Multiple Myeloma Presenting Research Articles

Presentation of multiple myeloma with absolute lymphocytosis? Coexistence of CLL & multiple myeloma

The presence of a chronic lymphocytic leukemia and multiple myeloma in a single patient is very rare. Multiple myeloma is a plasma cell disorder, whereas CLL (Chronic Lymphocytic Leukemia) is the mature B-cell lymphocytes disorder. We described a 50 year-old man who presented with fatigue and lethargy of 1 month duration. He was found to be anemic, with lymphocytosis, decreased renal function, high calcium level, and conspicuous M-Spike on serum electrophoresis. Furthermore, peripheral smear & bone marrow biopsy demonstrated two distinct hematological malignancies on morphological basis.

Multiple myeloma presenting as a pathological rib fracture in a primary health care center and its diagnostic challenges during the COVID 19 pandemic

Multiple Myeloma commonly presents with a myriad of symptoms, signs and abnormal laboratory findings namely bone pains, pathological fractures, lytic bone lesions, anaemia, high ESR, hypercalcemia, raised globulin and presence of monoclonal band in serum/urine. Here, we present a 54-year-old gentleman whose initial presentation was a pathological rib fracture. However, review of his past medical history revealed gout (now asymptomatic) and abnormal laboratory findings that helped us to subsequently diagnose as Multiple Myeloma. The importance of simple investigations like ESR when managing patients with nonspecific symptoms in primary care, listening and looking for signals that suggest an alarming aetiology, following up of investigations and the continuity of care assured by the electronic medical record is highlighted by this case report. Keywords: Multiple myeloma, pathological rib fracture, telemedicine, early diagnosis, primary care

Bacterial meningitis as the first presentation of multiple myeloma

Bacterial meningitis as the first presentation of multiple myeloma

An unusual presentation of multiple myeloma

Multiple myeloma commonly presents as anemia, renal failure, bone pain, and infections. Presentation with epistaxis is extremely rare, and hence myeloma as the etiologic factor is seldom considered. We report the case of a patient who initially presented with recurrent epistaxis and then with myasthenia. It was only when he developed acute kidney injury 4 months after the initial presentation with epistaxis that a diagnosis of multiple myeloma was made.

Central Nervous System Infiltration by Multiple Myeloma: Two Case Reports of a Rare Clinical Presentation

Introduction: We present two case reports of rare and aggressive presentation of multiple myeloma, one of the most common hematological malignancies. To our knowledge, there are very few case reports of meningeal invasion by multiple myeloma, denoting the importance of describing the clinical features and the complementary investigation necessary to develop a better approach to these patients. Cases presentation: In case 1, we present a 64 years old patient with vague symptoms of headache associated with exacerbated tendinous reflexes and previous diagnosis of multiple myeloma. In case 2, a 58 years old presents with auricular plenitude, headache and encephalopathy, and a medical antecedent of multiple myeloma. Both were diagnosed with different sites of multiple myeloma central nervous system invasion, case 1 with predominant meningeal infiltration and case 2 with intraparenchymal infiltration. Conclusion: Analyzing these cases, we conclude that besides the rarity of the meningeal accometiment in myeloma patients compared to other hematological disorders, the identification of clinical signals and symptoms suggestive of this invasion is necessary to provide better health care to these patients.

A Case of Multiple Myeloma Presenting With Resistant Hypercalcemia

A Case of Multiple Myeloma Presenting With Resistant Hypercalcemia

Amyloid cast nephropathy: A rare presentation of multiple myeloma–associated light chain amyloidosis

