Cases Of Multiple Myeloma Research Articles

Usability of German hospital administrative claims data for healthcare research: General assessment and use case of multiple myeloma in Munich university hospital in 2015–2017

ObjectivesTo assess the usability of German hospital administrative claims data (GHACD) to determine inpatient management patterns, healthcare resource utilization, and quality-of-care in patients with multiple myeloma (PwMM).MethodsBased on German tertiary hospital’s claims data (2015–2017), PwMM aged >18 years were included if they had an International Classification of Diseases, Tenth Revision, code of C90.0 or received anti-MM therapy. Subgroup analysis was performed on stem cell transplantation (SCT) patients.ResultsOf 230 PwMM, 59.1% were men; 56.1% were aged ≥65 years. Hypertension and infections were present in 50% and 67.0%, respectively. Seventy percent of PwMM received combination therapy. Innovative drugs such as bortezomib and lenalidomide were given to 36.1% and 10.9% of the patients, respectively. Mean number of admissions and mean hospitalization length/patient were 3.69 (standard deviation (SD) 2.71 (1–16)) and 12.52 (SD 9.55 (1–68.5)) days, respectively. In-hospital mortality was recorded in 12.2%. Seventy-two percent of SCT patients (n = 88) were aged ≤65 years, 22.7% required second transplantation, and 89.8% received platelet transfusion at a mean of 1.42(SD 0.63 (1–3)).ConclusionGHACD provided relevant information essential for healthcare studies about PwMM from routine care settings. Data fundamental for quality-of-care assessment were also captured.

Application de la radiothérapie dans les hémopathies malignes : expérience du pôle d’onco-hématologie de l’hôpital Dalal Jamm de Dakar

INTRODUCTION: The treatment of hematologic malignancies is based on chemotherapy and/or targeted therapies. The place of radiotherapy was once highly debated because it could be responsible for significant late toxicity, but the progress of recent years has made practices evolve in the direction of the integration of radiotherapy in the multidisciplinary management of these malignant hemopathies. .We report the profile of malignant haematological pathologies, the indications for radiotherapy and its impact in improving the care of patients in the onco-hematology center of the Dalal Jamm Hospital in Dakar. MATERIALS AND METHODS: All patients treated with curative or palliative radiotherapy in the radiotherapy department of Dalal Jamm Hospital in Dakar for a malignant hemopathy duly diagnosed between June 2018 and July 2021 were retrospectively included. RESULTS: From June 2018 to July 2021, 20 patients with malignant hemopathy were treated in the radiotherapy department. These 11 men and 9 women had a mean age of 50.1 years ± 15.6. The main malignant haematological pathologies were lymphomas (6 cases) including 2 cases of non-Hodgkin's type, 4 cases of multiple myeloma, 6 cases of solitary plasmacytoma, 2 cases of multiple myeloid associated with a solitary plasmacytoma, 1 case of chronic lymphoid leukemia and 1 case of myeloid splenomegaly. The indication for radiotherapy was curative in the cases of Hodgkin lymphoma and solitary plasmacytoma and palliative in the remainder. The dose was 36 Gy in 18 fractions for Hodgkin lymphoma, 30 Gy in 10 fractions for cases of solitary plasmacytomas in exclusive irradiation, 20 Gy in 5 fractions for plasmacytomas in consolidation after resection and 8 Gy in one fraction for analgesic treatments. With a mean follow-up of 23 months, we noted three deaths including the case of myeloid splenomegaly, chronic lymphoid leukemia and one case of multiple myeloma associated with a solitary plasmacytoma. The rest of the patients were in remission. CONCLUSION: Radiotherapy, with to its technical progress, has gained in precision and retains a place in the multidisciplinary management of hematologic malignancies. KEYWORDS: Hematologic malignancies; Radiotherapy; Senegal.

Radiomic Analysis of Positron-Emission Tomography and Computed Tomography Images to Differentiate between Multiple Myeloma and Skeletal Metastases.

