hyperviscosity in multiple myeloma

A high level of calcium in the blood (hypercalcaemia) can develop in people with multiple myeloma because too much calcium is released from affected bones into the bloodstream. doi:10.1016/j.revmed.2015.02.005, 5. Multiple myeloma (MM) is a plasma cellderived neoplasm characterized primarily by the abnormal production of monoclonal immunoglobulin (M-protein) found in serum or urine and resulting in various complications (1). Despite confirmation of specific haemostasis disorder, no severe complication was observed, which can be explained by a quick recognition and management of HVS in a tertiary center. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. Chen LY, Wong PC, Noda S, Collins DR, Sreenivasan GM, Coupland RC. eCollection 2022. Ann Intern Med (1972) 77:853. doi:10.7326/0003-4819-77-6-853, 8. Plasma cells, which are a type of white blood cell, are produced in the bone marrow and normally reside there. Cerebral Infarction in IgG Multiple Myeloma with Hyperviscosity Nevertheless, only two patients (8%) were included in a clinical trial. Crit Care Clin. Multiple myeloma, COVID-19 vaccination, adverse effect, and blood Federal government websites often end in .gov or .mil. Early deaths (in the first two months) occurred in 21% of older patients (>65 years). . [QxMD MEDLINE Link]. We saw the efficacy of TPE associated with anti-plasma cell therapy with 86% of full recovery after one or two sessions and a good safety profile (no severe reaction during procedure). The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). KaplanMeier curves were plotted for survival, and data for various groups were compared using a log-rank test. Ophthalmic manifestations include proptosis, diplopia, lid ecchymosis, xanthomatosis, conjunctival and corneal crystalline and non-crystalline deposits, scleritis, episcleritis, secondary glaucoma, ciliary body cysts, ciliochoroidal effusion, uveal plasmacytoma, hyperviscosity retinopathy, retinal vasculitis, detachment of sensory retina and retinal pigment epithelium, and neuro-ophthalmic manifestations. Figure2 Description and outcomes of HVS NDMM (A) Monoclonal protein level between Ig type and HVS symptoms for NDMM. Health experts know that genetic mutations in specific proteins, such as KRAS, BRAF, NRAS, and TP53, occur in many cases of MM, but what leads to these genetic mutations is unknown. As such, a relatively small reduction in the paraprotein concentration has a significant effect on lowering serum viscosity. Eighteen patients (47%) died during the follow-up, including three early deaths (one septic shock, one pneumonia and one liver failure) two months after the diagnosis in older patients (>65 years), thirteen deaths with active MM and two deaths related to transplant-related toxicity (one post-auto-hematopoietic stem cell transplantation [HSCT] and one post-allo-HSCT) (Supplementary Table2). The primary outcome was OS. Correction of hyperviscosity by apheresis. This is due to the excess proteins that myeloma cells often produce. Thomas EL, Olk RJ, Markman M, et al. Nevertheless, HVS in the modern therapeutic era for NDMM (median OS at 3.6 years) was associated with dismal prognosis compared to the control group from the same institution (median OS at 7.7 years, similar to other real life cohort (23)) with adjustment of cytogenetics and prognosis score. DeVita VT Jr, Lawrence TS, & Rosenberg SA. Epub 2017 Dec 14. 2017 Dec. 31 (6):927-940. Collection and assembly of data: P-ED, SH, NP, VS, LG, FM, WC, DE, FT, AT. Epub 2010 Dec 28. -, Mehta J, Singhal S. Hyperviscosity syndrome in plasma cell dyscrasias. We mitigate this effect with the multivariate analysis which confirmed the dismal prognosis of HVS. Please enable it to take advantage of the complete set of features! We highlight the importance of the ophthalmic presentation of MM. Intraocular manifestations of multiple myeloma. N Engl J Med. For clinical presentation, our cohort was similar to a previous report (majority of mild signs and 1020% of severe forms with neurological signs) and similar to recent report of HVS in 997 WM (22). [Full Text]. Oncologic Mechanical Emergencies. Hu WL, Song JY, Li X, Pei XJ, Zhang JJ, Shen M, Tang R, Pan ZY, Huang ZX. 1981 Nov-Dec;26(3):157-69. doi: 10.1016/0039-6257(81)90065-5. Next review due: 02 June 2024, numbness and weakness in the legs and feet, problems controlling your bladder and bowels. 