ABSTRACT
Multiple myeloma (MM) remains an incurable hematologic cancer leading to damage to the bone marrow that causes destructive bone lesions in addition to many other effects. I am a patient with MM who has undergone treatment to date since the diagnosis of this disease in December 2019. This paper reviews the treatments and observations made throughout this period. The salient results of such treatments are discussed in chronological order. During this period, my MM relapsed and then I was introduced to teclistamab treatment. The outcome of teclistamab treatment is quite promising, and I anticipate a longer life at a maintenance dose of this drug with a better quality of life. When writing this article, I am still receiving the teclistamab treatment cycles that maintain a constant normal level of my kappa-free light chain (FLC) and kappa/lambda ratio, with no significant side effects.
ABSTRACT
The P106L mutation in the human myeloproliferative leukemia virus oncogene (MPL) was shown to be associated with hereditary thrombocythemia in Arabs. The clinical and bone marrow (BM) features of P106L mutation are unknown. Genetic databases at two tertiary hospitals in Saudi Arabia were searched to identify patients with the MPL P106L mutation. Clinical data were collected retrospectively and the BM aspirates and biopsies were independently reviewed by two hematopathologists. In total, 115 patients were included. Median age was 33 years of which 31 patients were pediatric and 65 were female. The mutation was homozygous in 87 patients. Thrombocytosis was documented in 107 patients, with a median platelet count of 667 × 109/L. The homozygous genotype was associated with a higher platelet count. Thirty-three patients had an evaluable BM and clustering of megakaryocytes was observed in 30/33 patients. At the time of last follow-up, 114 patients were alive. The median follow-up was 7.8 years from the time of thrombocytosis. No patients developed disease progression to myelofibrosis. The P106L mutation was associated with marked thrombocytosis at a younger age and with a low risk of thrombosis, splenomegaly, and marrow fibrosis. The BM demonstrated normal or hypocellular marrow with megakaryocyte clusters.
Subject(s)
Primary Myelofibrosis , Receptors, Thrombopoietin , Thrombocytosis , Thrombosis , Adult , Bone Marrow/pathology , Child , Female , Humans , Male , Mutation , Primary Myelofibrosis/genetics , Primary Myelofibrosis/pathology , Receptors, Thrombopoietin/genetics , Retrospective Studies , Splenomegaly/genetics , Thrombocytosis/genetics , Thrombocytosis/pathology , Thrombosis/complicationsABSTRACT
BACKGROUND AND OBJECTIVES: Studies about stroke in Saudi Arabia are limited. This retrospective study aims to determine the clinical characteristics of Saudi patients with heart failure (HF) with and without subsequent stroke, and also to find out whether gender differences exist in the presentation of HF patients who had stroke. DESIGN AND SETTINGS: Retrospective study done at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia, from 2002-2008. PATIENTS AND METHODS: A total of 293 patient (151 males, 142 females) charts from 2002-2008 were re.viewed at KAMC. These charts were from Saudi patients who were diagnosed with HF, with and without subsequent stroke. Demographics, HF characteristics, stroke risk factors, and metabolic characteristics were noted and analyzed. RESULTS: No difference was observed in HF characteristics and stroke risk factors among HF patients with and without subsequent stroke. In terms of metabolic profile, those who had stroke had significantly higher low-density lipoprotein (LDL)--cholesterol levels as compared to those without (P=.03). Stratification to gender and adjusting for age and risk factors revealed that significantly higher LDL-cholesterol and total cholesterol levels were observed in female stroke patients (P values .02, .028, respectively) and significantly higher blood urea nitrogen levels were observed in male stroke patients (P=.04) as compared to their counterparts who never had a stroke. CONCLUSION: The gender differences in the metabolic presentation of Saudi HF patients with stroke warrant further clinical investigation. Atherogenic dyslipidemia and renal insufficiency are suggested to be early predic.tors for stroke and should be closely monitored in Saudi HF patients.
