Hyperviscosity syndrome secondary to a myeloma‐associated IgG1κ paraprotein strongly reactive against the HIV‐1 p24 gag antigen

Jin, David; Nowakowski, Maja; Kramer, Martin; Essex, David W.

doi:10.1002/1096-8652(200007)64:3<210::aid-ajh13>3.3.co;2-r

Cited by 7 publications

(11 citation statements)

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“…Also, several case reports have been presented in which the monoclonal antibody was shown to react with HIV-specific antigens, suggesting that HIV antigens may act as super-antigens and directly stimulate the proliferation of malignant plasma cells. [8][9][10][11] Furthermore, immunodeficiency caused by HIV-induced T-cell depletion was found to increase the risk of developing several types of cancer, including MM. [3] Over the past three decades, much has changed in the treatment and outcomes of patients suffering from both MM and HIV.…”

Section: Researchmentioning

confidence: 99%

“…[8] Three other studies reported paraproteins that were specific for the HIV p24 and p31 antigens, and all paraproteins were of the IgGκ type. [9][10][11] Lefrère et al [36] screened 341 asymptomatic HIV patients for over 6 years and found 11 cases of monoclonal gammopathy; again all para proteins were of the IgGκ and IgGλ type. These data may suggest a possible role for antigenic stimulation directly by the HIV virion or other antigens in the pathogenesis of plasma-cell neoplasms in HIVassociated cases, and may indicate a causative role for HIV or an HIVassociated infection in MM.…”

Section: Multiple Myeloma Stagingmentioning

confidence: 99%

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Concomitant HIV infection in newly diagnosed multiple myeloma patients is hard to recognise and should be tested for routinely in areas of high endemicity

et al. 2017

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Background. Over the past three decades much has changed in the treatment and outcomes of patients suffering concurrently from both multiple myeloma (MM) and HIV. While the prevalence of MM appears to be higher in HIV-positive individuals than in those who are uninfected, early recognition of patients suffering from both diseases is difficult and little information is available on their demographics and clinical presentation. Objective. To compare the presenting features of HIV-positive patients diagnosed with MM with those of HIV-negative patients. Methods. A single-centre, retrospective cohort study included 16 HIV-positive and 73 HIV-negative patients diagnosed with MM, in order to compare variables related to the clinical presentation of both conditions. Results. HIV-positive patients presented with MM at a significantly younger age, and had fewer osteolytic lesions, less renal impairment and lower neutrophil counts. Disease stage, gender, pathological fractures, bone marrow plasmacytosis, plasmacytomas and lymphocyte counts were comparable, emphasising the difficulty of identifying these patients. The HIV-positive patients had relatively high CD4 counts and a low prevalence of abnormal Freelite kappa/lambda ratios. All HIV-positive patients presented with paraproteins of the immunoglobulin G (IgG) type, implying a possible relationship between MM and an IgG response to HIV antigens. Conclusions. On the basis of our findings and literature on the treatment of both diseases, we suggest that HIV be tested for routinely in younger MM patients, especially in areas with a high prevalence of HIV. The integration of our results into the sparse knowledge on the role of HIV infection-related MM provides possible new insights into the interaction between these diseases.

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Section: Researchmentioning

confidence: 99%

Section: Multiple Myeloma Stagingmentioning

confidence: 99%

Concomitant HIV infection in newly diagnosed multiple myeloma patients is hard to recognise and should be tested for routinely in areas of high endemicity

et al. 2017

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“…MM in the context of HIV has some features that distinguish this plasma cell disorder from the typical presentation seen in non-HIV patients. HIV-related MM typically affects patients under the age of 40 and can manifest with atypical and aggressive features [142], with reports of large malignant effusions [143], hyperviscosity [144], and extramedullary plasmacytomas presenting in unusual locations [145]. The prognosis is generally poor, with reported patients dying within weeks to months of diagnosis, many from treatment-related toxicity [141].…”