61 (2):236-47. Although these treatments are helpful in the acute phase, they typically do not alter the prognosis of the disease process, which is the underlying etiology. Multiple myeloma. [Myeloma serum hyperviscosity syndrome treated with plasmapheresis]. Emerg Med Clin North Am. In a context of HVS suspicion or for asymptomatic patients with a high protein concentration, the diagnosis can be confirmed by ophthalmologic examination. To our knowledge, we report here the most extensive study of NDMM patients with HVS in the modern era therapy. In parallel, the prognosis of newly diagnosed MM (NDMM) patients has dramatically improved by the arrival of new drugs tested in recent clinical trials (12, 13). Clin Exp Immunol (1971) 8:97380. Sloop G, Holsworth RE Jr, Weidman JJ, St Cyr JA. Multiple myeloma, COVID-19 vaccination, adverse effect, and blood viscosity J Cancer Res Ther. Scientists remain unsure about how exactly this process occurs. Overall survival (OS) was calculated from the MM diagnosis until death or the last follow-up (whichever occurred first). Table1 Initial characteristics of NDMM with HVS. The median time to the next treatment was 2.1 years (95%IC 1.43.4, Figure2B). Bookshelf Haemostasis disorder with HVS in NDMM was confirmed in our case-controls analysis related to lower fibrinogen level and slightly elevated INR, both likely related to haemodilution (correlation with M-protein level). If plasma/cellular pheresis is not readily available and the patient is decompensating, one may try vigorous intravenous hydration coupled with a 2-3 unit phlebotomy in the interim as a temporizing measure. Syndrome dhyperviscosit plasmatique. However, there is some evidence that various factors can make MM more likely, including: Doctors need to perform various tests to diagnose MM, including: According to research, there are several staging systems for MM, with modern staging systems measuring blood chemicals, such as: Thanks to new treatments and improved supportive care, survival rates for people with MM have significantly increased over the last few decades. Blood. The authors thank the patients with MM and their families. It may happen because you have too many red blood cells, white blood cells or blood proteins. Simultaneous protein turnover studies with radiolabeled normal IgG and the patient's own myeloma protein revealed a predominantly . For example, there is evidence that corticosteroids can cause such adverse effects as: Similarly, chemotherapy often kills healthy cells in addition to cancer cells, leading to side effects, such as: MM is a potentially serious type of bone marrow cancer. HVS classically presents with mucosal bleeding, visual and neurological abnormalities. The .gov means its official. (A) Monoclonal protein level between HVS and controls for each sub-type (B, C) PT expressed in INR (B) and fibrinogen (C) levels between HVS and control NDMM. Symptoms of multiple myeloma | Canadian Cancer Society Br J Haematol (2003) 121:74957. The Oncology Nursing Society (ONS) is a professional association that represents 100,000 nurses and is the professional home to more than 35,000 members. myeloma is always associated with hyperviscosity, amyloidosis, fatigue, and recurrent infections. You may find you get frequent infections that last for a long time. Plasmapheresis can also reverse HVS-induced retinal changes promptly, including reducing retinal venous diameter and increased venous blood viscosity. Serum hyperviscosity may cause a variety of clinical manifestations including bleeding from mucosal membranes, congestive heart failure, retinopathy, and various neurologic deficits. The https:// ensures that you are connecting to the IgG is presented mainly in the intravascular compartment (4565%), but the turnover rate from extravascular to intravascular is 2% per hour, which could require multiple TPE until HVS symptoms resolve (5). Would you like email updates of new search results? real-world data on 4904 patients from the Swedish myeloma registry. Clin Lymphoma Myeloma Leuk (2010) 10:4648. Objective: Kumar S, Paiva B, Anderson KC, Durie B, Landgren O, Moreau P, et al. The first prognosis scores and treatment criteria were based on tumour mass and related complications, with the Salmon & Durie classification published in 1975 (2). All statistical tests were two-tailed with a significance level of 0.05. