Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0026764 (multiple myeloma)
 36,148 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A case with prolonged bacterial infection accompanied by an abnormal serum protein which migrated in the post-gamma region on electrophoresis is presented. The abnormal protein was identified as IgG with gamma-type light chain moiety. The patient suffered from prolonged pneumonia and cholecystitis, Bone marrow aspiration and skeletal x-rays did not indicate multiple myeloma.
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PMID:An extremely basic monoclonal IgG in an aged apoplectic patient with prolonged bacterial infection. 13 72

Infusion of cycloheximide i.v., an antibiotic known to inhibit synthesis of protein, at a rate of 0.2 mg/kg/hr, reliably caused lysis of fever in 15 chronically febrile patients with Hodgkin's disease who did not have detectable bacterial, fungal, or viral infection. Antipyretic effects were also seen in some patients with reticulum cell sarcoma, lymphosarcoma, acute leukemia, histiocytic medullary reticulosis, plasma cell myeloma, carcinoma of the lung, and carcinoma of the cervix. The drug failed to produce defervescence in four patients with normal granulocyte reserves, who were febrile due to bacterial infection. When infused at a rate of 0.2 mg/kg/hr, the drug apparently caused an acute alteration of protein metabolism in man in that plasma amino acid nitrogen rose acutely while plasma levels of muramidase and ribonuclease fell during the period of the infusion. The data suggest that continuing synthesis of protein may be involved in nonbacterial fever of neoplastic disease. Mammalian granulocytes and monocytes are known to elaborate a pyrogenic protein following appropriate stimulation; it is suggested that in some types of neoplastic disease, particularly Hodgkin's disease, tumor cells may produce and release a pyrogenic protein and that drug-induced inhibition of its synthesis is responsible for the observed lysis of fever.
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PMID:Antipyretic effect of cycloheximide, and inhibitor of protein synthesis, in patients with Hodgkin's disease or other malignant neoplasms. 109 49

The purpose of this single arm phase II study was to test a modified version of the three drug combination vincristine, adriamycin and dexamethasone (m-VAD), in which intravenous vincristine (0.4 mg/d) and adriamycin (9 mg/m2 per day) infusions are administered for only 2 h on days 1-4 of each 28 d cycle, in patients with refractory multiple myeloma. In addition, only two 4 d courses of dexamethasone 40 mg/d was given during each cycle. The entry criteria for 44 patients included plasma cell myeloma and a measurable monoclonal peak, either refractory to initial treatment with melphalan and prednisone, or resistant to melphalan and prednisone after initially responding (resistant relapsed disease, 27 patients). Patients treated previously with chemotherapy other than melphalan and prednisone were excluded. There were no complete responses. Of the 41 evaluable patients who completed at least one course of therapy 11 had a partial response (27%, 95% C.I. 14-40%). The response rates were 19% for primary refractory disease patients, and 32% for those with resistant relapsed disease. The median duration of response was 4 months. The median survival for all 44 patients was 7.6 months (5.5 months for primary refractory patients, and 10 months for relapsed resistant disease patients). Episodes of documented bacterial infection occurred in 12 patients, and 10 patients had minor viral infection. The dexamethasone dose was reduced in 12 patients. The median neutrophil nadir was 1.2 x 10(9)/l, and median platelet nadir was 147 x 10(9)/l. Five deaths were judged as treatment related and occurred during marrow cytopenia. The results of this modified form of VAD are inferior to that reported previously for 4 d continuous infusions of vincristine and doxorubicin. This could be related to either patient selection factors, or to a reduction of the efficacy of the drug combination produced by either the shortened intravenous infusions and/or omission of one 4 d course of dexamethasone.
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PMID:Modified adriamycin-vincristine-dexamethasone (m-VAD) in primary refractory and relapsed plasma cell myeloma: an NCI (Canada) pilot study. The National Cancer Institute of Canada Clinical Trials Group. 148 35