Introduction: Monoclonal immunoglobulins can cause a variety of histologic patterns of kidney injury, depending on the physicochemical properties. Multiple myeloma manifests more often as light-chain nephropathy. On the other hand, light-chain amyloidosis leads to glomerular and vascular amyloid deposits, but a less common presentation with amyloid casts has also been described. Rarely, more than one histologic pattern can be present in the same patient. Case report: We report a case of a 73-year-old man, diagnosed with multiple myeloma that 8 months after achieving partial response to chemotherapy develops acute kidney injury and nephrotic syndrome. Kidney biopsy revealed features of light-chain nephropathy, amyloid cast nephropathy, and glomerular and vascular amyloid deposits. Immunofluorescence was positive for IgA (++) and lambda chains (+++) and negative for kappa chains. After the diagnosis of multiple myeloma-associated light-chain amyloidosis, chemotherapy was initiated; unfortunately, the patient died 1 month after the diagnosis. Conclusion: Amyloid casts, isolated or accompanied by other renal or extra-renal amyloid deposits, are another form of tubular toxicity caused by dysproteinemias and should be systematically screened in kidney biopsies.

Amyloid Gallbladder as an Initial Presentation of Multiple Myeloma (MM): A Rare Presentation

We present a rare case of Amyloid (AL) deposition in the gallbladder as an initial presentation of MM. The patient was a 92-year-old female who was admitted to the hospital with right upper quadrant pain. Computed Tomography (CT) abdomen and pelvis showed stone in the distal common bile duct and mildly distended gallbladder with wall thickening, she underwent ERCP for stone extraction followed by cholecystectomy. A postoperative histological examination revealed congo red stain positive for amyloidosis, positive apple-green birefringence under polarized light, and was typed as AL. Further workup, showed a lytic bone lesion on the skeletal survey and bone marrow core biopsy showed hypercellular bone marrow with increased plasma cells confirming the diagnosis of MM.

Safety of Daratumumab Combined with Bortezomib, Cyclophosphamide and Dexamethasone for the Treatment of Patients with Multiple Myeloma Presenting with Extramedullary Disease during the COVID-19 Pandemic

Safety of Daratumumab Combined with Bortezomib, Cyclophosphamide and Dexamethasone for the Treatment of Patients with Multiple Myeloma Presenting with Extramedullary Disease during the COVID-19 Pandemic

Prediction of Malignant Cell Infiltration Patterns with Texture Features of Biopsy-Correlated Positron Emission Tomography of Osteolytic Lesions in Multiple Myeloma

Prediction of Malignant Cell Infiltration Patterns with Texture Features of Biopsy-Correlated Positron Emission Tomography of Osteolytic Lesions in Multiple Myeloma

S3169 An Unusual Cause for Persistent Anemia: Gastric Amyloidosis

Introduction: This case highlights an unusual presentation of amyloidosis and multiple myeloma which was discovered during endoscopic and histological evaluation of the gastrointestinal tract for persistent anemia. Thus, it is important to consider these underlying malignancies during work up of anemia with proper biopsies and staining. Case Description/Methods: 67 year old woman with Zenker’s diverticulum and chronic gastrointestinal symptoms attributed to IBS presented for persistent iron deficiency anemia of Hgb 10 and rectal bleeding. A 2 cm sigmoid colon Hamartomatous polyp and a 4 mm cecal tubular adenoma were resected during colonoscopy with normal terminal ileum. While rectal bleeding resolved, surveillance colonoscopy in 6 months showed no residual polyp. Due to persistent anemia despite iron replacement, she underwent an EGD which showed a grossly normal stomach and mild duodenitis. Random biopsies of antrum and duodenum showed acellular pink/amorphic matrix in lamina propria and muscularis mucosa with green birefringence on congo red staining, consistent with amyloid. The patient was referred to hematology/oncology for further work up of amyloidosis. SPEP and immunofixation showed IgA monoclonal gammopathy and free light chain assay revealed 2401.9 mg/L kappa light chains, with a kappa/lamda ratio of 343.13. UPEP showed M spike with positive Bence Jones protein, kappa type. Bone marrow biopsy revealed 13% plasma cells. Patient was diagnosed with amyloid light chain amyloidosis and multiple myeloma and began treatment with systemic chemotherapy. Later in the course, patient had recurrence of rectal bleeding. Repeat colonoscopy was normal, but EGD showed multiple small gastric ulcers which was felt to be the sequelae of gastric amyloidosis. Discussion: Gastric amyloidosis as the presenting pathology of multiple myeloma is rare. Symptoms include abdominal pain, bleeding, motility issues, and malabsorption. Endoscopic findings most commonly show ulcerations, mucosal erosions, and submucosal hematomas. Because these findings are nonspecific, it can be difficult to diagnose unless the clinician has high suspicion for the disease. In our patient’s case, the initial investigation was prompted due to persistent anemia. Unlike the typical mucosal abnormalities seen in gastric amyloidosis, our patient had grossly normal mucosa. Only after biopsies of the stomach and duodenum to rule out H. pylori and celiac disease were performed did we discover the patient had amyloidosis and ultimately multiple myeloma.