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. Background: Waldenstrom's macroglobulinemia and sensorineural hearing loss. PRUZANSKl W. Serum viscosity and hyperviscosity syndrome in IgG multiple myeloma: Report on 10 patients and a review of the literature. Hidden in the Eyes-Recurrence of Systemic Hemopathies Reportedly "In Remission": Six Cases and Review of Literature. HHS Vulnerability Disclosure, Help Signs and symptoms also may appear if the immunoglobulins (M-proteins) build up in organs like the kidney. Concomitant multiple myeloma spectrum diagnosis in a central retinal vein occlusion: a case report and review. Robin R Hemphill, MD, MPH Associate Professor, Director, Quality and Safety, Department of Emergency Medicine, Emory University School of Medicine Seeing through thick and through thin: Retinal manifestations of thrombophilic and hyperviscosity syndromes. Raje N, Hideshima T, Anderson KC One patient experienced a transitory hypotension during a session that was quickly resolved after fluid resuscitation. 2010 Jan. 26 (1):181-205. Please confirm that you would like to log out of Medscape. Skeletal complications are common in MM. [QxMD MEDLINE Link]. MGUS is a noncancerous condition that can progress to multiple myeloma. It may also develop if you have irregularly shaped red blood cells. Multiple myeloma (MM) is a debilitating malignancy that is part of a spectrum of diseases ranging from monoclonal gammopathy of unknown significance (MGUS) to plasma cell leukemia. HVS seems associated with dismal survival in multiple myeloma but additional study and cohort are needed to confirm the results. [QxMD MEDLINE Link]. FOIA It can lead to bone, blood, kidney, and sometimes neurological problems. 13:1069360. doi: 10.3389/fimmu.2022.1069360. Later, the treatment criteria evolved to be based on principal complications of high tumour burden as summarized in the CRAB acronym: hyperCalcemia, Renal insufficiency, Anemia, and Bone lesions and the SLiM acronym: greater than or equal to Sixty percent clonal plasma cells in the bone marrow, involved/uninvolved free Light chain ratio of 100 or more with the involved FLC being greater than or equal 100 mg/L and MRIM with more than one focal marrow lesion (3). Early detection may permit safer and effective treatment. The cancerous plasma cells. 2018 Sep 3;7(9):253. doi: 10.3390/jcm7090253. [ 3, 4] Constitutional symptoms and cardiorespiratory symptoms may. Br J Haematol (1978) 38:51730. (b) Diffuse infiltration of plasmacytoid cells over the left upper lung (H and E, 400). Before Hyperviscosity in IgG myeloma: detection and treatment in community medical facilities. Stone MJ, Bogen SA. Stat Med (1986) 5:25560. We did not find any NDMM with IgG3 subclass associated with HVS based on eight IgG myeloma tested (29% of the IgG MM). Multiple Myeloma Clinical Presentation - Medscape Other health conditions can cause the same signs and symptoms as multiple myeloma. Role of plasmapheresis in Waldenstrm's macroglobulinemia. Hong WK, Bast RC Jr, Hait WN, et al (eds.). doi:10.3324/haematol.2017.178103, Keywords: HVS, myeloma, prognosis, TPE, neurological, Citation: Debureaux P-E, Harel S, Parquet N, Lemiale V, Siguret V, Goubeau L, Morin F, Royer B, Cuccuini W, Elessa D, Theves F, Brignier AC, Azoulay E, Arnulf B and Talbot A (2022) Prognosis of hyperviscosity syndrome in newly diagnosed multiple myeloma in modern-era therapy: A real-life study.
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