Section: Multiple Myelomamentioning

confidence: 99%

“…Some HIV-related paraproteins have monoclonal specificity to HIV antigens, suggesting that viral proteins, such as the p24 gag protein, directly underlie the clonal selection of B cells [144,148,149].…”

Section: Multiple Myelomamentioning

confidence: 99%

“…It is anticipated that the immune reconstitution afforded with HAART will enable further successful attempts with dose-intense regimens. Lower-dose regimens, including melphalan [144,153,154], anthracycline [155,156], and thalidomide-based protocols [157] have been reported in the literature, with variable clinical effects [141]. A recent review of all published cases did not identify a superior treatment protocol, but suggested a possible association of HAART therapy with prolonged survival [141].…”

Section: Multiple Myelomamentioning

confidence: 99%

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AIDS-Related Malignancies: Emerging Challenges in the Era of Highly Active Antiretroviral Therapy

2005

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Human immunodeficiency virus (HIV)-infected patients are at increased risk of developing cancer, particularly in the later stages of acquired immune deficiency syndrome (AIDS). LEARNING OBJECTIVESAfter completing this course, the reader will be able to:1. Describe the pathogenesis and clinical presentation of Kaposi's sarcoma, with a special emphasis on Kaposi's sarcoma herpesvirus/human herpesvirus-8, and outline treatment approaches.2. Discuss the pathogenesis, epidemiology, and treatment of AIDS-related lymphomas.3. Discuss the increasing incidence of non-AIDS-defining malignancies such as Hodgkin's lymphoma and plasma cell disorders in patients with HIV infection.4. Explain how, in the era of highly active antiretroviral therapy, both AIDS-related lymphoma and Hodgkin's lymphoma patients may be treated with therapies previously reserved for their immunocompetent counterparts.Access and take the CME test online and receive 1 hour of AMA PRA category 1 credit at CME.TheOncologist.com CME CME by guest on May 11, 2018http://theoncologist.alphamedpress.org/ Downloaded fromThis material is protected by U.S.

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Multiple myeloma as the first manifestation of acquired immunodeficiency syndrome: a case report and review of the literature

Pouli¹,

Lemessiou

Rontogianni

et al. 2001

Ann Hematol

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Various hematologic malignancies and solid tumors are increasingly diagnosed in patients with human immunodeficiency virus (HIV) infection and may be the presenting manifestation of acquired immunodeficiency syndrome (AIDS). Multiple myeloma, however, has never been reported as the presenting manifestation of AIDS. We report on a 34-year-old man who presented with back pain, paresthesias, paraparesis, vertebral bony disease, and an associated soft tissue mass. Biopsy of the mass revealed immature plasmacytes with very faint cytoplasmic expression of kappa light chains. Bone marrow biopsy revealed 25% infiltration with poorly characterized malignant cells and 15% polyclonal plasma cells. Immunofixation of serum and urine was positive for IgG kappa and kappa light chains, respectively. A bone survey revealed lesions in the skull, left femur bone, and the pelvis. The diagnosis of an anaplastic myeloma was made. Because of the poorly characterized nature of the malignant cells and the difficulties in immunophenotyping, serologic evaluation for HIV was undertaken and was positive. The concept of myeloma as an opportunistic neoplasm defining AIDS was considered. We discuss this view and recommend that patients with multiple myeloma with poorly characterized myeloma cells as well as difficulties in immunophenotyping should undergo testing for HIV infection.

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Hyperviscosity syndrome secondary to a myeloma‐associated IgG1κ paraprotein strongly reactive against the HIV‐1 p24 gag antigen

Cited by 7 publications

References 0 publications

Concomitant HIV infection in newly diagnosed multiple myeloma patients is hard to recognise and should be tested for routinely in areas of high endemicity

Concomitant HIV infection in newly diagnosed multiple myeloma patients is hard to recognise and should be tested for routinely in areas of high endemicity

AIDS-Related Malignancies: Emerging Challenges in the Era of Highly Active Antiretroviral Therapy

Multiple myeloma as the first manifestation of acquired immunodeficiency syndrome: a case report and review of the literature

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