Characteristics of patients with myelomatous pleural effusion. A systematic review

Abstract

BackgroundMyelomatous pleural effusion (MPE) is rare in multiple myeloma, and therefore its characteristics are not well defined. MethodsA systematic review (4 online databases) was conducted of articles describing the clinical characteristics of patients with MPE, pleural effusion's biochemical characteristics and treatment efficacy. We analyzed isolated cases and small retrospective series. ResultsWe included 98 articles with a total of 153 patients with MPE. The median age was 62 years, and the ratio of males to females was 1.7:1. The most common symptoms were dyspnea (98.8%), bone pain (100%) and chest pain (95.3%), and the most relevant abnormal laboratory test results were anemia (90.1%) and renal failure (53.8%). MPE was predominantly unilateral (63.9%) and covered more than two-thirds of the hemithorax (54.5%). The pleural fluid (PF) had a haematologic/serohaematologic appearance (87%) and met the criteria for lymphocytic (78.6%) exudate (94.7%). The most cost-effective diagnostic procedures were pleural cytology (95.9%) and the observation of a monoclonal peak in the PF (94.7%). In a significant proportion of patients (54.7%), the MPE did not respond to treatment, and the best response was achieved when chemotherapy (with/without corticosteroids) was combined with therapeutic thoracentesis, chest drainage or pleurodesis. ConclusionsMPE predominates in middle to older age men, is symptomatic and is usually unilateral. PF is an exudate with a hemorrhagic appearance, and the most cost-effective diagnostic procedure is pleural cytology. Treatment response is unfavorable in more than half of patients.