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Multiple myeloma-associated amyloidosis is an independent high-risk prognostic factor
Several prognostic factors have been recognized in patients with multiple myeloma (MM). Among the most important are: the serum levels of β2-microglobulin, albumin, and LDH; the labeling index; and an abnormal karyotype. Patients with amyloidosis (AL) have poor prognosis; however, little is known co...
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| Published in: | Annals of hematology 2009, Vol.88 (1), p.59-66 |
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| creator | Vela-Ojeda, J. García-Ruiz Esparza, M. A. Padilla-González, Y. Sánchez-Cortes, E. García-Chávez, J. Montiel-Cervantes, L. Reyes-Maldonado, E. Majluf-Cruz, A. Mayani, H. |
| description | Several prognostic factors have been recognized in patients with multiple myeloma (MM). Among the most important are: the serum levels of β2-microglobulin, albumin, and LDH; the labeling index; and an abnormal karyotype. Patients with amyloidosis (AL) have poor prognosis; however, little is known concerning the prognostic significance of AL associated to MM. In 201 consecutive patients with de novo MM, we performed a fat-pad biopsy needle aspiration (FPBNA) that was stained with Congo red. Sixty eight (34%) patients had AL and a poorer prognosis disease: lower performance status, presence of B symptoms, higher LDH and calcium values, and worse response to chemotherapy. Cox regression model for overall survival detected three variables having independent prognostic significance: the presence of AL (RR = 3.4,
P
|
| doi_str_mv | 10.1007/s00277-008-0554-0 |
| format | article |
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P
< 0.004), serum albumin levels <3.5 g/dl (RR 3.2,
p
< 0.005), and patients not achieving complete remission or very good partial remission (RR 2.9,
p
< 0.02). In 28% of patients with de novo MM, FPBNA was useful to detect incidental amyloidosis. During follow-up, 69% of these patients had symptoms of AL. Excluding 16 patients with obvious symptoms of AL at diagnosis, overall survival was worse in patients who developed later symptoms of AL. MM-associated AL represents a poorer prognosis disease even in the absence of symptoms at diagnosis, and this specific association may be considered as an independent high-risk prognostic factor. The routine study of periumbilical fat-pad tissue should be mandatory in all patients with MM.</description><identifier>ISSN: 0939-5555</identifier><identifier>EISSN: 1432-0584</identifier><identifier>DOI: 10.1007/s00277-008-0554-0</identifier><identifier>PMID: 18648809</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer-Verlag</publisher><subject>Adipose Tissue - pathology ; Adult ; Aged ; Amyloidosis - blood ; Amyloidosis - diagnosis ; Amyloidosis - drug therapy ; Amyloidosis - pathology ; Antineoplastic Agents - therapeutic use ; Biopsy ; Disease-Free Survival ; Female ; Hematology ; Humans ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Multiple Myeloma - blood ; Multiple Myeloma - diagnosis ; Multiple Myeloma - drug therapy ; Multiple Myeloma - pathology ; Oncology ; Original Article ; Prognosis ; Proportional Hazards Models ; Regression Analysis ; Remission Induction ; Risk Factors</subject><ispartof>Annals of hematology, 2009, Vol.88 (1), p.59-66</ispartof><rights>Springer-Verlag 2008</rights><rights>Springer-Verlag 2009</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c369t-676b96b4ca2dd2709e08c53ad3383f6b26474ee07b8b04278a19392ea40fb70a3</citedby><cites>FETCH-LOGICAL-c369t-676b96b4ca2dd2709e08c53ad3383f6b26474ee07b8b04278a19392ea40fb70a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18648809$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vela-Ojeda, J.</creatorcontrib><creatorcontrib>García-Ruiz Esparza, M. A.</creatorcontrib><creatorcontrib>Padilla-González, Y.</creatorcontrib><creatorcontrib>Sánchez-Cortes, E.</creatorcontrib><creatorcontrib>García-Chávez, J.</creatorcontrib><creatorcontrib>Montiel-Cervantes, L.