Multiple myeloma and extensive lytic skeletal metastases may appear similar on positron-emission tomography and computed tomography (PET-CT) in the absence of an obvious primary site or occult malignancy. Radiomic analysis extracts a large number of quantitative features from medical images with the potential to uncover disease characteristics below the human visual threshold. This study aimed to evaluate the diagnostic capability of PET and CT radiomic features to differentiate skeletal metastases from multiple myeloma. Forty patients (20 histopathologically proven cases of multiple myeloma and 20 cases of a variety of bone metastases) underwent staging 18F-fluorodeoxyglucose PET-CT at our institute. A total of 138 PET and 138 CT radiomic features were extracted by manual semi-automatic segmentation and standardized. The original dataset was subject separately to receiver operating curve analysis and correlation matrix filtering. The former showed 16 CT and 19 PET parameters to be significantly related to the outcome at 5%, whereas the latter resulted in 16 CT and 14 PET features. Feature selection was done with 7 evaluators with stratified 10-fold cross-validation. The selected features of each evaluator were subject to 14 machine-learning algorithms. In view of small sample size, two approaches for model performance were adopted: The first using 10-fold stratified cross-validation and the second using independent random training and test samples (26:14). In both approaches, the highest area under the curve (AUC) values were selected for 5 CT and 5 PET features. These 10 features were combined and the same process was repeated. The quality of the performance of the models was assessed by MSE, RMSE, kappa statistic, AUC, area under the precision-recall curve, F-measure, and Matthews correlation coefficient. In the first approach, the highest AUC = 0.945 was seen with 5 CT parameters. In the second approach, the highest AUC = 0.9538 was seen with 4 CT and one PET parameter. CT neighborhood gray-level different matrix coarseness and CT gray-level run-length matrix LGRE were common parameters in both approaches. Comparison of AUC of the above models showed no significant difference (P = 0.9845). Feature selection by principal components analysis and feature classification by the multilayer perceptron machine-learning model using independent training and test samples yielded the overall highest AUC. Machine-learning models using CT parameters were found to differentiate bone metastases from multiple myeloma better than models using PET parameters. Combined models using PET and CECT data showed better overall performance than models using only either PET or CECT data. Machine-learning models using independent training and test sets were performed on par with those using 10-fold stratified cross-validation with the former incorporating slightly more PET features. Certain first- and second-order CT and PET texture features contributed in differentiating these two conditions. Our findings suggested that, in general, metastases were finer in CT and PET texture and myelomas were more compact.

PB2120: HIV AND MALIGNANT HEMOPATHIES

Background: Hematological malignancies remain a major cause of morbidity and mortality in patients living with the HIV virus (PLHIV). Their training would be linked to several factors. Aims: The objective of our study is to describe the main types of blood diseases malignancies and their epidemiological characteristics in PLHIV followed up internal medicine department – ​​clinical hematology of the CHU Ibn Sina in Rabat. Methods: This is a retrospective and descriptive observational study of PLHIV having an associated hematological malignancy. Results: Among the 1035 PLHIV followed, we collected 11 patients with blood disease malignant (1.06%). The average age was 40.6 years (29 – 73 years). The F/M sex ratio was 0.1. 90% of patients were in stage C. Heterosexual transmission was the main mode of contamination (100%). They had as antecedent: chronic smoking 60%; pulmonary tuberculosis 30%; drug addiction 10%. The regimens of ARVs received corresponded to international recommendations: 90% received triple therapy of the TNF+FTC+EFZ type and 10% received DTG+TNF+3TC. HIV infection was discovered incidentally in 73% of PLHIV during the pre-therapeutic assessment of the management of hemopathy. their viral status revealed an average viral load of 6.2 log (4.3 – 6.5 log). the mean CD4 count was estimated at 148 (78 – 243 cells/mm3). 27% of patients had an average follow-up time of 4 months. they had an undetectable viral load and persistently low CD4 count (< 200 /mm3). We identified 9 cases (82%) of NHL: 2 DLBCL (22%), 2 plasmablastic lymphomas (22%), 3 Burkitt’s lymphomas (34%), 1 T-cell lymphoma angioimmunoblastic (11%), 1 T/NK lymphoma (11%), 1 case of classic HL at mixed cellularity (9%), and 1 case of multiple myeloma (9%). The other syndromes lymphoproliferative or myeloproliferative were not found in our series. The advanced Ann Arbor stage (III – IV) was found in 90% of PLHIV. All patients received first-line poly-chemotherapy: 40% of patients received an R-DAEPOCH, 20% CHOEP, 20% R-CHOP, 10% BEACOPP, 10% CTD. 10% of patients required a second line of therapy (R-DHAOX) then a third line (Ciclosporine). The evolution was favorable with remission complete in 30% of patients. A negative viral load was obtained in 80% of PLHIV. We mourn 6 deaths: 5 deaths were related to hematological malignancy, and 1 was related to opportunistic infections complicating HIV after poor adherence to ARVs. Summary/Conclusion: Our series is mainly distinguished by a low frequency of the HIV association – hematological malignancy, but also by the diversity of these hemopathies. The persistence of a low CD4 count in PLHIV on ARVs should encourage look for possible hematological malignancies. Early introduction of ARVs is mandatory before starting any chemotherapy. The prognosis mainly depends type and stage of hemopathies.

