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)

The role of selected prior medical conditions in the etiology of hematopoietic malignancies was examined in a case-control study of members of two regional branches of the Kaiser Permanente Medical Care Program (USA). Past history of chronic infectious, autoimmune, allergic, and musculoskeletal disorders was abstracted from medical records for leukemia (n = 299), non-Hodgkin's lymphoma (NHL, n = 100), and multiple myeloma (n = 175) cases and matched controls (n = 787). Little difference was found between cases and controls for most of the chronic conditions evaluated, including sinusitis, carbuncles, urinary tract infections, pelvic infections, herpes zoster, asthma, rheumatoid arthritis, psoriasis, bursitis, and gout. Only three statistically significant elevated risks were found, i.e., with combined disc disease myeloma among patients with prior eczema and disk and other musculoskeletal conditions, and NHL following tuberculosis. Only two of these associations showed consistent patterns by sex and geographic region (myeloma with eczema and with musculoskeletal conditions). While prior history of eczema and musculoskeletal conditions may slightly increase risk of myeloma, this study provided little if any support for an association of chronic infectious, autoimmune, allergic, and musculoskeletal conditions with subsequent occurrence of the leukemias or NHL. Additionally, these data did not support a role for chronic antigenic stimulation, as defined in previous epidemiologic studies, in the etiology of hematopoietic malignancies.
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PMID:Leukemia, lymphoma, and multiple myeloma following selected medical conditions. 152 26

The introduction of preparations of immune serum globulin that are safe for intravenous use (IVIG) has made possible safe and effective prophylactic treatment for patients with a variety of humoral immunodeficiencies. These include not only primary agammaglobulinemia and common variable hypogammaglobulinemia but also the antibody deficiencies that accompany chronic lymphocytic leukemia (CLL) and multiple myeloma, as well as the hypogamma-globulinemia found in very low birth weight newborns who have not received adequate transplacental IgG from their mothers. In contrast, trials to date have not shown efficacy of IVIG in preventing sepsis in burn patients. The ease of administration and efficacy of IVIG in preventing respiratory symptoms in hypogammaglobulinemic patients has suggested that many other patients presenting with sinusitis and asthma, recurrent bronchitis, and other chronic chest symptoms might also benefit from IVIG and that they should be worked up for IgG subclass or specific antibody deficiencies. Side effects of IVIG administration are generally minor and may be prevented by slow administration and/or pretreatment with aspirin or Benadryl. The only contraindication to IVIG treatment is anaphylactic sensitivity to IgA, which is extremely rare. IVIG is thus an effective and safe form of prophylaxis that can reduce the incidence of pneumonia and other respiratory infections in patients with antibody deficiency as a predisposing factor.
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PMID:Role of gamma globulin. 251 39

The clinical and diagnostic features of 29 adult patients with H. influenzae septic arthritis are reviewed. Twelve men and 17 women ranging in age from 22 to 82 years developed the infection. H. influenzae septic arthritis is an acute, febrile disease with a mean duration of symptoms before diagnosis of 4 days. Fifteen patients had monoarticular arthritis, 6 with an infected knee. Polyarticular involvement, with a range of 2 to 9 joints, was diagnosed in 14 patients. Nineteen patients had concurrent extraarticular sites of infection, including meningitis, pneumonia, pharyngitis, sinusitis, conjunctivitis, and cellulitis. Twenty-two of 29 patients had predisposing factors for infection, including ethanolism, trauma, rheumatoid arthritis, systemic lupus erythematosus, diabetes mellitus, splenectomy, multiple myeloma, lymphoma, gout, and acquired common variable hypogammaglobulinemia. Characteristic synovial fluid findings included purulent, greenish fluid, elevated WBC count, and gram-negative pleomorphic microorganisms. Treatment for these patients included antibiotic therapy, most often ampicillin and chloramphenicol, and joint drainage by repeated arthrocentesis or arthrotomy. A favorable outcome was reported in 25 of 29 patients. Hemophilus influenzae septic arthritis should be suspected in adults who are immunocompromised and have a concurrent extraarticular source of infection.
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PMID:Hemophilus influenzae septic arthritis in adults. A report of four cases and a review of the literature. 348 37