</creatorcontrib><creatorcontrib>Reyes-Maldonado, E.</creatorcontrib><creatorcontrib>Majluf-Cruz, A.</creatorcontrib><creatorcontrib>Mayani, H.</creatorcontrib><title>Multiple myeloma-associated amyloidosis is an independent high-risk prognostic factor</title><title>Annals of hematology</title><addtitle>Ann Hematol</addtitle><addtitle>Ann Hematol</addtitle><description>Several prognostic factors have been recognized in patients with multiple myeloma (MM). Among the most important are: the serum levels of β2-microglobulin, albumin, and LDH; the labeling index; and an abnormal karyotype. Patients with amyloidosis (AL) have poor prognosis; however, little is known concerning the prognostic significance of AL associated to MM. In 201 consecutive patients with de novo MM, we performed a fat-pad biopsy needle aspiration (FPBNA) that was stained with Congo red. Sixty eight (34%) patients had AL and a poorer prognosis disease: lower performance status, presence of B symptoms, higher LDH and calcium values, and worse response to chemotherapy. Cox regression model for overall survival detected three variables having independent prognostic significance: the presence of AL (RR = 3.4,
P
< 0.004), serum albumin levels <3.5 g/dl (RR 3.2,
p
< 0.005), and patients not achieving complete remission or very good partial remission (RR 2.9,
p
< 0.02). In 28% of patients with de novo MM, FPBNA was useful to detect incidental amyloidosis. During follow-up, 69% of these patients had symptoms of AL. Excluding 16 patients with obvious symptoms of AL at diagnosis, overall survival was worse in patients who developed later symptoms of AL. MM-associated AL represents a poorer prognosis disease even in the absence of symptoms at diagnosis, and this specific association may be considered as an independent high-risk prognostic factor. The routine study of periumbilical fat-pad tissue should be mandatory in all patients with MM.</description><subject>Adipose Tissue - pathology</subject><subject>Adult</subject><subject>Aged</subject><subject>Amyloidosis - blood</subject><subject>Amyloidosis - diagnosis</subject><subject>Amyloidosis - drug therapy</subject><subject>Amyloidosis - pathology</subject><subject>Antineoplastic Agents - therapeutic use</subject><subject>Biopsy</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Hematology</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Multiple Myeloma - blood</subject><subject>Multiple Myeloma - diagnosis</subject><subject>Multiple Myeloma - drug therapy</subject><subject>Multiple Myeloma - pathology</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Regression Analysis</subject><subject>Remission Induction</subject><subject>Risk Factors</subject><issn>0939-5555</issn><issn>1432-0584</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><recordid>eNp1kE9PwyAYh4nRuDn9AF5M48Eb-kIp0KMx_ktmvLgzoS3dmG2p0B727WXpkiUmEgIhPO-PlwehawL3BEA8BAAqBAaQGLKMYThBc8JSGk-SnaI55GmOszhm6CKELQChktFzNCOSMykhn6PVx9gMtm9M0u5M41qNdQiutHowVaLbXeNs5YINSZy6S2xXmd7EpRuSjV1vsLfhO-m9W3cuDLZMal0Ozl-is1o3wVwd9gVavTx_Pb3h5efr-9PjEpcpzwfMBS9yXrBS06qiAnIDssxSXaWpTGteUM4EMwZEIQtgVEhN4o-o0QzqQoBOF-huyo0d_IwmDKq1oTRNozvjxqA4F5TnjETw9g-4daPvYm-KMyZzxuUeIhNUeheCN7XqvW213ykCai9cTcJVFK72whXEmptD8Fi0pjpWHAxHgE5AiFfd2vjjy_-n_gJtZYt6</recordid><startdate>2009</startdate><enddate>2009</enddate><creator>Vela-Ojeda, J.</creator><creator>García-Ruiz Esparza, M. A.</creator><creator>Padilla-González, Y.</creator><creator>Sánchez-Cortes, E.</creator><creator>García-Chávez, J.</creator><creator>Montiel-Cervantes, L.</creator><creator>Reyes-Maldonado, E.</creator><creator>Majluf-Cruz, A.</creator><creator>Mayani, H.