Pleural Effusion in Multiple Myeloma: Characteristics and Practice Patterns

Abstract

In many Asian countries battling with the double burden of increasing noninfectious diseases on top of infectious diseases, multiple myeloma (MM) patients presenting with pleural effusion (PE) pose a great diagnostic challenge. Thus, we aimed to analyze the clinical features and practice patterns of such patients. This is a multicenter retrospective study of newly diagnosed MM patients between January 2011 and December 2015. Among 575 MM patients diagnosed during the study period, 80 (13.9%) that were associated with PE were identified and analyzed. The most common cause of PE was parapneumonic (25%), followed by reactive (18.8%). Higher CRP levels and leukocytosis were indicators of parapneumonic PE. There were 7 (8.8%) with myelomatous PE and 2 (2.5%) with tuberculosis. Fifty-six patients underwent additional examinations to determine the exact cause of effusion; 28 patients received computed tomography (CT) of the chest, 5 patients underwent thoracentesis/biopsy, and 23 patients underwent both CT and thoracentesis/biopsy. On the other hand, 24 patients did not undergo additional analyses but were treated empirically. Real-world analyses of practice patterns in MM patients with PE showed the suboptimal use of invasive procedures to determine the exact cause of PE. Since reversible causes and tuberculosis pleurisy are not uncommon, invasive procedures should be actively incorporated as needed.

Myelomatous Pleural Effusion: A Rare Occurrence in Multiple Myeloma

“…Multiple myeloma (MM), a plasma cell cancer, is responsible for 10% of blood malignancies [ 6 ]. Plasma cells cause M protein hypersecretion, a defective immunoglobulin that causes the well-known CRAB syndrome, including hypercalcemia, renal failure, anemia, and bone lytic lesions [ 1 ].…”

“…Even though these malignant cells are most frequently located in the bone marrow, they can also be found in extramedullary tissues. The thorax is a well-known site for skeletal disease (lytic bone lesion or pathological fracture), plasmacytomas, pulmonary infiltrates (including infections), and pleural effusions, amongst many other findings [ 4 , 6 ].…”

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

“… 3 Given the presence of malignant plasma cells in pleural effusion outside bone marrow, myelomatous pleural effusion (MPE) is considered as a manifestation of EMD, reported in＜1% of MM patients. 4 , 5 Byun et al 5 reported MPE accounted for 8.8% in the whole MM patients with pleural effusion, stressing the importance of watching out for MPE when MM patients develop pleural effusion. Besides, some reports described MPE to be associated with an inferior prognosis to MM without extramedullary infiltration.…”

Pleural effusion and multiple myeloma ‑ more than meets the eye: A case report

“…Pleural effusion (PE) in multiple myeloma is not an uncommon finding, comprising about 6-14% of MM patients (4)(5)(6). The most common causes of MM associated PE are congestive heart failure, renal failure with or without nephrotic syndrome, parapneumonic effusion and amyloidosis.…”