Large Abdominal Mass: An Unusual Presentation of Multiple Myeloma

Large Abdominal Mass: An Unusual Presentation of Multiple Myeloma

S1821 Colon Mass: An Uncommon Presentation of Multiple Myeloma

S1821 Colon Mass: An Uncommon Presentation of Multiple Myeloma

A case of multiple myeloma presenting with rapidly progressive glomerulonephritis

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MM-217: Successful Management of an Unusual Presentation of Multiple Myeloma without Transplantation

>A 45-year-old male presented to the ER with fatigue and severe chest, scapula, and shoulder pain. The blood test showed anemia (Hb=6 g/dL) and hypercalcemia (Ca+=10.9 mg/dL). A bone Marrow biopsy was consistent with MM. A PET scan was done and showed diffuse large bone tissue. He was diagnosed with IgA kappa MM. Induction of chemotherapy with bortezomib 1.3 mg/m2, thalidomide 200 mg, steroids 4 mg, and zoledronic acid 4 mg IV was initiated with a very good partial response after 2 cycles, with regression of the bone lesions. The patient refused to have an autologous stem cell transplant (ASCT). He completed the VTD protocols, and he was maintained on thalidomide 100 mg/day, dexamethasone, and zoledronic acid. After 8 months of maintenance, noting that the patient was not compliant, a new PET scan showed massive bone lesions and tissue lesions progression. Bone marrow aspiration and biopsy with protein electrophoresis and immunofixation were performed, confirming disease relapse. After a thorough discussion with the patient, we decided to start second-line treatment with KRD, carfilzomib 20 mg/m2, REVLIMID 25 mg/day 1–21, and dexamethasone 40 mg. A subsequent evaluation of response by PET scan was performed after 2 cycles showed VGPR. The patient still refusing the ASCT due to financial reasons. He completed 6 cycles of KRD and remained under maintenance on REVLIMID.

Periocular Presentation of Solitary Plasmacytomas and Multiple Myeloma.

To describe patients with periocular solitary extramedullary plasmacytoma (SEMP) and multiple myeloma (MM), together with an estimate of the risk of progression from SEMP to MM. A retrospective case-note review for patients seen between 1978 and 2020, examining demographics, presentation, imaging, pathology, management, and outcome. Twenty patients (10 male; 50%) presented at a mean age of 60.9 years, with an average symptom duration of 4.5 months. Ten (50%) patients had known systemic myeloma at ophthalmic presentation (the MM group) and, on average, they presented one decade earlier than those with occult MM discovered after orbital biopsy (p = 0.06); the majority (9/15; 60%) of patients with MM were female, whereas there was a male bias (4/5; 80%) with SEMP (p = 0.30). Most tumors (15/20; 75%) were within the anterior part of the orbit, especially superolaterally (16 patients; 80%), and the soft-tissue mass often appeared to "explode" from the frontal bone or greater wing of the sphenoid (16/20; 80%). Full treatment details were known for 19 patients: 6 (32%) had solely orbital radiotherapy, 4 (21%) chemotherapy, 6 (32%) combined chemoradiation, and 3 (16%) had combined chemoradiation with stem-cell transplant (Table 3). After an average follow up of 58 months, 1/5 (20%) patients with SEMP and 11/15 (73%) with MM had tumor-related death. The overall survival probability for all 20 patients with periocular plasmacytoma was 34% at 5 and 10 years, with MM patients having a worse outlook (27% 5-year, and 18% 10-year survival) compared with SEMP (53% survival at 5 and 10 years) (p = 0.18). None of the 5 patients with SEMP progressed to systemic MM over an average follow up of 9.1 years. Although 50% patients with periocular plasmacytoma appear to have a SEMP at ophthalmic presentation, a half of these patients were found to have occult MM within 6 months of biopsy. Of those without systemic disease around the time of biopsy, none developed MM over an average follow up of more than 9 years.