PB1993: MULTIPLE MYELOMA BRAZILIAN REGISTER- HOW ABOUT THE TRANSPLANT ELIGIBLE PATIENTS?

Background: The Brazilian Multiple Myeloma Group (GBRAM) developed an electronic database platform with the intention of prospectively registering the multiple myeloma (MM) cases diagnosed in the Brazilian healthcare system and analyzing the disease characteristics, treatments patterns and the outcomes. Aims: Describe characteristics, treatment and outcomes from MM transplant eligible patients belonging to GBRAM prospective database plataform. Methods: This is a prospective, multicenter data-based platform. This analysis was focused on the MM transplant eligible patients (TE). The MM patients diagnosed after January 1, 2018 have been included. The eligibility criteria were: intent-to-treat (ITT) MM patients, aged over 18 years and under care in any healthcare system (private and public). All clinical and laboratory data, prognostic profiling, treatment patterns and responses, adverse events and survival were compiled. The data were analyzed with the NCSS® 2020 software. This project is registered in the Brazilian study platform (CAAE-05340918.3.1001.8098). Results: A total of 915 patients were registered with transplant intent-to-treat. The median age was 59 (25 - 80) years and 475 (51.9%) were male. A total of 413 (45.1%) of the patients were nonwhite. According to the (ECOG) rating at diagnosis: 0 = 217 (32.9%), 1 = 222 (33.7%), 2 = 110 (17.6%), 3 = 71 (10.85%) and 4 = 39 (5.9%). The ISS 1, 2, and 3 were 209 (25.7%), 228 (28.1%) and 303 (37.2%), respectively, and 72 (8.9%) not available (NA). The respective isotypes were: 466 (52.5%) IgG, 168 (18.9%) IgA, 158 (17.8%) free-light chain, 15(1.7%) non-secretor and 68 (7.7%) NA. Stratifying the intent-to-treat TE patients according to healthcare system, 178 (19.5%) and 737 (80.5%) were from the private and public systems, respectively. Among the patients who underwent the transplant, 89 (66.4%) belonged to the private system and 154 (32.6%), the public. The induction chemotherapy treatments in the public system were: 366 (59%) based on thalidomide, 226 (36.5%) based on bortezomib and 21 (3.4%) based on daratumumab. In the private system the induction treatments were: 7 (4.2%) based on thalidomide, 135 (75.8%) based on bortezomib and 31 (18.8%) based on daratumumab. After a median follow-up of 18.4 months, the complete response (RC) rate post transplant was 13.5% for the public and 28.7% for the private system, respectively (p < 0.01). Summary/Conclusion: This prospective register enrolled patients diagnosed since January 2018 and is of a nationwide scope. Our register, in addition to identifying the epidemiological characteristics of the Brazilian multiple myeloma patients, demonstrates the treatment standards at the public and private institutions. Patients eligible for transplant have greater access to the procedure at private institutions than at public ones (p < 0.001), as well as to better chemotherapy induction protocols. The complete remission (CR) rate following transplant was greater in the private system than in the public and, with a longer follow-up, it will be possible to demonstrate the impact of the treatments on the survival in patients eligible for transplant.

