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)

We performed the first successful syngeneic bone marrow transplantation (BM Txp) in a patient with multiple myeloma. The patient and his normal identical twin are 50-year-old physicians. Prior to BM Txp, a partial remission was achieved with 1 year of continuous low dosage melphalan and prednisone therapy. Immediately before BM Txp, high dose cyclophosphamide and total body irradiation were administered in an attempt to eradicate the residual tumor. For 17 months after BM Txp, the patient was asymptomatic and hematologically normal although a low concentration of serum monoclonal IgGK persisted. In the 18th month, recurrence of bone pain and increase in the monoclonal IgG signalled exacerbation of the disease. Chemotherapy was resumed and again produced objective and subjective evidence of response. This study demonstrates the feasibility and potential usefulness of syngeneic BM Txp in myeloma.
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PMID:Identical twin marrow transplantation in multiple myeloma. 621 15

We report the long-term effects of dichloromethylene diphosphonate (CI2MDP), an inhibitor of bone resorption, on the skeletal lesions in multiple myeloma. Thirteen patients received either CI2MDP 1600 mg/d (seven patients) or a placebo (six patients) in addition to other chemotherapy, and the effects of treatment were followed over a period of up to 18 months in a double-blind study. CI2MDP treatment resulted in a marked reduction in bone pain, with no progression of radiologic skeletal lesions during the first year. This contrasted with a clinical deterioration and the occurrence of new fractures in half of the patients receiving the placebo. Two patients with hypercalciuria and increased excretion of hydroxyproline before treatment had normalized values following CI2MDP. Finally, iliac crest bone biopsies showed a reduction in osteoclast number after CI2MDP administration. We conclude from these results that CI2MDP could be of use in preventing the bone loss that occurs in multiple myeloma.
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PMID:Long-term effects of dichloromethylene diphosphonate (CI2MDP) on skeletal lesions in multiple myeloma. 621 70

Peripheral polyneuropathy (PPN) is a rare complication of plasma cell neoplasia (PCN), occurring in less than one percent of the patients. Fifty-four such patients (including our 5) were reviewed. There were 42 men (78%) and 12 women (22%) aged 28 to 72 years. Forty-nine percent of patients were younger than 51 years at the time of diagnosis. The initial complaints were different from those observed in multiple myeloma in general, and were related to polyneuropathy in 80% of the patients. PPN was usually of a mixed sensory-motor type and most often involved all four extremities. Skeletal pain was less common than in myeloma in general, occurring initially in 15% and at diagnosis in 45% of the patients. In 21 patients, reversibility of neuropathy was observed. These patients were compared to those with irreversible neuropathy and found to be relatively younger and more aggressively treated with irradiation and modern chemotherapy. Elevated sedimentation rate was uncommon. Less than half of the patients had anemia, and six patients, all with osteosclerotic lesions, had polycythemia. Azotemia was detected in 44% of the cases. No hypercalcemia was observed in 21 examined patients. M components were usually of IgG class, and when the light chains of M components were examined they were invariably of lambda type. Often the level of M component was below 2.0 g/dl. In all patients the bone marrow was infiltrated with immature, abnormal-looking plasma cells, but the infiltrate was often limited to one or a few foci. Solitary plasmacytoma was observed in 14 patients. No anemia, hypercalcemia or azotemia was recorded in this group. Eight patients had serum M components. Bone marrow aspirate was usually normal. In seven patients definite reversibility of PPN was observed after irradiation of plasmacytoma. Twelve patients presented with osteosclerotic lesions (22%), 18 with both osteosclerotic and osteolytic lesions (33%) and 13 with osteolytic lesions. Forty-two percent of the patients had less than three visible lesions in the skeleton. Eleven patients had either osteoporosis or radiologically normal skeleton. The mean survival from the first symptom was about 28 months and from the diagnosis 20 months. The five-year survival was 21% and 20%, respectively. These observations highlight the differences between PCN with PPN and multiple myeloma without PPN.
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PMID:Plasma cell neoplasia with peripheral polyneuropathy. A study of five cases and a review of the literature. 624 19

A 58-year-old man with multiple myeloma presented with a 3-month history of a sensation of occipital pressure, transient blurring of vision and increased bone pain. Funduscopic examination revealed disc swelling, tortuous veins and superficial retinal hemorrhages simulating early hyperviscosity syndrome. Clinical investigation and computerized tomography, however, indicated that an intracranial plasmacytoma was the cause of his papilledema. Cobalt 60 beam therapy and vincristine were added to his treatment regimen. Seven weeks later the intracranial tumour had almost totally disappeared. Symptomatic cerebral compression from an intracranial plasmacytoma associated with systemic disease is uncommon. The diagnosis and management are reviewed.
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PMID:Intracranial plasmacytoma associated with multiple myeloma. 649 5