Thirty-four patients with refractory multiple myeloma were treated with 4-d continuous infusions of vincristine and adriamycin in combination with 4-d pulsed high-dose dexamethasone (VAD). Of 31 evaluable patients, 16 entered a complete remission (50%) and three a partial remission (10%). No difference in response rate was observed between primary refractory and relapsed patients. The median response duration was 9 months and the median survival of the responding patients was 12 months versus 4 months for the non-responders. Ten patients have currently survived longer than 360 d, of which six are stable in complete remission without therapy. All responding patients showed a remarkable improvement of their performance status and 70% of these patients became pain-free. Bacterial infection was the major complication and was probably due to the intensive corticosteroid programme. Severe myelosuppression was rarely observed. Irrespective of the response to VAD, a high beta 2-microglobulin of 4 micrograms/ml or more was a bad prognostic parameter. As early relapses were seen especially in this group of patients, in the patients with a plasma-cell LI% of 3 or more, and in patients with previous anthracyclin treatment, early consolidation, with, for instance, high dose melphalan, might improve the prognosis for these patients.
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PMID:VAD chemotherapy for refractory multiple myeloma. 264 70

Multiple myeloma has rarely been reported in patients with ankylosing spondylitis. We observed a patient with a 20-year history of ankylosing spondylitis, who subsequently developed IgA myeloma. This association may not be simply coincidental. It has been proposed that the protracted stimulation of immunocytes by inflammatory lesions on the mucosal surfaces of the gastrointestinal, respiratory, and biliary tracts, where lymphocytes are already committed to IgA production, may be implicated in the pathogenesis of IgA myeloma in some patients. Ankylosing spondylitis is a chronic inflammatory disease, probably resulting from the interaction of a genetic predisposition involving HLA-B27 with an environmental event such as enteric bacterial infection. We propose that ankylosing spondylitis and IgA myeloma occurring concomitantly in our patient implies a possible pathogenetic relationship. In ankylosing spondylitis, persistent reticuloendothelial stimulation, due to chronic subclinical gastrointestinal infection, may lead to IgA-producing plasma cell activation and proliferation, and subsequent IgA myeloma development.
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PMID:Association of ankylosing spondylitis with IgA-multiple myeloma: report of a case and pathogenetic considerations. 280 65

Patients with multiple myeloma are at increased risk of severe bacterial infection. A variety of immune deficits has been described in such patients, including a decreased primary antibody response and defects in complement and granulocyte function. The depressed humoral response appears to result primarily from the activity of suppressor monocytes. Pneumovax (Merck Sharp & Dohme, West Point, Penn) should be administered to patients with myeloma, although its effectiveness in this population has not been proven. The role of other potential modalities of treatment and prophylaxis, such as IV gamma globulin, requires further study.
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PMID:Immunosuppression and infection in multiple myeloma. 353 28

The role of the renal papillae in the pathogenesis of pyelonephritis and reflux nephropathy was studied by endoscopy and histology in adult autopsy kidneys. Compound papillae with a concave area cribrosa of the "reflux type" were found in greater frequency in adults than in children. Acute purulent inflammation in the renal parenchyma or coarse pyelonephritic scars were seen almost always overlying "refluxing" papillae or overlying papillae altered by papillary necrosis, obstructive atrophy and other changes of papillary shape. Intrapapillary tubular obstruction in early analgesic nephropathy, gout, myeloma and medullary cystic disease is an other factor favouring bacterial infection to occur. Without an underlying renal papillary damage renal injury attributable to urinary infection seems to be rare.
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PMID:[Significance of kidney papillae in the pathogenesis of pyelonephritis and reflux nephropathy]. 405 18