Normal and malignant plasma cells (PC), follicular dendritic cells (FDC), myofibroblasts (MFB) and perineurial cells (PNC) were investigated for the expression of MUC-1 glycoprotein (MUC-1gp) by immunohistochemical and immunoelectron microscopic techniques using monoclonal antibodies E29, 115D8, DF3 and a combination of the three. MUC-1 glycoprotein-positive PC detected by the combined antibodies were frequently seen in a variety of pathological lesions tested, including chronic cervicitis, chronic synovitis, Hodgkin's disease, allergic rhinitis and sinusitis, tuberculous lymphadenitis, foreign body granuloma, multiple myeloma, and chronic tonsillitis. In the lesions containing MUC-1gp-positive PC, the infiltration of immunoglobulin (Ig) E PC and/or IgE-bound mast cells was significantly increased, but MUC-1gp-positive PC did not contain any specific immunoglobulin heavy or light chains. The findings suggest that the expression of MUC-1 gp in PC, although not restricted to IgE-class cells, may be induced in an allergic status. Plasma cells and PNC mainly reacted with the antibodies E29 and 115D8, while FDC and MFB were principally reactive with the antibody DF3. In some cases of multiple myeloma, the neoplastic PC were predominantly immunoreactive with DF3. The results indicate: (i) the epitopic variability of MUC-1gp molecules expressed on the non-epithelial cells; and (ii) the epitopic alterations during malignant transformation. It should also be noted that the expression of MUC-1gp in the non-epithelial cells represents a pitfall in histopathological diagnosis.
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PMID:Expression of MUC-1 glycoprotein in plasma cells, follicular dendritic cells, myofibroblasts and perineurial cells: immunohistochemical analysis using three monoclonal antibodies. 978 61

A 59-year-old man with a 4-year history of light chain myeloma relapsing after two preceding autografts and salvage therapy with thalidomide underwent a peripheral blood stem cell (PBSC) transplant from his HLA-identical sister after conditioning with 100 mg/m2 melphalan. Graft-versus-host disease (GVHD) prophylaxis comprised cyclosporine. Despite pulmonary infiltrates and sinusitis at the time of the allograft, it was decided to proceed with the transplant because the myeloma was refractory and rapidly progressive. Sputum cultures obtained 2 days before the allograft grew Aspergillus fumigatus 2 days post transplant. A fumigatus grew repeatedly on specimens obtained post transplant. Prompt hematologic recovery was seen with full donor-type chimerism. The fungal infection subsided gradually on a combination of amphotericin B lipid complex and itraconazole. A second aliquot of donor PBSC was infused electively on day +42 to induce graft-versus-myeloma. Complete remission of the myeloma was achieved by 75 days post transplant. No acute GVHD was seen. No chronic GVHD was seen at 16 weeks when he received the third PBSC infusion. He is currently alive and well in remission 9 months post transplant. This case demonstrates the safety and potential usefulness of allogeneic PBSC transplantation with reduced-intensity conditioning in patients with markedly compromised performance status.
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PMID:Non-myeloablative allogeneic transplantation ('microallograft') for refractory myeloma after two preceding autografts: feasibility and efficacy in a patient with active aspergillosis. 1114 38

Certain chemotherapeutic agents can induce bizarre epithelial atypia. The lower respiratory tract is a frequently targeted site, but similar changes have not been described adequately in the sinonasal tract. Unfamiliarity with these changes could potentially cause confusion with an infectious or neoplastic process. All biopsies of the sinonasal tract at The Johns Hopkins Hospital were reviewed prospectively over a 54-month period. Eleven cases with bizarre atypia of the respiratory epithelium formed the basis of this study. The medical records of these patients were reviewed. The specimens were from 11 patients who had previously undergone chemotherapy and bone marrow transplantation for acute myelocytic leukemia (n = 5), multiple myeloma (n = 3), acute lymphocytic leukemia (n = 2), and chronic myelocytic leukemia (n = 1). Although the chemotherapy regimens were highly variable, all included one or more of the alkylating agents (cyclophosphamide, n = 11; busulfan, n = 5; melphalan, n = 1). In all 11 patients, biopsies were acquired to rule out invasive fungal sinusitis. The atypical epithelial changes included striking nuclear enlargement, hyperchromasia, and pleomorphism. Sometimes these changes were full thickness and were associated with squamous metaplasia. Two of eight cases evaluated by frozen section were misinterpreted initially as high-grade epithelial dysplasia. Certain chemotherapeutic agents can induce striking epithelial atypia in the sinonasal tract. These changes should not be interpreted as neoplastic in nature, a potential pitfall in the frozen section evaluation of a destructive nasal process in oncology patients.
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PMID:Bizarre epithelial atypia of the sinonasal tract after chemotherapy. 1134 78

