Multiple myeloma: the disease and its treatment

Gupta, Meenakshi V.; Pal, Rana Arun Gopal Krishan; Tikoo, Deepika

doi:10.5455/2319-2003.ijbcp20130302

Cited by 11 publications

(16 citation statements)

References 159 publications

(122 reference statements)

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“…Estimated incidence in India varies from 0.3 to 1.9 per 1,00,000 for men and 0.4 to 1.3 per 1,00,000 for women. The age incidence in India is nearly a decade Iess than that in the USA, at 55 years [2][3][4][5].…”

Section: Discussionmentioning

confidence: 99%

IgG Lambda Myeloma Presenting as Plasmacytic Ascites: Case Report and Review of Literature

Mitra

Mukherjee

Chakraborty

et al. 2014

Indian J Hematol Blood Transfus

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Multiple myeloma is a neoplastic disease of plasma cells accounting for 13 % of haematological malignancies and 2 % of all malignancies worldwide. Ascites may develop very rarely during the course of disease in multiple myeloma. We report the case of a 78 years old male with IgG lambda multiple myeloma who initially presented with plasmacytic ascites. An exhaustive review of world literature reveals 65 cases of ascites to have been reported in myeloma over a span of 62 years (1952 till date), usually developing in the course of treatment. This is the 7th case of plasmacytic ascites to have been diagnosed at initial presentation. We review the clinical features, diagnosis, prognostic significance and treatment of such cases.

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Section: Discussionmentioning

confidence: 99%

IgG Lambda Myeloma Presenting as Plasmacytic Ascites: Case Report and Review of Literature

Mitra

Mukherjee

Chakraborty

et al. 2014

Indian J Hematol Blood Transfus

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“…Patients in the initial year are placed in different stages, based on the existing evidence on stage-wise distribution of multiple myeloma patients in India [20]. Subsequently, patients were modelled to move on to other states if their condition worsens or if they have any adverse event.…”

Section: Clinical and Epidemiological Parametersmentioning

confidence: 99%

Cost-Effectiveness of Autologous Stem Cell Treatment as Compared to Conventional Chemotherapy for Treatment of Multiple Myeloma in India

Prinja

Kaur

Malhotra

et al. 2017

Indian J Hematol Blood Transfus

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Recent innovations in treatment of multiple myeloma include autologous stem cell transplantation (ASCT) along with high dose chemotherapy (HDC). We undertook this study to estimate incremental cost per quality adjusted life year gained (QALY) with use of ASCT along with HDC as compared to conventional chemotherapy (CC) alone in treatment of multiple myeloma. A combination of decision tree and markov model was used to undertake the analysis. Incremental costs and effects of ASCT were compared against the baseline scenario of CC (based on Melphalan and Prednisolone regimen) in the patients of multiple myeloma. A lifetime study horizon was used and future costs and consequences were discounted at 5%. Consequences were valued in terms of QALYs. Incremental cost per QALY gained using ASCT as against CC for treatment of multiple myeloma was estimated using both a health system and societal perspective. The cost of providing ASCT (with HDC) for multiple myeloma patients was INR 500,631, while the cost of CC alone was INR 159,775. In the long run, cost per patient per year for ASCT and CC arms was estimated to be INR 119,740 and INR 111,565 respectively. The number of QALYs lived per patient in case of ASCT and HDC alone were found to be 4.1 and 3.5 years respectively.From a societal perspective, ASCT was found to incur an incremental cost of INR 334,433 per QALY gained. If the ASCT is initiated early to patients, the incremental cost for ASCT was found to be INR 180,434 per QALY gained. With current mix of patients, stem cell treatment for multiple myeloma is not cost effective at a threshold of GDP per capita. It becomes marginally cost-effective at 3-times the GDP per capita threshold. However, accounting for the model uncertainties, the probability of ASCT to be cost effective is 59%. Cost effectiveness of ASCT can be improved with early detection and initiation of treatment.

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“…1,2,13 Easy bruising and bleeding, recurrent infection, weight loss, altered mental status, and other neurologic I symptoms may also be present in the constellation of MM symptoms. Given that the clinical picture of MM is nebulous and nonspecific, it may be prudent to maintain an index of suspicion for MM in older adults with new onset back pain and unexplained anemia.…”

Section: Clinical Featuresmentioning

confidence: 99%

“…1,2 Also known as plasma cell myeloma, plasmacytic myeloma, myelomatosis, or Kahler's disease, the term MM can be misleading since plasma cells are of lymphoid lineage and not myeloid; rather, the name reflects involvement of the myelum or bone marrow, where plasma cells reside. 1,2 Malignant transformation of plasma cells typically occurs in multiple bone sites, and may form masses capable of advancing locally or involving distant organs through lymphatic or hematogenous spread. 3 The cause of MM remains uncertain, 4 and it continues to be incurable, with almost all patients eventually developing treatment-resistant disease.…”

Section: Introductionmentioning

confidence: 99%

“…10 Median survival with conventional treatment is about four years, but median survival can be extended to five to seven years with high-dose treatment and autologous stem-cell transplantation. 2,10 In many patients, MM is preceded by a pre-malignant stage called monoclonal gammopathy of undetermined significance (MGUS). 7 MGUS has a 1% annual risk of progression to MM, with free light chain (FLC) ratio, M-protein concentration, and depressed levels of non-affected immunoglobulins having been identified as risk factors for progression.…”

Section: Introductionmentioning

confidence: 99%

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Clinical features and diagnosis of multiple myeloma

Wong

Taylor

2016

DMJ

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Clinical VignetteEM, an 85 year-old female, was admitted to the Medical Teaching Unit with a one-week history of confusion. In the Emergency Department, she was disoriented and later became somnolent. During the month prior to admission, she had experienced progressive mid-back pain, and had been diagnosed with a T8 compression fracture.Laboratory investigations showed a hemoglobin of 81 g/L with mean corpuscular volume of 101 fL. Rouleaux formations were seen on peripheral smear. EM had elevated creatinine (133 mmol/L), urea (11.2 mmol/L), and ionized calcium (1.97 mmol/L); however, parathyroid hormone levels were normal, as were iron studies, vitamin B12, folate, and thyroid stimulating hormone (TSH).Urine culture revealed Escherichia coli bacteriuria, which was treated with ceftriaxone. Pamidronate was administered for hypercalcemia. Early into the admission, she became fluid overloaded and required diuresis, while simultaneously receiving intravenous fluids for her hypercalcemia.Multiple myeloma was considered as the cause of EM's constellation of symptoms, so a serum protein electrophoresis was performed, revealing an IgA monoclonal protein spike. Free light chain analysis showed an increase in free kappa light chains (7.69 mg/L) with a markedly elevated kappa/lambda ratio of 157.5.

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Multiple myeloma: the disease and its treatment

Cited by 11 publications

References 159 publications

IgG Lambda Myeloma Presenting as Plasmacytic Ascites: Case Report and Review of Literature

IgG Lambda Myeloma Presenting as Plasmacytic Ascites: Case Report and Review of Literature

Cost-Effectiveness of Autologous Stem Cell Treatment as Compared to Conventional Chemotherapy for Treatment of Multiple Myeloma in India

Clinical features and diagnosis of multiple myeloma

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