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Multiple Myeloma
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
The most common abnormality seen on a full blood count is a normochromic, normocytic anemia, or macrocytic anemia. The blood film often shows rouleaux formation due to the presence of a paraprotein. When circulating plasma cells are seen at a level of over 2 × 109/L, a diagnosis of plasma cell leukemia can be made. The ESR is usually raised in myeloma (except light chain myeloma) as the result of the high serum globulin levels.
Lymphocyte and plasma cell malignancies
Published in Gabriel Virella, Medical Immunology, 2019
Juan Carlos Varela, Gabriel Virella
Plasma cell leukemia is the designation applied to cases in which large numbers of plasma cells can be detected in the peripheral blood (exceeding 5%–10% of the total white blood cell count). Besides the leukemic picture in the peripheral blood, the remaining clinical and laboratory features of plasma cell leukemia are usually indistinguishable from those of multiple myeloma. The prognosis is generally poor; this may reflect a higher degree of de-differentiation on the part of malignant plasma cells that abandon their normal territory.
Clinical Studies In Oncology
Published in Siegfried Matzku, Rolf A. Stahel, Antibodies in Diagnosis and Therapy, 2019
Jan Schmielau, Wolff Schmiegel
Since IL-6 is known to be a potent growth factor for tumor cells in multiple myeloma Klein et al. (1991) treated one patient with plasma cell leukemia for two months with daily infusions of two murine anti-IL-6 mAb, IgG2b and IgGl. Ex vivo proliferation assays with bone marrow tumor cells harvested pre-treatment demonstrated a completely IL-6-dependent proliferation. During therapy with increasing amounts of monoclonal antibody a loss of tumor cells in the S-phase, which was 4.5% on day 0, was observed on day 10, followed by a recurrence of 2% cells in the S-phase on day 60. The application of anti-IL-6-antibody was paralleled by a considerable increase of biologically inactive IL-6 serum levels, due to blocking antibodies. This has been reflected by reduction in serum calcium, serum monoclonal IgG, and C-reactive protein levels. The progression of disease has been suggested in part to be due to the development of HAMA against both antibodies. In a second trial 10 patients with multiple myeloma were treated with multiple injections with a total dose of up to 1,510 mg (Bataille et al., 1995). Three patients had an antiproliferative effect with significant reduction of the myeloma cell labelling index within the bone marrow, with one 30% regression of tumor mass. Antiproliferative effects were associated with complete inhibition of the C-reactive protein.
Comprehensive evaluation of older patients with suspected malignancy: 5-year experience of a tertiary geriatric inpatient unit
Published in Current Medical Research and Opinion, 2023
Bahar Bektan Kanat, Veysel Suzan, Gulru Ulugerger Avci, Halit Eyyup Mungan, Damla Unal, Tugce Emiroglu Gedik, Deniz Suna Erdincler, Alper Doventas, Hakan Yavuzer
The first three cancer types we detected most frequently were hematological cancer (32%), lung cancer (15%), and gastrointestinal system cancers (15%). Of the 21 patients with hematological malignancy, eight had plasma cell disease (multiple myeloma and plasma cell leukemia) (38%), four had acute myeloid leukemia (19%), three had chronic lymphocytic leukemia (14%), 3 had B-cell lymphoma (14%), and 3 had myelodysplastic syndrome (14%). Localizations and rates of malignancies among all malignancy patients are given in Supplement 2. Malignancy was detected in 11 (40%) of 27 patients with a history of malignancy, and 6 (55%) of the newly detected malignancies were new primary malignancies not compatible with recurrence or metastasis. For newly diagnosed malignancies in patients with a history of malignancy see Supplement 3. The most common benign conditions detected in patients hospitalized with a preliminary diagnosis of malignancy were chronic bleeding due to anticoagulant or antiplatelet drugs, cirrhosis and hypersplenism, tuberculosis and polymyalgia rheumatica. Details are given in Supplement 4.
Angioimmunoblastic T-cell lymphoma with exuberant plasmacytosis and spontaneous tumor lysis syndrome
Published in Baylor University Medical Center Proceedings, 2022
Hafsa Faisal, Syed Ather Hussain, Rachel David, Stephen Silver
Reactive plasmacytosis can be due to infections, autoimmune diseases, serum sickness, or malignancies like AITL.3 The term “exuberant plasmacytosis” has been used to describe severe reactive plasmacytosis, which can very rarely be seen with AITL.3 Exuberant plasmacytosis is defined as more than 20% polyclonal plasma cells in the peripheral blood or >2 × 103/μL absolute plasma cell count.1 The mechanism behind polyclonal plasma cell proliferation in AITL is most likely multifactorial.3 Epstein-Barr virus infection of B cells, resulting in increased production of cytokines like IL-6 and IL-10, has been implicated in reactive plasma cell proliferation.1 The plasmacytosis can initially be concerning for a plasma cell leukemia. However, the establishment of polyclonality with peripheral blood flow cytometry essentially rules out plasma cell malignancy.
Investigation of demographic features, performance, comorbidity status and mortality causes among multiple myeloma patients: real-life data
Published in Expert Review of Hematology, 2021
Tuğba Şahin, Atakan Turgutkaya, Gürhan Kadıköylü, Ali Zahit Bolaman, İrfan Yavaşoğlu
Multiple myeloma (MM) is a neoplasm of plasma cells capable of producing monoclonal immunoglobulin and represents a cause of morbidity and mortality due to end-organ damage. It is the second most common hematological malignancy after lymphoma and is found among more than 17% of hematological neoplasms [1,2]. In this context, the proliferation and accumulation of plasma cells lead to bone destruction (osteolysis) and subsequent pathological bone fractures, hypercalcemia, renal disease, anemia and mass formation. With the introduction of novel therapies, patient outcomes continue to improve [3]. The prognosis is essentially influenced by heterogeneous disease biology and patient-specific factors, such as age and frailty, performance status, presence of myeloma-related organ injury, plasma cell leukemia or extramedullary disease, stage, and cytogenetic features per the Revised International Staging System (R-ISS) [4]. Organ dysfunctions were found to be associated with the outcome of MM treatment. The first systematic organ and functional assessment in myeloma patients was performed by Kleber et al. and underscored that age alone represented an insufficient parameter relative to renal and pulmonary comorbidities and Karnofsky Performance Status [5]. Most comorbidity risk scoring systems are based on clinical trials, and few real-life data are available. Here, we retrospectively investigated our myeloma patients’ demographic data, performance status, comorbidity indexes, and causes of death and aimed to present them in contrast with the literature.