PB2036: RISK AND PATTERN OF INFECTIONS IN NEWLY DIAGNOSED PATIENTS OF MULTIPLE MYELOMA VACCINATED UPFRONT AGAINST PNEUMOCOCCUS &amp; INFLUENZA

Background: Infections contribute to an early mortality risk of 15 percent in newly diagnosed multiple myeloma(NDMM) cases. There is a limited literature on the type of infections in fully vaccinated NDMM patients. Aims: To study epidemiology, clinical profile and predictors of infection in NDMM who are immunised against pneumococci and influenza. Methods: NDMM patients were prospectively studied for 6 months for the pattern of infections. All patients were vaccinated with pneumococcal and Influenza vaccine at diagnosis. PJP prophylaxis and fluconazole prophylaxis was given for patients receiving high dose steroids while acyclovir was given to all. Infections were classified as microbiologically defined, clinically defined and fever of unknown focus according to definitions published by the International Immunocompromised Host Society. Severity of infections were graded according to the NCI CTCAE Ver5. Results: Forty-eight NDMM patients with a median age 55 years comprising of 26 males and 22 females were enrolled. Renal involvement was noted in 42% of enrolled patients and two third of them required renal replacement therapy. ISSIII and R–ISS III were 70.8 % and 62.5 % respectively. 85% had poor performance status(ECOG ≥2) at baseline. RVD was the most common regimen (37%)used. 6 patients received daratumumab based regimen. Treatment response of atleast VGPR was seen in 97 % of NDMM patients. A total of 19 episodes of infections were observed during 6 months. All episodes of infections were reported in the first 45 of myeloma diagnosis(Median 6 days; Range 0–45). Ten of these episodes of infection were diagnosed during the initial evaluation for myeloma defining events. Microbiological diagnosis was possible in 63 %. Commonest infectious agent was COVID 19(n=8) followed by Gram negative bacteria (n=5) viz E.coli and Klebsiella pneumoniae. None of the eight patients who developed COVID 19 infection had received COVID vaccine as they antedated the operationalisation of national guidelines for immunisation. Respiratory and the urinary tract were the most common focus of infection. All critically ill COVID patients succumbed to progressive respiratory failure and all patients with mild and moderate COVID illness recovered uneventfully. Early mortality in our cohort of forty eight patients was twenty percent(n=10). Three fourths of infections in our cohort were Grade≥3 severity. A total of seven deaths were attributable to infectious diseases in this cohort of NDMM patients. Imune paresis was seen in eighty four percent of patients at diagnosis. On follow up at 6 months; immune paresis had persisted in only thirty seven percent. Regression analysis of variables with odds of infection is shown in Table 1 Baseline BMI<18.5 kg/m2; albumin<3g/dl and ISS or R–ISS stage ≥ 2 was found to be have statistically significant odds of predicting infection risk in the cohort of patients. The choice of myeloma regimen, presence of high risk cytogenetics and response to therapy did not correlate with increased odds of infection in our cohort. Image:Summary/Conclusion: Conclusion In this prospective study of NDMM patients vaccinated against pneumococci and influenza at baseline; infection attributable early mortality was 14.5 %. Advanced stage of presentation, hypoalbuminemia and baseline BMI < 18.5 kg/m2 correlated with increased odds of infection. COVID vaccination and COVID appropriate behavioural practices may mitigate COVID related outcomes including deaths in myeloma patients.

CNV assessments associated with outcome distinctions for adult and pediatric cancers: Loss of BRCA1 in neuroblastoma associates with a lower survival probability

DNA copy number variations (CNV) are common in cancer development, however, CNV detection approaches that include assessments of small CNVs, for example, due to locally misaligned sister chromatid exchanges, have not been substantially applied. Using such approaches, CNVs have been detected, in the cancer setting, for regulatory elements common to both proliferation and apoptosis effector genes, but no linkage has yet been made to cancer patient clinical data. Thus, we hypothesized that copy number losses, including local copy number losses, of specific apoptosis effector genes would be associated with reduced survival. Both whole genome and whole exome files were processed for validations and consistency. Results indicated lower late-stage survival for multiple myeloma cases representing reduced BAD and CASP3 copies, as well as for lung adenocarcinoma cases representing reduced BAX and CASP3 copies. Results also indicated that neuroblastoma (NBL) cases representing reduced copies of CASP9 and BRCA1 had reduced overall survival probabilities, with the BRCA1 results being particularly notable due to previous reports of BRCA1 inactivating mutations in NBL. Overall, novel approaches to assessing CNVs offers the promise of establishing patient risk stratifications and of identifying single genes or other small spaces in the genome where a CNV may be linked to specific outcomes.