Secondary hypogammaglobulinemia may be a relevant predisposing condition in patients with recurrent bacterial upper airway disease (pneumonia, sinusitis) or first-time opportunistic infection, particularly if additional immunosuppressive factors like underlying hematological disease or immunosuppressive therapy are present. As an example, we present a retired farmer with myeloma, treated Hodgkin-lymphoma and hypogammaglobulinemia suffering from the third episode of Rhodococcus equi pneumonia. Screening for hypogammaglobulinemia is recommended in patients with unexplained recurrent bacterial airway infection or first time opportunistic disease, particularly with micro-organisms controlled by humoral immunity. Screening should include the analysis of total immunoglobulin levels (IgA, IgG and IgM). If results are ambiguous, tetanus toxoid and pneumococcal polysaccharide vaccine should be administered with measurement of specific antibody titer before and one month after vaccination. An adequate antibody response largely excludes a clinically significant humoral immunodeficiency. If hypogammaglobulinemia is present in a patient with recurrent or opportunistic infections, periodical substitution of IVIG in a dose and frequency to prevent further infectious episodes should be initiated. This is usually achieved with an IVIG-dose of 0.4g/kg body weight every 3 - 4 weeks to reach a trough IgG-level of 5 - 7g/L.
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PMID:[Secondary hypogammaglobulinemia with recurrent opportunistic pulmonary infection]. 2318 80

The role of bacteria and viruses as aetiological agents in the pathogenesis of cancer has been well established for several sites, including a number of haematological malignancies. Less clear is the impact of such exposures on the subsequent development of multiple myeloma (MM). Using the population-based U.S. Surveillance Epidemiology and End Results-Medicare dataset, 15,318 elderly MM and 200,000 controls were identified to investigate the impact of 14 common community-acquired infections and risk of MM. Odds ratios (ORs) and associated 95% confidence intervals (CIs) were adjusted for sex, age and calendar year of selection. The 13-month period prior to diagnosis/selection was excluded. Risk of MM was increased by 5-39% following Medicare claims for eight of the investigated infections. Positive associations were observed for several infections including bronchitis (adjusted OR 1.14, 95% CI 1.09-1.18), sinusitis (OR 1.15, 95% CI 1.10-1.20) pneumonia (OR 1.27, 95% CI 1.21-1.33), herpes zoster (OR 1.39, 95% CI 1.29-1.49) and cystitis (OR 1.09, 95% CI 1.05-1.14). Each of these infections remained significantly elevated following the exclusion of more than 6 years of claims data. Exposure to infectious antigens may therefore play a role in the development of MM. Alternatively, the observed associations may be a manifestation of an underlying immune disturbance present several years prior to MM diagnosis and thereby part of the natural history of disease progression.
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PMID:Common community-acquired infections and subsequent risk of multiple myeloma: a population-based study. 2410 62

We report a case of cryptococcal sinusitis, a rare presentation of Cryptococcus neoformans infection in a patient with multiple myeloma. The objective of this case report is to highlight the utility of structural and functional imaging modalities in the differential diagnosis of sinonasal soft tissue masses in the immunocompromised patient population. PET-CT was the first imaging modality in this patient, who presented for routine follow-up staging of multiple myeloma, and was asymptomatic at the time of his presentation. PET-CT findings prompted further evaluation with MRI, to aid in the differential diagnosis with respect to a neoplastic versus infectious etiology. Ultimately, surgical excision with histopathology was required to provide definitive diagnosis. Final histopathology displayed yeast-organism staining consistent with Cryptococcus neoformans/gatti. The patient subsequently underwent treatment for this infection, along continued treatment for multiple myeloma. To our knowledge this is the first known case of cryptococcal sinusitis in a patient with neoplastic disease. Imaging represents an important tool to differentiate fungal infection from neoplasm in the immunocompromised patient population. As the population of immunocompromised patients continues to grow, the relevance of this diagnosis as well as the use of alternative imaging modalities is becoming more important in clinical practice.
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PMID:Invasive granulomatous cryptococcal sinusitis in an adult with multiple myeloma. 2781 78

Opportunistic fungal infections are rare but life-threatening in immunocompromised patients. We discuss a case of an immunocompromised patient with multiple myeloma who presented with shortness of breath, fever, ocular palsy, and hemiplegia. She was found to have influenza A respiratory tract infection complicated by invasive aspergillosis and mucormycosis. Investigation revealed invasive fungal sinusitis and cerebritis. Serum biomarkers, beta-d-glucan, and galactomannan failed to detect fungal disease. We believe that our case is unique as there is limited data available regarding the occurrence of invasive fungal infections after Influenza infections. Furthermore, it highlights the hurdles in the diagnosis of disseminated fungal infection.
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PMID:Aspergillus and Rhizopus Fungal Coinfection in a Patient With Multiple Myeloma. 3253 69


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