To better characterize the apparent secretory immune response of the prostate to bacterial infection of the genitourinary tract, we assayed serial expressed prostatic secretion (EPS) specimens for total and antibacterial immunoglobulin. Three men with bacterial prostatitis, including 2 otherwise healthy men with chronic infections and 1 man with IgG multiple myeloma and an acute infection, were studied. In the former 2 cases the infections were associated with greater increases in total EPS IgA than total EPS IgG or IgM. The patient with multiple myeloma had markedly elevated serum IgG levels and subnormal serum IgA and IgM levels and the acute infection was accompanied by increases in total EPS IgG and IgM but consistently low total EPS IgA. Antibacterial EPS IgA, which was measurable in each case, was always quantitatively greater than antibacterial EPS IgG. Antibacterial IgM was never detectable. Alterations in the concentrations of antibacterial EPS IgG and IgA were generally not associated with comparable alterations of total EPS IgG and IgA, respectively, and the concentrations of antibacterial EPS IgG and IgA did not correlate well with the clinical or bacteriologic response to antimicrobial therapy. The concentration of antibacterial IgA expressed as a function of total IgA was as much as 1550 times greater in the EPS than in the serum. However, the relative concentrations of antibacterial IgG and IgM were similar in the EPS and serum. These data suggest local synthesis of antibacterial IgA in the prostate that persists following eradication of the infection and that is regulated independent of both the systemic immune response and the concentration of total prostatic fluid immunoglobulin.
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PMID:Longitudinal studies of prostatic fluid immunoglobulin in men with bacterial prostatitis. 669 75

The clinical, laboratory and pathologic findings were studied in 62 consecutively autopsied patients with multiple myeloma between 1954 and 1975. All patients were 40 years of age or older. Bone pain was the initial symptom in 2/3 of patients. Anemia (81%), thrombocytopenia (29%), azotemia (41%), hypercalcemia (46%) and hyperuricemia (52%), were common laboratory findings at diagnosis. Ninety-seven percent had a monoclonal protein in serum or urine. Extensive plasma cell replacement of marrow was invariably seen at autopsy although in 15% of patients no abnormality was found on skeletal survey. Extraskeletal spread (67%) was due to direct extension to paraosseous tissue resulting from cortical destruction and to distant organ involvement mainly of splenic red pulp and hepatic sinusoids. The patients were susceptible to bacterial infection, mainly gram-negative, of the lung (56%), urinary tract (35%), and blood (24%). Fungal infection was less frequent and usually consisted of superficial candidal overgrowth of gastrointestinal tract ulcerations (18%). Amyloidosis (10%) was perivascular and associated with light chain proteinuria. Renal failure as a cause of death (21%) was secondary only to infection (52%). Severity of histologic findings in the kidney at autopsy had little correlation to initial BUN concentration. The median survival was 11.5 months with alkylating agent therapy (responders, 29 months; non-responders, 6 months), and 6 months with urethan. Initial azotemia (greater than 80 mg/dl) and hypercalcemia (greater than 12 mg/dl) were important prognostic indicators (median survival, less than 1 month and 3 months, respectively). A good response to alkylating agent therapy, initial BUN less than 40 mg/dl and serum calcium less than 12 mg/dl were favorable to prognostic indicators.
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PMID:Multiple myeloma: a clinicopathologic study of 62 consecutively autopsied cases. 743 54

A peculiarity of infection, as a complication of multiple myeloma in hematopoietic malignancies, is discussed. The Hanshin Study Group of Hematopoietic Disorders and Infection treated 3346 cases of bacterial infection during the past 13 years. Myeloma patients showed a low rate of 3.0% as compared with 28.2% of acute myelogenous leukemia patients. In patients with long term administration of antibiotics or bone marrow suppression, it is necessary to watch for fungus infection. Recently, new combination chemotherapy (DMVM-IFN alpha) is widely used in Japan. A high complete remission rate has been achieved by this regimen, but the incidence of infection tends to increase. Measures for infection in multiple myeloma should therefore be similar to that acute leukemia.
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PMID:[Measures for infection in multiple myeloma]. 769 8


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