</creator><general>Springer-Verlag</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>2009</creationdate><title>Multiple myeloma-associated amyloidosis is an independent high-risk prognostic factor</title><author>Vela-Ojeda, J. ; García-Ruiz Esparza, M. A. ; Padilla-González, Y. ; Sánchez-Cortes, E. ; García-Chávez, J. ; Montiel-Cervantes, L. ; Reyes-Maldonado, E. ; Majluf-Cruz, A. ; Mayani, H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c369t-676b96b4ca2dd2709e08c53ad3383f6b26474ee07b8b04278a19392ea40fb70a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adipose Tissue - pathology</topic><topic>Adult</topic><topic>Aged</topic><topic>Amyloidosis - blood</topic><topic>Amyloidosis - diagnosis</topic><topic>Amyloidosis - drug therapy</topic><topic>Amyloidosis - pathology</topic><topic>Antineoplastic Agents - therapeutic use</topic><topic>Biopsy</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Hematology</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Multiple Myeloma - blood</topic><topic>Multiple Myeloma - diagnosis</topic><topic>Multiple Myeloma - drug therapy</topic><topic>Multiple Myeloma - pathology</topic><topic>Oncology</topic><topic>Original Article</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Regression Analysis</topic><topic>Remission Induction</topic><topic>Risk Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vela-Ojeda, J.</creatorcontrib><creatorcontrib>García-Ruiz Esparza, M. 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A.</au><au>Padilla-González, Y.</au><au>Sánchez-Cortes, E.</au><au>García-Chávez, J.</au><au>Montiel-Cervantes, L.</au><au>Reyes-Maldonado, E.</au><au>Majluf-Cruz, A.</au><au>Mayani, H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Multiple myeloma-associated amyloidosis is an independent high-risk prognostic factor</atitle><jtitle>Annals of hematology</jtitle><stitle>Ann Hematol</stitle><addtitle>Ann Hematol</addtitle><date>2009</date><risdate>2009</risdate><volume>88</volume><issue>1</issue><spage>59</spage><epage>66</epage><pages>59-66</pages><issn>0939-5555</issn><eissn>1432-0584</eissn><abstract>Several prognostic factors have been recognized in patients with multiple myeloma (MM). Among the most important are: the serum levels of β2-microglobulin, albumin, and LDH; the labeling index; and an abnormal karyotype. Patients with amyloidosis (AL) have poor prognosis; however, little is known concerning the prognostic significance of AL associated to MM. In 201 consecutive patients with de novo MM, we performed a fat-pad biopsy needle aspiration (FPBNA) that was stained with Congo red. Sixty eight (34%) patients had AL and a poorer prognosis disease: lower performance status, presence of B symptoms, higher LDH and calcium values, and worse response to chemotherapy. Cox regression model for overall survival detected three variables having independent prognostic significance: the presence of AL (RR = 3.4,
P
< 0.004), serum albumin levels <3.5 g/dl (RR 3.2,
p
< 0.005), and patients not achieving complete remission or very good partial remission (RR 2.9,
p
< 0.02). In 28% of patients with de novo MM, FPBNA was useful to detect incidental amyloidosis. During follow-up, 69% of these patients had symptoms of AL. Excluding 16 patients with obvious symptoms of AL at diagnosis, overall survival was worse in patients who developed later symptoms of AL. MM-associated AL represents a poorer prognosis disease even in the absence of symptoms at diagnosis, and this specific association may be considered as an independent high-risk prognostic factor. The routine study of periumbilical fat-pad tissue should be mandatory in all patients with MM.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer-Verlag</pub><pmid>18648809</pmid><doi>10.1007/s00277-008-0554-0</doi><tpages>8</tpages></addata></record> |
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| subjects | Adipose Tissue - pathology Adult Aged Amyloidosis - blood Amyloidosis - diagnosis Amyloidosis - drug therapy Amyloidosis - pathology Antineoplastic Agents - therapeutic use Biopsy Disease-Free Survival Female Hematology Humans Male Medicine Medicine & Public Health Middle Aged Multiple Myeloma - blood Multiple Myeloma - diagnosis Multiple Myeloma - drug therapy Multiple Myeloma - pathology Oncology Original Article Prognosis Proportional Hazards Models Regression Analysis Remission Induction Risk Factors |
| title | Multiple myeloma-associated amyloidosis is an independent high-risk prognostic factor |
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