Concomitant HIV infection in newly diagnosed multiple myeloma patients is hard to recognise and should be tested for routinely in areas of high endemicity

Background. Over the past three decades much has changed in the treatment and outcomes of patients suffering concurrently from both multiple myeloma (MM) and HIV. While the prevalence of MM appears to be higher in HIV-positive individuals than in those who are uninfected, early recognition of patients suffering from both diseases is difficult and little information is available on their demographics and clinical presentation.Objective. To compare the presenting features of HIV-positive patients diagnosed with MM with those of HIV-negative patients.Methods. A single-centre, retrospective cohort study included 16 HIV-positive and 73 HIV-negative patients diagnosed with MM, in order to compare variables related to the clinical presentation of both conditions.Results. HIV-positive patients presented with MM at a significantly younger age, and had fewer osteolytic lesions, less renal impairment and lower neutrophil counts. Disease stage, gender, pathological fractures, bone marrow plasmacytosis, plasmacytomas and lymphocyte counts were comparable, emphasising the difficulty of identifying these patients. The HIV-positive patients had relatively high CD4 counts and a low prevalence of abnormal Freelite kappa/lambda ratios. All HIV-positive patients presented with paraproteins of the immunoglobulin G (IgG) type, implying a possible relationship between MM and an IgG response to HIV antigens.Conclusions. On the basis of our findings and literature on the treatment of both diseases, we suggest that HIV be tested for routinely in younger MM patients, especially in areas with a high prevalence of HIV. The integration of our results into the sparse knowledge on the role of HIV infection-related MM provides possible new insights into the interaction between these diseases

Multiple myeloma : 2 case reports

This is a report of multiple myeloma in first cousins from the Niger delta region of Nigeria.The first patient was a 60-year-old Negroid male with a 3-month history of productive cough; chest pain; fever and 1 month history of weight loss. The diagnosis was confirmed by greater than 50neoplastic plasma cells in the bone marrow; monoclonal band on electrophoresis and lytic bone lesions in the skull. He was treated with cyclophosphamide; prednisolone and allopurinol and received a total of 4 pints of packed cells. His PCV improved subsequently.The second patient was a 54-year-old Negroid housewife. She presented with a six-month history of bone pains and weakness in both lower limbs. She also had cough productive of mucoid sputum. The diagnosis of MM was confirmed by the presence of more than 30neoplastic plasma cells in the bone marrow; a monoclonal band on serum electrophoresis and lytic lesions in the pelvic bones on skeletal survey. She had three 28-day cycles of vincristine; adriamycin and dexamethasone (VAD). She was also transfused with 3 pints of packed cells. We conclude that while we cannot rule out the effect of environmental factors in pathogenesis of MM in our patients; the occurrence of MM in first cousins is suggestive of a possible familial origin. We advocate screening of urine for Bence Jones protein and serum electrophoresis for relatives of patients with MM; especially those from the Niger Delta region

Multiple myeloma : 2 case reports

This is a report of multiple myeloma in first cousins from the Niger delta region of Nigeria.The first patient was a 60-year-old Negroid male with a 3-month history of productive cough; chest pain; fever and 1 month history of weight loss. The diagnosis was confirmed by greater than 50neoplastic plasma cells in the bone marrow; monoclonal band on electrophoresis and lytic bone lesions in the skull. He was treated with cyclophosphamide; prednisolone and allopurinol and received a total of 4 pints of packed cells. His PCV improved subsequently.The second patient was a 54-year-old Negroid housewife. She presented with a six-month history of bone pains and weakness in both lower limbs. She also had cough productive of mucoid sputum. The diagnosis of MM was confirmed by the presence of more than 30neoplastic plasma cells in the bone marrow; a monoclonal band on serum electrophoresis and lytic lesions in the pelvic bones on skeletal survey. She had three 28-day cycles of vincristine; adriamycin and dexamethasone (VAD). She was also transfused with 3 pints of packed cells. We conclude that while we cannot rule out the effect of environmental factors in pathogenesis of MM in our patients; the occurrence of MM in first cousins is suggestive of a possible familial origin. We advocate screening of urine for Bence Jones protein and serum electrophoresis for relatives of patients with MM; especially those from the Niger Delta region

Mieloma multiplo no Hospital Central de Maputo

"Um estudo retrospectivo do mieloma multiplo foi realizado no Hospital Central de Maputo; abragendo um periodo de 9 anos (1980-1988). Dos 22 casos registados foram seleccionados 16; dos quais 8 homens e 8 mulheres com idades compreendidas entre 24 e 74 anos. O pico da doenca observou-se no grupo etario dos 50-59 anos. A dor ossea foi o sintoma mais comum em todos os doentes. O criterio para o diagnostico baseou-se em 2 ou mais dos seguintes dados: Proteinuria de Bance Jones; evidencia de para-proteinas; lesSes osseas osteoliticas e presenca de quantidade excessiva de plasmocitos na medula ossea. Os principais tipos de para-proteinas encontrados neste estudo foram IgG;7 (44 por centos) IgA; 4 (24 por centos); IgD; 1 (6 por centos). Observou-se a ausencia de para-prteinas em 4 doentes. Contudo; a imunoelectroforese da urina demonstrou a presenca da cadeias leves ""K"" em 2 doentes (12 por centos) e cadeias leves ""Lambda"" em 1(6 por centos). Para os restantes doentes o diagnostico beseou-se no diagnostico radiologico de lesSes osseas osteoliticas bem como de um elevado valor de plasmocitos (70 por centos) na medula ossea. O internamento dos doentes verificou-se num periodo extremamentte variavel da evolucio da doenca (entre 1 a 24 meses). O unico tratamento adoptado foi a quimioterapia baseada na administracio de melfalan e prednisolona e; em certos casos; associado a vincristina e/ou ciclofosfamida. Dez (62;5 por centos) dos doentes morreram. Este estudo foi realizado para demonstrar que o mieloma multiplo nio e uma doenca rara em Mocambique como anteriormente se pensava."