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)

One hundred sixty-eight patients with primary systemic amyloidosis (AL) were identified. Median survival after diagnosis was 12 months and ranged from 4 months for patients presenting with congestive heart failure to 50 months for those presenting with peripheral neuropathy only. Utilizing the proportional-hazards model in a stepwise multivariate fashion to evaluate the simultaneous influence of putative risk factors as of diagnosis revealed that congestive heart failure, urine light chain, hepatomegaly, and multiple myeloma were the major factors adversely affecting survival during the first year after diagnosis. Serum creatinine, multiple myeloma, orthostatic hypotension, and monoclonal serum protein were the most important variables adversely affecting survival for patients surviving 1 year. These models were used to categorize patients according to the variables in the models into low-, moderate-, and high-risk groups for the first year after diagnosis and separately for subsequent years. The influence of these variables on survival is important in stratification of patients randomized to prospective clinical trials.
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PMID:Primary systemic amyloidosis: multivariate analysis for prognostic factors in 168 cases. 371 98

Pharmacokinetic studies in 11 patients with multiple myeloma were undertaken on the first and last days of one course of chemotherapy. The drug was administered PO in single doses of 6-14 mg daily. Melphalan concentrations were determined by high-performance liquid chromatography. The interpatient variability of pharmacokinetic parameters noted by other authors was observed. Regression analysis showed a significant positive correlation between the elimination rate constant for melphalan and renal function (P = 0.003). The form of the line which describes the overall elimination rate constant for melphalan is given by the equation: Kel = 5.67 X 10(-3) + [4.90 X 10(-5) X GFR]. There was also a significant negative correlation between renal function and the area under the plasma melphalan concentration/time curve (P = 0.006). In vitro stability studies of melphalan in plasma at 37 degrees C and pharmacokinetic data suggest that hydrolysis and renal clearance are the major mechanisms of melphalan elimination. This work shows quantitatively the relationship between renal function and drug elimination and how the data may be used in predicting melphalan half-life from creatinine clearance.
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PMID:Renal function in the elimination of oral melphalan in patients with multiple myeloma. 371

The presenting clinical features, response to treatment and survival duration of 26 consecutive multiple myeloma patients with renal failure at diagnosis were investigated. All but 1 of the patients had high tumour cell mass stage, as identified by one (3 cases) or more (22 cases) of the criteria defined by Durie and Salmon. Survival length of azotaemic patients was significantly shorter than that of stage III patients with normal renal function (median: 4 months vs 41 months, respectively, P less than 0.0005), and was positively affected by reversal of renal failure following treatment (P less than 0.0005). Of the 26 patients, 56% achieved reversal of renal failure. Recovery of normal renal function was prompt in most of the cases and appeared to be independent from both M component type and pretreatment serum creatinine levels. Finally, it was shown that patients with reversible renal impairment but with myeloma unresponsive to alkylating agents had early recurrence of impaired renal function and a shorter life expectancy than patients with a significant decrease in tumour cell mass.
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PMID:Renal failure in multiple myeloma. A study of the presenting findings, response to treatment and prognosis in 26 patients. 374 98

The authors study the serum lactate dehydrogenase (LDH) activity in multiple myeloma patients in relation to survival, plasma cells bone marrow infiltration, and creatinine and paraprotein serum values. Twenty five patients seen between 1979 and 1983 were studied considering two groups, one with LDH values higher than 100 IU/1 and the other with LDH values lower than 100 IU/1. Patients having more than 100 IU/1 showed a more marked bone marrow infiltration. Paraprotein concentration was higher in patients having less than 100 IU/1. No correlation was observed for the other factors considered.
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PMID:[Serum LDH and myeloma. Correlation with the degree of bone marrow infiltration]. 384 55

The levels of serum beta 2 microglobulin, blood urea concentration, serum creatinine, haemoglobin and performance status have been measured in 476 patients in the Medical Research Council's 4th trial for myelomatosis. Levels of serum beta 2 microglobulin were also subsequently measured in 208 patients who achieved a stable "plateau" condition. Serum beta 2 microglobulin levels, uncorrected for serum creatinine, were found to be the single most powerful prognostic variable available at presentation. Multivariate analysis showed that only the addition of haemoglobin levels could improve upon this and the improvement, though statistically significant (P = 0.006), appeared to be of much less clinical value. The prognostic value of serum beta 2 microglobulin at plateau appeared to be equally large for a given difference in value, but the variability between patients was much less at that time. Serum beta 2 microglobulin would appear to be a key measurement for assessing the prognosis and response to treatment in patients with myelomatosis.
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PMID:The prognostic value of serum beta 2 microglobulin compared with other presentation features in myelomatosis. 389 5