Multiple Myeloma Presenting as a Fistulous Rectal Mass Eroding Into the Retroperitoneum.

Multiple Myeloma Presenting as a Fistulous Rectal Mass Eroding Into the Retroperitoneum.

An Atypical Kidney-Related Presentation of Multiple Myeloma.

An Atypical Kidney-Related Presentation of Multiple Myeloma.

Multiple Myeloma Presenting as a Left Clavicular Swelling – A Case Report

Multiple Myeloma Presenting as a Left Clavicular Swelling – A Case Report

Clinical presentation of multiple myeloma by race/ethnicity and Asian subgroup in an integrated healthcare system.

e20012 Background: Several US studies have evaluated ethnic differences in patients with multiple myeloma (MM), but few have focused on populations other than non-Hispanic Whites and Blacks. We examined ethnic differences in a contemporary cohort of MM patients and their presenting laboratory findings in a large, insured, community-based population, including findings across Asian American subgroups. Methods: Using the Kaiser Permanente Northern California (KPNC) Cancer Registry, we identified all new cases of MM from 2010-2018 and obtained data on age, sex, race/ethnicity, Asian subgroup, and presenting hemoglobin, calcium, and estimated renal function (eGFR derived from serum creatinine) from health plan databases. Moderate to severe anemia was defined by hemoglobin <10 g/dL, hypercalcemia by calcium >11 mg/dL, and chronic kidney disease (CKD) by eGFR: stage 3 (eGFR 30-59) and stages 4-5 (eGFR <30). MM incidence was estimated using membership denominators. Results: There were 2224 new MM cases (mean age 68y, 60% male) in 2010-2018, with an annual MM incidence of 7.9-9.8/100,000. Table 1 compares presentation by race/ethnicity. Non-Whites (45%) were more likely to present at age <65 than non-Hispanic Whites (30%, p<0.01). Black (43%) and Asian (39%) adults were more likely to present with hemoglobin <10 g/dL than non-Hispanic Whites (27%, p<0.01); Black adults were more likely to present with hemoglobin <10 g/dL than Hispanic adults (31%, p=0.02). Among the primary Asian subgroups, proportions with hemoglobin <10 g/dL were 38% (East Asian), 43% (Filipino), and 45% (South Asian). Blacks were more likely to present with CKD stage 4-5 (19.5%) than other races/ethnicities (p=0.04); differences between White vs non-White or Asian vs non-Asian were not significant. In Asians, 12.7% (South Asian) and 19.0% (Filipino, East Asian) presented with CKD 4-5. Asians were least likely to present with hypercalcemia (6.7%, p=0.03), and this was similar for Asian subgroups. Conclusions: We observed ethnic differences in MM presentation in a large integrated healthcare system. Blacks were more likely to have CKD stage 4-5 and hemoglobin <10 g/dL than non-Hispanic Whites. Asians were more likely to have CKD stage 4-5 than non-Hispanic Whites but least likely to have hypercalcemia. This is one of the first studies to identify Asian subgroups and examine variation across East Asians, Filipinos, and South Asians. Analyses examining ethnic differences in survival among MM patients are in progress.[Table: see text]