Clinical Characteristics and Prognosis of Multiple Myeloma With Myelomatous Pleural Effusion: A Retrospective Single-Center Study

Abstract

Objectives: Myelomatous pleural effusion is a rare presentation of extramedullary disease in multiple myeloma, which has been reported with dismal prognosis. We aimed to explore whether it has distinctive clinical characteristics and outcomes compared to other anatomic locations of extramedullary involvements. Methods: Multiple myeloma patients diagnosed at our institution from 2010 to 2020 were retrieved retrospectively. In total, 42 pairs of patients with and without extramedullary disease were enrolled, including 13 with myelomatous pleural effusion. The clinical and laboratory parameters were collected and compared between different groups. Prognostic effect of myelomatous pleural effusion was assessed in cox regression model and Kaplan–Meier curves. Results: Myelomatous pleural effusion patients presented a higher level of β2-microglobulin ( P = .041), greater prevalence of multisites extramedullary lesions (69.2% vs 38.0%, P = .036) and International Staging System stage III (76.9% vs 44.8%, P = .016). Median overall survival was 60.6 months in patients without extramedullary disease versus 35.0 months in patients with extramedullary disease ( P = .045). Notably, median overall survival was 13.0 months in myelomatous pleural effusion patients versus 37.0 months in other extramedullary disease patients with a significant difference ( P = .029). Furtherly, multivariate analysis recognized myelomatous pleural effusion as an independent prognostic indicator (Hazard ratio: 2.669, 95% CI [1.132-6.293], P = .025). Conclusion: Myelomatous pleural effusion patients presented heavier tumor burden and worse outcomes than other extramedullary diseases.

Massive Myelomatous Pleural Effusion With Contralateral Mediastinal Shift: A Unique Presentation of Extramedullary Myeloma

“…Extramedullary MM of any type is associated with worse outcomes than MM with intramedullary disease only [ 8 ]. MPE in particular carries a significantly worse prognosis than other forms of extramedullary plasmacytoma, with the exception of CNS extramedullary plasmacytoma, which has the highest mortality [ 9 ]. Prior research indicates a median survival of approximately three to four months from the development of MPE [ 10 , 11 ].…”

A Case of Plasmablastic Multiple Myeloma With Extramedullary Disease Manifesting as a Myelomatous Pleural Effusion

“…Pleural effusion of various causes can be found in up to 13% of cases, including parapneumonic, reactive, renal, CHF, TB, and MPE, with MPE rendering a poorer outcome in comparison. A study found median overall survival in MPE was 13.0 months, compared to 37.0 months in other EMD and 60.6 months in MM without EMD, with MPE patients being found to have a higher level of beta 2-microglobulin tumor burden and greater multisite extramedullary lesions [ 5 ].…”

“…Myelomatous pleural effusion (MPE) is a possible manifestation of EMD. Although MPE only occurs in <1% of patients with MM, it has been associated with a poorer prognosis than MM alone or combined with EMD in other tissues and a marked decrease in survival from the onset of pleural involvement [ 5 ]. It is therefore clinically important to identify and treat pleural effusions caused by EMD in a timely manner.…”

Quiz case: Abnormal haematopoietic cells in pleural effusion

“…As for complex karyotypic abnormalities, MPE in patients with multiple myeloma is associated with high‐risk disease. MPE is associated with poor prognosis and short survival times, with a median between 2.4 to 13 months 9,11,12 …”

“…MPE is associated with poor prognosis and short survival times, with a median between 2.4 to 13 months. 9,11,12…”