BACKGROUND. The objectives of this study were to assess the status and clinical course of patients with multiple myeloma based on the direct visualization of changes in medullary, extramedullary, and focal osteolytic myeloma involvement by using whole‐body, low‐dose, multidetector computed tomography (WBLD‐MDCT) and to compare those results with an assessment based on conventional hematologic parameters. METHODS. Between June 2002 and December 2005, WBLD‐MDCT scans were obtained from 131 consecutive multiple myeloma patients with or without therapy, resulting in a total of 439 examinations. The number and size of osteolytic lesions and the number, size, and density of focal or diffuse medullary and extramedullary lesions were analyzed. Those results and the results at follow‐up were related to current laboratory tests for myeloma. Validation was achieved by the combined reading of both hematologic and radiologic parameters at follow‐up. RESULTS. Association between both diagnostic modalities was assessed by using European Group for Blood and Marrow Transplantation response criteria, resulting in an agreement of κ = 0.70. Hematologic parameters proved correct in 84% of all examinations, whereas WBLD‐MDCT resulted in correct assessment in 94% of all examinations. Among 91 of 439 examinations that produced discrepant findings (21%), WBLD‐MDCT proved correct in 68 of 91 examinations (75%), as determined at further follow‐up (95% confidence interval, 66–83%; P = .000003; sign test). The combination of WBLD‐MDCT with conventional, laboratory‐based follow‐up resulted in significantly greater diagnostic accuracy compared with laboratory testing alone. CONCLUSIONS. The results from this study indicated that WBLD‐MDCT represents a reliable, imaging‐based method for the direct monitoring of the course of patients with myeloma under specific therapy, and it showed good concordance with established hematologic parameters. It is noteworthy that, in the current investigation, WBLD‐MDCT proved to be even more reliable than conventional, laboratory‐based follow‐up. Cancer 2007. © 2007 American Cancer Society.
Acute kidney injury (AKI) is frequent in multiple myeloma (MM) patients and strongly affects prognosis, with particularly poor outcomes in patients requiring hemodialysis. Introduction of the novel therapeutic agents to MM therapy has improved myeloma response and renal outcome. This case series reviews the efficacy of combined systemic and extracorporeal therapy to further optimize time to light chain (serum-free light chain (sFLC)) reduction and renal recovery in MM patients with dialysis-dependent AKI (n = 19). High cut-off (HCO) hemodialysis for extracorporeal sFLC removal was initiated in parallel to chemotherapy. Combined therapy resulted in early sFLC response after a median of 13 (range 4-48) days and 6 (3-22) HCO hemodialysis sessions. Time to sFLC response was shorter in patients recovering renal function. Median time to dialysis independence was 15 (4-64) days. By intent-to-treat analysis, sustained renal recovery was achieved in 73.7% (77.8% adjusted for death) of patients. In multivariate analysis, duration of AKI prior to initiation of therapy was an independent predictor of renal functional outcome. Combining HCO hemodialysis for extracorporeal sFLC elimination and effective chemotherapy is a novel treatment strategy allowing for early and sustained sFLC reduction and a high proportion of renal recovery in these patients. Timely diagnosis and onset of therapy is essential for improving renal outcome.
We aimed to establish the role of hyperattenuating medullary abnormalities detected by whole-body non-enhanced low-dose multidetector CT (WBLD-MDCT) in multiple myeloma (MM) patients referred for primary evaluation. 50 consecutive patients with untreated Stage I (n(I) = 11), Stage II (n(II) = 10) and Stage III (n(III) = 29) MM underwent WBLD-MDCT for staging. The number and size of osteolysis, as well as haematologic parameters including paraprotein and beta2-microglobulin levels, were assessed and related to the number, size and density of medullary abnormalities assumed to represent myeloma involvement. Bone marrow abnormalities were found in 2/11 (18%) Stage I, 6/10 (60%) Stage II and 20/29 (69%) Stage III myeloma patients, and did not parallel the incidence of osteolysis. Patients with medullary lesions had higher levels of immunoglobulin A (median, 4730 mg dl(-1) vs 1520 mg dl(-1)), light-chain proteinuria (median, 690 mg dl(-1) vs 214 mg dl(-1)) and IgG paraprotein (median, 3270 mg dl(-1) vs 2610 mg dl(-1)) compared with patients without medullary lesions. In patients with medullary abnormalities, levels of serum beta2-microglobulin were significantly higher than in patients without detectable marrow infiltrates (median, 4.3 mg dl(-1) vs 2.4 mg dl(-1); p = 0.0015). In conclusion, medullary abnormalities visualized by WBLD-MDCT are encountered in all stages of myeloma, including cases without osteolysis. They are associated with significantly elevated serum levels of paraprotein (reflecting tumour mass) and beta2-microglobulin, a prospective prognostic marker for myeloma. The nature and possible prognostic significance of medullary abnormalities detected by WBLD-MDCT therefore warrants further investigation.
Thrombocytopenia, fever, and acute renal failure are characteristic features of nephropathia epidemica, the predominant hantavirus infection in Europe. However, clinical presentation and blood cell counts may point to other disorders, such as a hematologic disease, particularly when impairment of renal function is not evident. This differential diagnosis often results in further extensive and unnecessary testing. We describe 3 patients with hantavirus infection with no renal failure, in whom a hematologic disorder was initially suspected. Serologic testing of hantavirus finally unraveled the mystery, and outcome of the patients was excellent. It is conceivable that similar cases often remain undiagnosed. Thus, testing for hantavirus should always be considered in cases of thrombocytopenia and fever of unknown origin, especially in areas endemic for the infection.
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