Uday Yanamandra1, Prateek Deo2, Kamal Kant Sahu3, Ram Vasudevan Nampoothiri3, Nalini Gupta4, Anusree Prabhakaran3, Deb Prasad Dhibhar2, Alka Khadwal3, Gaurav Prakash3, Man Upadesh Singh Sachdeva5, Deepesh Lad3, Neelam Varma2, Subhash Varma3, Pankaj Malhotra6. 1. Department of Hematology & Stem Cell Transplantation, Army Hospital (Research & Referral), Delhi, India. 2. Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India. 3. Clinical Hematology Division, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India. 4. Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. 5. Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. 6. Clinical Hematology Division, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: hematpgi@gmail.com.
Abstract
BACKGROUND: Multiple myeloma (MM) is a hematologic malignancy of plasma cell origin. MM primarily affects bone marrow, but extramedullary sites can also be involved. Myelomatous pleural effusion (MPE) is an atypical and rare complication of MM. We aimed to systematically study the incidence and clinicopathologic profile of patients with MPE in a real-world setting. PATIENTS AND METHODS: In this retrospective study, 415 consecutive patients with MM managed at a tertiary care center in North India during a study period of January 1, 2010 to December 31, 2015 were evaluated for MPE. The patients with MPE were analyzed for their clinical profile, diagnosis, treatment, and outcomes. RESULTS: Of these 415 patients, 11 (2.65%) patients had MPE. The median age of the study population was 50 years with male preponderance. The majority of these patients had immunoglobin (Ig)G Kappa disease. All patients had higher than International Staging System stage I disease. MPE was a presenting feature at MM diagnosis in 45.45% (n = 5) of the patients, whereas the rest developed MPE during follow-up. MPE presented predominantly (81.8%) as a unilateral effusion. Concurrent extramedullary involvement at other site was seen in 45.45% (n = 5), with 3 (27%) patients having concurrent myelomatous ascites. Six of these were managed aggressively, whereas 5 patients opted for palliation. The outcomes were dismal (90.9% mortality), with a median survival of 2.47 months. CONCLUSION: MPE is a rare entity, and positive outcomes of therapy remain low with dismal prognosis.
BACKGROUND:Multiple myeloma (MM) is a hematologic malignancy of plasma cell origin. MM primarily affects bone marrow, but extramedullary sites can also be involved. Myelomatous pleural effusion (MPE) is an atypical and rare complication of MM. We aimed to systematically study the incidence and clinicopathologic profile of patients with MPE in a real-world setting. PATIENTS AND METHODS: In this retrospective study, 415 consecutive patients with MM managed at a tertiary care center in North India during a study period of January 1, 2010 to December 31, 2015 were evaluated for MPE. The patients with MPE were analyzed for their clinical profile, diagnosis, treatment, and outcomes. RESULTS: Of these 415 patients, 11 (2.65%) patients had MPE. The median age of the study population was 50 years with male preponderance. The majority of these patients had immunoglobin (Ig)G Kappa disease. All patients had higher than International Staging System stage I disease. MPE was a presenting feature at MM diagnosis in 45.45% (n = 5) of the patients, whereas the rest developed MPE during follow-up. MPE presented predominantly (81.8%) as a unilateral effusion. Concurrent extramedullary involvement at other site was seen in 45.45% (n = 5), with 3 (27%) patients having concurrent myelomatous ascites. Six of these were managed aggressively, whereas 5 patients opted for palliation. The outcomes were dismal (90.9% mortality), with a median survival of 2.47 months. CONCLUSION: MPE is a rare entity, and positive outcomes of therapy remain low with dismal prognosis.
Authors: Wing Hang Woo; Azlin Ithnin; Mohd Asyiq Al-Fard Mohd Raffali; Mohamed Faisal Abd Hamid; S Fadilah Abdul Wahid; Wan Fariza Wan Jamaludin Journal: Oxf Med Case Reports Date: 2022-08-18