Does a Multiple Myeloma Polygenic Risk Score Predict Overall Survival of Patients with Myeloma?

Genome-wide association studies (GWAS) of multiple myeloma in populations of European ancestry (EA) identified and confirmed 24 susceptibility loci. For other cancers (e.g., colorectum and melanoma), risk loci have also been associated with patient survival. We explored the possible association of all the known risk variants and their polygenic risk score (PRS) with multiple myeloma overall survival (OS) in multiple populations of EA [the International Multiple Myeloma rESEarch (IMMEnSE) consortium, the International Lymphoma Epidemiology consortium, CoMMpass, and the German GWAS] for a total of 3,748 multiple myeloma cases. Cox proportional hazards regression was used to assess the association between each risk SNP with OS under the allelic and codominant models of inheritance. All analyses were adjusted for age, sex, country of origin (for IMMEnSE) or principal components (for the others) and disease stage (ISS). SNP associations were meta-analyzed. SNP associations were meta-analyzed. From the meta-analysis, two multiple myeloma risk SNPs were associated with OS (P &lt; 0.05), specifically POT1-AS1-rs2170352 [HR = 1.37; 95% confidence interval (CI) = 1.09-1.73; P = 0.007] and TNFRSF13B-rs4273077 (HR = 1.19; 95% CI = 1.01-1.41; P = 0.04). The association between the combined 24 SNP MM-PRS and OS, however, was not significant. Overall, our results did not support an association between the majority of multiple myeloma risk SNPs and OS. This is the first study to investigate the association between multiple myeloma PRS and OS in multiple myeloma.

Multiple Myeloma Case with Pericardial Involvement

Multiple myeloma (MM) is an atypical plasma cell dyscrasia in the bone marrow (BM) which accounts for about 10% of all hematological malignancies. While extramedullary disease (EMD) is reported at a ratio of 6-20% in MM, cardiac and pericardial involvement is rare. In the event of cardiac or pericardiac involvement, on the other hand, progression into cardiac tamponade takes place in 60% of the patients. We will present a very rare case of recurrence with pericardial involvement after autologous stem cell transplantation

Frequency of t(4;14) in Multiple Myeloma and Its Clinicopathological Correlation

Objective: To determine the frequency of t(4;14) in multiple myeloma in Pakistani population and study the clinicpathological correlation of this translocation in myeloma patients.&#x0D; Study Design: Cross sectional study.&#x0D; Place and Duration of Study: This study was conducted at Armed Forces Institute of Pathology from Jun 2017 to May 2018 using non probability convenience sampling technique.&#x0D; Methodology: A total of 53 newly diagnosed cases of multiple myeloma were included in the study. Patients were diagnosed as having multiple myeloma based on diagnostic criteria of international myeloma working group. Fish analysis was done for t (4; 14). Workup for end organ damage /myeloma defining events was done.&#x0D; Results: Out of 53 patients, 16 (30%) were females and 37(70%) were males; the mean age of the patients was 59.81 ± 11.34 range from 37 to 87 years. Fish for t(4;14) was positive in eight (15%) patients while negative in forty-five (85%) patients. Patients with positive results have significantly deranged renal function tests and raised beta 2 micoglobulins levels as compare to t(4;14)negative patients.&#x0D; Conclusions: Detection of t (4:14) in multiple myeloma patients not only has diagnostic value but is important in risk stratification of these patients and thus effect treatment decision.

Assessing frailty using comprehensive geriatric assessment in older patients with hematologic malignancy.

