Myelomatous Pleural Effusion: A Case Series in a Single Institution and Literature Review
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Background: Myelomatous pleural effusion (MPE) is rare in myeloma patients. We present a consecutive series of patients with MPE in a single institution. Methods: We retrospectively reviewed the medical records of 19 patients diagnosed with MPE between 1989 and 2008 at the Asan Medical Center. Diagnoses were confirmed by cytologic identification of malignant plasma cells in the pleural fluid. Results: Our patients showed dominance of IgA (36.8%) and IgD (31.6%) subtypes. Of 734 myeloma patients, the incidence of MPE was remarkably high for the IgD myeloma subtype (16.7%), compared to the other subtypes (1.4% for IgG and 4.6% for IgA). At the time of diagnosis of MPE, elevated serum β2-microglobulin, anemia, elevated serum lactate dehydrogenase, and elevated creatinine levels were found in 100%, 89.5%, 83.3%, and 57.9% of the patients, respectively. Approximately one-third (31.3%) of the patients had adenosine deaminase (ADA) activities in their pleural fluid exceeding the upper limit of the reported cutoff values for tuberculous pleural effusion (55.8 U/L). Chromosome 13 abnormality was seen in 77.8% of the tested patients. The median survival period from the development of MPE was 2.8 months. Conclusions: Patients with MPE have aggressive clinical and laboratory characteristics. The preponderance of IgD myeloma in MPE patients is a noteworthy finding because IgD myeloma is a rare subtype. Elevated ADA activity in the pleural fluid is also noteworthy, and may be helpful for detecting MPE. Physicians treating myeloma patients should monitor the development of MPE and consider the possibility of a worse clinical course.
Abstract
Background: Myelomatous pleural effusion (MPE) is rare in myeloma patients. We present a consecutive series of patients with MPE in a single institution. Methods: We retrospectively reviewed the medical records of 19 patients diagnosed with MPE between 1989 and 2008 at the Asan Medical Center. Diagnoses were confirmed by cytologic identification of malignant plasma cells in the pleural fluid. Results: Our patients showed dominance of IgA (36.8%) and IgD (31.6%) subtypes. Of 734 myeloma patients, the incidence of MPE was remarkably high for the IgD myeloma subtype (16.7%), compared to the other subtypes (1.4% for IgG and 4.6% for IgA). At the time of diagnosis of MPE, elevated serum β2-microglobulin, anemia, elevated serum lactate dehydrogenase, and elevated creatinine levels were found in 100%, 89.5%, 83.3%, and 57.9% of the patients, respectively. Approximately one-third (31.3%) of the patients had adenosine deaminase (ADA) activities in their pleural fluid exceeding the upper limit of the reported cutoff values for tuberculous pleural effusion (55.8 U/L). Chromosome 13 abnormality was seen in 77.8% of the tested patients. The median survival period from the development of MPE was 2.8 months. Conclusions: Patients with MPE have aggressive clinical and laboratory characteristics. The preponderance of IgD myeloma in MPE patients is a noteworthy finding because IgD myeloma is a rare subtype. Elevated ADA activity in the pleural fluid is also noteworthy, and may be helpful for detecting MPE. Physicians treating myeloma patients should monitor the development of MPE and consider the possibility of a worse clinical course.
참고문헌 (27)
- Kintzer JS, "Thoracic and pulmonary abnormalities in multiple myeloma. A review of 958 cases", Arch Intern Med, 138, pp.727~730 (1978)
- Alexandrakis MG, "Pleural effusions in hematologic malignancies", Chest, 125, pp.1546~1555 (2004)
- Rodriguez JN, "Pleural effusion in multiple myeloma", Chest, 105, pp.622~624 (1994)
- Meoli A, "Myelomatous pleural effusion", South Med J, 90, pp.65~68 (1997)
- Kim YJ, "Multiple Myeloma with Myelomatous Pleural Effusion: A Case Report and Review of the Literature", ACTA HAEMATOLOGICA, 120, pp.108~111 (2008), Acta Haematol
- Kamble R, "Malignant pleural effusion of multiple myeloma: prognostic factors and outcome", Leuk Lymphoma, 46, pp.1137~1142 (2005)
- International Myeloma Working Group, "Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group", Br J Haematol, 121, pp.749~757 (2003)
- Munshi NC, "Plasma cell disorders In Harrison’s principles of internal medicine. 17th ed", pp.700~707 (2008), McGraw Hill Medical
- Shimamoto Y, "A new risk grouping for IgD myeloma based on analysis of 165 Japanese patients", Eur J Hae matol, 47, pp.262~267 (1991)
- Chen ML, "Diagnostic value of pleural fluid adenosine deaminase activity in tuberculous pleurisy", Clin Chim Acta, 341, pp.101~107 (2004)
- Zaric B, "Differential diagnosis of tuberculosis and malignant pleural effusions: what is the role of adenosine deaminase", Lung, 186, pp.233~240 (2008)
- Porcel JM, "A decision tree for differentiating tuberculous from malignant pleural effusions", Respir Med, 102, pp.1159~1164 (2008)
- McKenna RW, "Plasma cell neoplasms In WHO classification of tumours of haematopoietic and lymphoid tissues. 4th ed", pp.200~213 (2008), IARC
- Jancelewicz Z, "IgD multiple myeloma. Review of 133 cases", Arch Intern Med, 135, pp.87~93 (1975)
- Blade J, "Immunoglobulin D multiple myeloma: presenting features, response to therapy, and survival in a series of 53 cases", J Clin Oncol, 12, pp.2398~2404 (1994)
- Pruzanski W, "IgD plasma cell neoplasia: clinical manifestations and characteristic features", Can Med Assoc J, 102, pp.1061~1065 (1970)
- Johnston JB, "IgD kappa plasma cell dyscrasias: extraosseous manifestations including isolated leptomeningitis", Am J Clin Pathol, 77, pp.60~65 (1982)
- Kamal MK, "IgD myeloma with malignant pleural effusion", South Med J, 80, pp.657~658 (1987)
- 박성규, "Myelomatous effusion with poor response to chemotherapy", JOURNAL OF KOREAN MEDICAL SCIENCE, 15, pp.243~246 (2000), KOREAN ACAD MEDICAL SCIENCES
- Natori K, "IgD myeloma indicated by plasma cells in the peripheral blood and massive pleural effusion", Ann Hematol, 87, pp.587~589 (2008)
- Yokoyama T, "Multiple myeloma presenting initially with pleural effusion and a unique paraspinal tumor in the thorax", Inter Med, 47, pp.1917~1920 (2008)
- Chang H, "Myelomatous pleural effusion in a patient with plasmablastic myeloma: a case report", Diagn Cytopathol, 37, pp.205~207 (2009)
- Cristalli G, "Adenosine deaminase: functional implications and different classes of inhibitors", Med Res Rev, 21, pp.105~128 (2001)
- Meier J, "Adenosine deaminase activity in peripheral blood cells of patients with haematological malignancies", Br J Cancer, 33, pp.312~319 (1976)
- Ohata M, "Combination assay of IAP and ADA in hematologic malignancies", Rinsho Byori, 38, pp.703~710 (1990)
- Shaughnessy J Jr, "Prognostic impact of cytogenetic and interphase fluorescence in situ hybridization-defined chromosome 13 deletion in multiple myeloma: early results of total therapy II", Br J Haematol, 120, pp.44~52 (2003)
- Chiecchio L, "Deletion of chromosome 13 detected by conventional cytogenetics is a critical prognostic factor in myeloma", Leukemia, 20, pp.1610~1617 (2006)