In this regard, natural dietary agents have been described by the most recent literature as promising tools for controlling onset and progression of malignancies. Extensive research has been so far performed to shed light on the effects of natural products on tumor growth and survival, disclosing the most relevant signal transduction pathways targeted by such compounds. Overall, anti-inflammatory, anti-oxidant and cytotoxic effects of dietary agents on tumor cells are supported either by results from epidemiological or animal studies and even by clinical trials. : Multiple myeloma is a hematologic malignancy characterized by abnormal proliferation of bone marrow plasma cells and subsequent hypercalcemia, renal dysfunction, anemia, or bone disease, which remains incurable despite novel emerging therapeutic strategies. Notably, increasing evidence supports the capability of dietary natural compounds to antagonize multiple myeloma growth in preclinical models of the disease, underscoring their potential as candidate anti-cancer agents. : In this review, we aim at summarizing findings on the anti-tumor activity of dietary natural products, focusing on their molecular mechanisms, which include inhibition of oncogenic signal transduction pathways and/or epigenetic modulating effects, along with their potential clinical applications against multiple myeloma and its related bone disease.

Bone marrow necrosis and fat embolism syndrome: a near fatal complication in previously undiagnosed sickle beta + thalassaemia

2021 ◽  
Vol 14 (1) ◽  
pp. e238317
Author(s):  
Nibash Budhathoki ◽  
Sunita Timilsina ◽  
Bebu Ram ◽  
Douglas Marks
Keyword(s):  
Bone Marrow ◽  
Multiorgan Failure ◽  
Rare Condition ◽  
Altered Mental Status ◽  
Fat Embolism ◽  
Bone Marrow Necrosis ◽  
Embolism Syndrome ◽  
Hb S ◽  
High Index Of Suspicion ◽  
Specific Symptoms

Prevalence of haemoglobin sickle-β+ thalassaemia (Hb S/β+thal) is variable with geography ranging from 0.2% to 10% among sickle cell patients. Clinical presentation of Hb S/β+thal patients depends on HbA level, with milder disease often going undiagnosed. However, rarely these patients can present with a fulminant vaso-occlusive crisis (VOC). Given VOC can present with non-specific symptoms, the diagnosis and treatment is often delayed. Here, we present a patient who initially developed altered mental status, pancytopenia and multiorgan failure due a critical VOC resulting in bone marrow necrosis and fat embolism. Subsequent workup confirmed that our patient had Sickle-β+ thalassaemia, which had gone undiagnosed, despite subclinical evidence of haemolysis on routine lab work for years. Following diagnosis and initiation of RBC exchange, he improved significantly and was discharged home. High index of suspicion and bone marrow biopsy is vital for early diagnosis and management of this rare condition.

scholarly journals Comparison of the prognostic significance of 5 comorbidity scores and 12 functional tests in a prospective multiple myeloma patient cohort

Cancer ◽  
2021 ◽  
Author(s):  
Sophia Scheubeck ◽  
Gabriele Ihorst ◽  
Katja Schoeller ◽  
Maximilian Holler ◽  
Mandy‐Deborah Möller ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Prognostic Significance ◽  
Functional Tests ◽  
Myeloma Patient ◽  
Multiple Myeloma Patient ◽  
Patient Cohort ◽  
Comorbidity Scores

scholarly journals Belantamab Mafodotin to Treat Multiple Myeloma: A Comprehensive Review of Disease, Drug Efficacy and Side Effects

2021 ◽  
Vol 28 (1) ◽  
pp. 640-660
Author(s):  
Grace Lassiter ◽  
Cole Bergeron ◽  
Ryan Guedry ◽  
Julia Cucarola ◽  
Adam M. Kaye ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Plasma Cells ◽  
Hematologic Malignancy ◽  
Drug Efficacy ◽  
Treatment Modalities ◽  
Blurred Vision ◽  
Refractory Multiple Myeloma ◽  
Therapeutic Modalities ◽  
Clonal Proliferation ◽  
Refractory State

Multiple myeloma (MM) is a hematologic malignancy characterized by excessive clonal proliferation of plasma cells. The treatment of multiple myeloma presents a variety of unique challenges due to the complex molecular pathophysiology and incurable status of the disease at this time. Given that MM is the second most common blood cancer with a characteristic and unavoidable relapse/refractory state during the course of the disease, the development of new therapeutic modalities is crucial. Belantamab mafodotin (belamaf, GSK2857916) is a first-in-class therapeutic, indicated for patients who have previously attempted four other treatments, including an anti-CD38 monoclonal antibody, a proteosome inhibitor, and an immunomodulatory agent. In November 2017, the FDA designated belamaf as a breakthrough therapy for heavily pretreated patients with relapsed/refractory multiple myeloma. In August 2020, the FDA granted accelerated approval as a monotherapy for relapsed or treatment-refractory multiple myeloma. The drug was also approved in the EU for this indication in late August 2020. Of note, belamaf is associated with the following adverse events: decreased platelets, corneal disease, decreased or blurred vision, anemia, infusion-related reactions, pyrexia, and fetal risk, among others. Further studies are necessary to evaluate efficacy in comparison to other standard treatment modalities and as future drugs in this class are developed.

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