The incidence of hematologic malignancy increases with age; thus, the number of older patients who require intensive chemotherapy is expected to increase with the aging population. In Korea, 61.8%, 59.3%, 47.0%, and 46.7% of newly diagnosed cases of multiple myeloma, myelodysplastic syndrome, myeloproliferative disorder, and non-Hodgkin lymphoma, respectively, occurred in patients aged >65 years in 2018. Health status among older patients, defined by frailty, age-related syndrome of physiological decline and increased vulnerability, is associated with adverse health outcomes. Health status is highly heterogeneous among older patients, and treatment outcomes vary according to frailty and physiologic age rather than chronologic age. Comprehensive geriatric assessment (CGA) is a multidimensional and multidisciplinary diagnostic and treatment process that identifies multiple domains, including functional status, cognition, comorbidities, medications, socioeconomic status, and nutritional status, to develop a coordinated plan to improve treatment-related outcomes and quality of life. Frailty can be assessed with CGA findings, and CGA is considered the “gold standard of care” for frail, older patients. Through CGA, unidentified problems can be assessed, and pre-emptive and non-oncologic interventions can be delivered. CGA is an objective and reliable tool for predicting further treatment-related complications and identifying patients for whom intensive chemotherapy with curative intent is appropriate. CGA should be considered a routine practice before starting treatment planning in older patients diagnosed with hematologic malignancies who require intensive chemotherapy. Further study is needed to allocate individualized treatment plans or multidisciplinary geriatric interventions according to CGA results.

Prognostic role of TNF alpha, LT alpha, MDR1 and codon 72 Tp53 gene polymorphisms on multiple myeloma Egyptian patients

Multiple Myeloma (MM) is a type of hematologic malignancies that characterized by uncontrolled plasma cell proliferation. So, the diagnosis depends on the increased numbers of abnormal, immature, or atypical plasma cells in the bone marrow, and many patients present with laboratory abnormalities, such as anemia, hypercalcemia, renal disease, and high protein levels in blood and urine. We aim to analyze the association of some genetic polymorphisms and its effect on the overall survival (OS) among MM patients. Subjects and methodsWe analyzed TNFα 308 G/A, TNFα 238 G/A, LTA252A/G, MDR 3435 C/T, MDR 1236 C/T, TP53 Arg72Pro in 110 multiple myeloma case and 112 healthy controls. The genotyping was performed using PCR-RFFLP. ResultsIn TNF308 AA genotype and A allele were significantly lower with protective effect against MM development (OR=0.318, 0.742) respectively. LTA 252, GG genotypes had lower frequency in MM cases compared to control group with protective effect against MM development (OR=0.361). In TNF238, MDR1 3435 C/T, TP53 codon 72 polymorphism we didn’t find any statistically significant relation between MM and control groups. In Uni and multivariant analysis show ISS, IgG, TP53 Arg72ProGC+CC as risk predictors of shorter OS.But TNFα-308 GA+AA and LTA 252 AG+GG were considered as predictors of longer OS in MM cases. ConclusionOur result confirms the association of TNF-308, LTA and TP53 codon72 with prognostic outcome in MM. As a result, we suggest involving these genes as a biomarker test to predicts the risk and prognostic outcome of MM. Also, we recommend further investigations of these polymorphisms in MM especially LTA and TP53codon 72 polymorphism which have very low reported studies. MicroAbstractMany genes can affect the prognosis of MM. We analyzed some of them in 110 MM and 112 controls using PCR-RFLP. TNFα-308 AA and LTA-252 GG had lower frequency while MDR1–1236 TT had higher frequency in MM. TNFα-308 AA and LTA-252 GG were significantly associated with higher OS but TP53 codon72 polymorphism CC with lower OS. These findings confirm the association of these genes with prognostic outcome in MM.

Fluorodeoxyglucose Positron Emission Tomography Imaging in Pneumocystis jiroveci Pneumonia.

Fever or pyrexia of unknown origin (PUO) is commonly defined as body temperature higher than 38.3°C on several occasions for a period of at least 3 weeks with uncertain diagnosis after initial routine obligatory investigations. In most cases of PUO, there is an uncommon presentation of a common disease which includes infection, noninfectious inflammatory diseases, malignancy, and miscellaneous causes. We present an interesting case of a 48-year-old man with PUO, who is a known case of multiple myeloma on immunosuppressive therapy, where 18F-fluorodeoxyglucose positron emission tomography-computed tomography was able to detect occult cause of infective etiology.