Management of hematologic disorders in older patients must often be weighed in a setting of decreased physiological reserves and concurrent illnesses. Anemia in the elderly should never be attributed to old age. Even a mild anemia in collusion with multiple physical and mental problems may tip the balance for those previously able to cope with their disabilities. Iron deficiency anemia and the anemia of chronic disease are the most common types of anemia in the elderly. Nutritional anemias due to folate or vitamin B(12) deficiency are treatable and should not be overlooked. Newer chemotherapy regimens for acute nonlymphocytic leukemia have been effective in many older patients. Decisions to treat are sometimes difficult, often depending on the aggregate of coexistent physical and mental disorders. The most prevalent type of leukemia in the elderly is chronic lymphocytic leukemia. A benign asymptomatic course requires no therapy, but aggressive disease requires treatment. Multiple myeloma should be suspected in an elderly person who has both unexplained anemia and bone pain. After definitive diagnosis, phlebotomy therapy should be considered for both polycythemia vera and secondary erythrocytosis to reduce blood viscosity and increase cerebral blood flow.
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PMID:Hematologic disorders in the elderly. 680 66

3 patients with multiple myeloma developed hyperkalemic hypoaldosteronism and renal insufficiency while receiving indomethacin for bone pain. Claims are made that indomethacin has been responsible for these complications, possibly by inhibiting prostaglandin biosynthesis. Careful observation of myeloma patients during administration of this agent and perhaps other prostaglandin inhibitors appears warranted.
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PMID:Indomethacin-induced hyperkalemia and renal failure in multiple myeloma. 681 55

A new case of IgE myeloma is described. Patient G.M., a 60-year-old woman, complained with a 3-months' history of generalized bone pain, weight loss, profound weakness and severe anemia. A bone survey revealed multiple lytic lesions, and a heavy replacement by plasma cells was disclosed in the bone marrow examination of a sternal sample. In addition, an IgE serum M-component and gamma-type Bence Jones proteinuria were identified by immunochemical studies. The disease course was rapid, death occurring within 6 months of clinical onset. A molecular weight of 188,500 daltons was calculated for the purified protein G.M., whereas the molecular weights of its subunits were found to be 72,000 for the epsilon chains and 43,000 for the gamma chain dimers. This case is compared with 15 reported cases of IgE monoclonal gammapathy, an expanding clinical and laboratory spectrum emerging from the review of the literature.
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PMID:The expanding spectrum of clinical and laboratory features of IgE myeloma. (Report of a case and review of the literature). 720 93

The effectiveness of bone scintigraphy for the detection of skeletal involvement in multiple myeloma was studied in 27 patients. Bone scintigrams and roentgenographic surveys were performed every 6 months for a period of 5 years or less, depending on the final course of the disease. This group was compared with a group of 100 patients with prostatic cancer at the time of initial diagnosis. In the myeloma group, roentgenographic skeletal surveys indicated bone involvement with greater specificity and sensitivity at the time of the initial diagnosis, in follow-up studies, and in the evaluation of bone pain than did scintigrams. In contrast to results in prostatic cancer, the bone scan added little to the management of patients with multiple myeloma.
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PMID:Scintigraphic evaluation of the skeleton in multiple myeloma. 721 77

A comparative study of radionuclide bone scanning and skeletal radiology in patients with multiple myeloma revealed four principal findings: (i) There were no cases of negative bone scans with positive skeletal radiographs. (ii) Lytic bone lesions were seriously underestimated by bone scans. (iii) Bone scans tended to pick up lesions in ribs missed on the skeletal surveys. (iv) Patients with bone pain were more likely to have positive bone scans and skeletal radiographs than asymptomatic patients.
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PMID:Multiple myeloma: radiology or bone scanning? 723 11

An elderly patient with simultaneous hyperparathyroidism and light chain myeloma is described. The patient presented with hypercalcemia, bone pain, pathologic fractures, and cystic and lytic bone lesions. The problems of diagnosis and management are discussed. It is recommended that elderly patients with hypercalcemia and bone lesions should have not only diagnostic studies for hyperparathyroidism but also serum and urine immunoelectrophoresis to detect multiple myeloma or plasma cell neoplastic variants. Surgery is indicated for the hyperparathyroidism. Chemotherapy and localized radiotherapy usually control the myelomatous disease.
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PMID:Parathyroid adenoma and light chain myeloma. 727 22


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