Serum beta 2 microglobulin levels (B2M) were evaluated before and during chemotherapy in 97 previously untreated patients with multiple myeloma. Pretreatment values were useful in confirming tumor mass grade, and marked reductions following chemotherapy correlated well with the onset of remission. No gain was evident from correcting the B2M for the level of serum creatinine. A pretreatment B2M value greater than 6 mg/L correlated with a low response rate and was the most important variable that predicted a short survival time.
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PMID:Beta 2 microglobulin in multiple myeloma. 390 32

Urinary psi excretion is independent of the main indices of tumour activity in myelomatosis (serum paraprotein, serum beta 2-microglobulin, serum creatinine and urinary light chain production). The mean (+/- s.d.) psi at presentation was 40.7 +/- 22.6 nmol. mumol ucr-1, compared to 25.4 +/- 4.8 nmol. mumol ucr-1 in controls. Urinary psi levels at presentation are significantly related to prognosis, the higher the level the poorer the prognosis. However, when these levels have been stratified according to the corresponding level of serum beta 2m, the level adds little as a prognostic factor.
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PMID:Urinary pseudouridine excretion in myelomatosis. 390 86

A series of 21 patients with multiple myeloma and a survival of more than 5 years was compared to another series of 70 cases of myeloma, which all died within less than 5 years. The statistical analysis of these two groups revealed six factors with a significant prognostic value. The population with a long term survival presented: a low incidence of large tumour masses (stage III according to Durie and Salmon's classification): 24 per cent compared with 72 per cent p less than 0.01); a frequency on asymptomatic or minimally symptomatic forms of 29 per cent versus 7 per cent in the control series (p less than 0.001); a haemoglobin level of 7.3 mmol/l versus 6.4 mmol/l (p less than 0.01); a low beta-2-microglobulin level (4 mg/l versus 11 mg/l) (p less than 0.02); a usually normal serum creatinine level (p less than 0.05). Retrospectively, the authors also observed that the response to treatment constituted an essential prognostic factor (69 per cent response compared with 20 per cent) (p less than 0.001). The serum calcium, the immunological type, the level of monoclonal component and the marrow plasmocytosis did not differ between the two groups. The authors consider all of these parameters, together with the calcitonin hypocalcaemia test to be useful in three situations: the therapeutic decision in minimally symptomatic patients, the choice between single agent or combination chemotherapy, the establishment of criteria of remission and suspension of treatment.
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PMID:[Multiple myeloma with 5-year survival. Study of initial prognostic factors. Role of beta-2-microglobulin]. 390 65

Beta 2-microglobulin (B2-m) determinations in serum have recently been introduced as a method of stratifying patients suffering from multiple myeloma. Conflicting results from several studies prompted us to study retrospectively the correlation of B2-m with presenting features and disease stage, as well as the prognostic value of B2-m, in 87 myeloma patients. Significant correlations were found between B2-m and presenting features such as haemoglobin level, serum calcium level and total body myeloma cell mass. The strongest correlation existed between B2-m and serum creatinine (r = 0.68). B2-m did not discriminate between the different disease stages as defined by Durie and Salmon, nor between myeloma Stage IA and monoclonal gammopathy of undetermined significance (MGUS). Considered alone, B2-m was found to have prognostic value in terms of survival. This correlation disappeared after correction for serum creatinine level and tumour load (multivariate analysis). Furthermore, changes in tumour load during therapy were not reflected in changes in B2-m levels, thereby rendering B2-m levels invalid as tumour marker. Our findings indicate no value for B2-m determinations in the staging and follow-up of myeloma patients.
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PMID:Serum beta 2-microglobulin: a real improvement in the management of multiple myeloma? 391 76

The treatment of hypercalcemia remains a common problem in the management of many patients with cancer. We have used intravenously administered etidronate disodium as a therapy for hypercalcemia in 26 patients with malignant disease. Patients with persistent hypercalcemia despite adequate hydration and a serum creatinine level less than or equal to 1.5 mg/dL were allowed on study. Treatment consisted of intravenously administered etidronate disodium at 7.5 mg/kg/day in 250 mL of saline infused over two hours on 1, 2, 3, or 4 consecutive days. The serum calcium level in 19 (73%) of 26 patients returned to the normal range with a mean response time of 3 +/- 2 days. Similar response rates were seen in patients with a variety of tumors, including breast cancer, non-small-cell lung cancer, and multiple myeloma. Intravenously administered etidronate appears to be safe and effective therapy for hypercalcemia in patients with malignant disease.
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PMID:Intravenous etidronate in the management of malignant hypercalcemia. 391 67


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