Multiple Myeloma Case Developed During the Use of the Teriparatide

Multiple Myeloma Case Developed During the Use of the Teriparatide

A rare cause of anaemia in multiple myeloma

Multiple myeloma is a neoplastic plasma cell dyscrasia. Anaemia in multiple myeloma is usually related to many factors, of which the commonest cause being anaemia of chronic disease. We reported a 67 years old hypertensive male presented with low back pain and loss of appetite. Investigations revealed severe anaemia and elevated total serum protein with albumin/globulin (A/G) reversal (1:4). Bone marrow aspiration revealed plasma cell dyscrasia. Skeletal survey evaluation showed multiple osteolytic lesions. Serum protein electrophoresis revealed M spike in gamma globulin region with immunofixation suggestive of IgG and kappa monoclonal gammopathy. He was diagnosed as a case of multiple myeloma.. On evaluating the cause of severe anaemia, interestingly various findings suggestive of Autoimmune hemolytic anaemia (AIHA) were found. Packed red blood cell transfusion along with steroids was done for correction of severe anaemia. Review of literature showed that only about 4% of AIHA patients had multiple myeloma. We reported a rare case of multiple myeloma who presented with AIHA.

Isomer-specific biomarker discovery in multiple myeloma with dual-derivatized N-glycans.

As one of the most important post-translational modifications, protein glycosylation plays vital role in various physiological processes. With multitudinous glycosyltransferases, N-glycans present structural diversity in linkages and branching styles. Structure-specific glycan profiling may provide more potential biological information than compositional profiling. In this work, N-glycans released from human serum samples were derivatized with reduction and methylamination prior to profiling using nanoLC-ESI-MS with PGC as stationary phase. In addition, α 2-3 neuraminidase was also applied for distinguishing the linkage types of sialic acid corresponding to different isomers. Relative abundances of 280 isomeric N-glycans were compared and 20 isomers showed significant difference between multiple myeloma cases and healthy controls. ROC was performed to assess the significantly altered isomeric glycans and 6 AUCs have exceeded 0.80, providing high diagnostic accuracy for MM. PCA is also employed to establish the differences among sample sets. Furthermore, these specific isomers have also been used for early detection of multiple myeloma, presenting important clinical application value. Isomer-specific biomarker discovery in multiple myeloma with dual-derivatized N-glycans.

Genomics of Plasma Cell Leukemia.

Plasma cell leukemia (PCL) is a rare and highly aggressive plasma cell dyscrasia characterized by the presence of clonal circulating plasma cells in peripheral blood. PCL accounts for approximately 2-4% of all multiple myeloma (MM) cases. PCL can be classified in primary PCL (pPCL) when it appears de novo and in secondary PCL (sPCL) when it arises from a pre-existing relapsed/refractory MM. Despite the improvement in treatment modalities, the prognosis remains very poor. There is growing evidence that pPCL is a different clinicopathological entity as compared to MM, although the mechanisms underlying its pathogenesis are not fully elucidated. The development of new high-throughput technologies, such as microarrays and new generation sequencing (NGS), has contributed to a better understanding of the peculiar biological and clinical features of this disease. Relevant information is now available on cytogenetic alterations, genetic variants, transcriptome, methylation patterns, and non-coding RNA profiles. Additionally, attempts have been made to integrate genomic alterations with gene expression data. However, given the low frequency of PCL, most of the genetic information comes from retrospective studies with a small number of patients, sometimes leading to inconsistent results.

79 Hypercalcemia: A Rare Case of Multiple Myeloma During Pregnancy

79 Hypercalcemia: A Rare Case of Multiple Myeloma During Pregnancy

An Unusual Exhibit of Cervical Plasmacytoma with Trademarks of Cervical Myelopathy

We reported a case of a 76-year-old man presented with cervical neck pain since 16 days. He had also weakness of all limbs since 4 days, insidious in onset. MRI Cervical spine revealed an expansile lesion in C2-C3 vertebral level and C2 lamina pathological fracture. He was suspected as a case of multiple myeloma. However, the histopathology report revealed morphological features compatible with Plasmacytoma.

Multiple Myeloma with Plasmacytoma of the Lung - A Rare Entity

Multiple myeloma is a malignant proliferation of plasma cells that typically presents in the bone marrow.Extramedullaryplasmacytoma (EMP) represents an unusual and characteristically progressive malignancythat can arise outside the bone marrow. The occurrence of multiple myeloma with plasmacytoma of thelung is very unusual. Herein, we report a case of multiple myeloma with plasmacytoma of the lungdiagnosed by CT-guided FNAC and bone marrow trephine biopsy. J MEDICINE 2022; 23: 96-100