Clinicopathological features and management of Pakistani patients with multiple myeloma

OBJECTIVE: Purpose of the study was to evaluate the clinicopathological features of multiple myeloma in Pakistan and to study the influence of therapeutic management in these cases. METHODS: We retrospectively analyzed 99 newly diagnosed patients with multiple myeloma seen from 1988 to 1996. Diagnostic criteria included bone marrow plasmacytosis, monoclonal gammopathy in serum or urine and radiological evidence of skeletal lesions. There were 57 males and 42 females. Mean age of the patients was 58 years with a range of 23 to 86 years. One-third of the patients were bed ridden at the time of presentation. Common presenting symptoms included bone pain [82%], fatigue [78%] and backache [73%]. Physical findings, laboratory features and radiologic assessment revealed pallor [56%], severe anaemia with hemoglobin < 8.5 gm/dl [39%], creatinine > or = 2 2 mg/dl [57%], serum calcium > or = 12 gm/dl [23%], uric acid > or = 8 gm/dl [47%] and albumin < or = 3.5 gm/dl [63%]. Commonest monoclonal gammopathy was igG kappa. Majority [71%] of the patients presented with stage III disease. Commonest chemotherapeutic regimen utilized was melphalan and prednisolone which was administered to 88% of the patients. Complete remission was observed in 25% and partial remission in 36% of the evaluated patients. Commonest complication during the course of disease was related to skeletal involvement followed by renal failure and bone marrow suppression. Median survival of the patients was 34 months. Multiple myeloma patients in Pakistan are younger, more frequently have poor performance status and more often present with advanced stage of disease. Response to therapy, however, is adequate and survival is comparable to Western patients

Clinical features and management of malignant ascites

Retrospective analysis of 45 patients [33 females, 12 males] with cytologically-proven malignant ascites is presented. Abdominal pain was the most frequent symptom [69%]. Fiftythree percent cases had low serum albumin. Ascitic fluid was haemorrhagic or serosanguinous in 48% cases, in the rest it was clear or straw-coloured. Peritoneal effusion was exudative in 84% cases. Mean glucose content of ascitic fluid was 95 mg/dl and the mean white cell count of 919 cells/cmm. Vast majority [82%] of the cases had metastatic adenocarcinomas. Primary malignancy was mostly ovarian [47%] followed by non-Hodgkin's lymphoma [11%] and gall bladder carcinoma [9%]. Primary site could not be identified in 13% cases. Sixty-two percent patients received systemic chemotherapy for the underlying malignancy, of these 43% had complete or partial resolution of the ascites. Of the patients whose long-term follow-up is available, 54% were alive with a median follow-up of 9 months