ABSTRACT
We report a case of a 68-year-old man presented with upper-gastrointestinal bleeding. Endoscopy showed a large ulcerated gastric mass. Histological examination of the gastric biopsies revealed a k monoclonal extramedullary plasmacytoma (EMP). Further staging was negative for multiple myeloma. The patient was managed with bortezomib at a dose of 1.3mg/m2 on days 1, 4, 8 and 11 of a 21-day cycle in combination with dexamethasone 20mg p.o. on days 1, 2, 4, 5, 8, 9 and 11, 12 of each cycle. After 4 cycles of treatment, no endoscopic or histological findings of EMP were found. Thirteen months after diagnosis the patient is in complete remission with no evidence of local relapse or evolution to multiple myeloma. This is the first reported case of EMP successfully managed with the combination of bortezomib and dexamethasone.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Plasmacytoma/drug therapy , Stomach Neoplasms/drug therapy , Boronic Acids/administration & dosage , Bortezomib , Dexamethasone/administration & dosage , Humans , Male , Middle Aged , Plasmacytoma/pathology , Plasmacytoma/physiopathology , Pyrazines/administration & dosage , Stomach Neoplasms/pathology , Stomach Neoplasms/physiopathologyABSTRACT
BACKGROUND AND OBJECTIVE: Since the prognostic significance of the combination of beta-2-microglobulin (beta(2)m) and albumin in multiple myeloma (MM) has been recognized, these two easily obtainable parameters were subsequently employed in the staging systems of Bataille et al. (BSS), the South West Oncology Group (SWOG SS) and most recently the International Myeloma Working Group (ISS). There is no consensus, however, regarding the cut off levels of beta(2)m and the stage, early or advanced, at which albumin should be added to the model. At the same time, Weber et al. demonstrated similar results using beta(2)m alone in identical cut-offs with ISS (WSS). The aim of the present study is to apply these four staging systems in 504 MM patients, in order to discern the role of albumin in MM staging and evaluate if, and at which stage, albumin should be added to the model. METHODS: Median overall survival (OS) according to BSS, SWOG SS, ISS and WSS was estimated according to the Kaplan-Meier method. OS differences between the stages were assessed using the log-rank test. Patients with beta(2)m < 3.5 mg/l and albumin < 3.5 g/dl, who were classified in stage II according to ISS and in stage I according to WSS, were analyzed separately in order to detect in which prognostic group they practically belong. RESULTS: BSS and SWOG SS failed to distinguish stage II from stage III patients and stage III from stage IV patients, respectively. ISS and WSS achieved clear stratification of the patients into three distinct prognostic subgroups, but WSS I patients had a lower life expectancy than ISS I patients. This difference was due to false inclusion of patients with beta(2)m < 3.5 mg/l and albumin < 3.5 g/dl in stage I by WSS, while separate analysis of these patients proved that they belong, in fact, in stage II. In an attempt to improve its prognostic impact, WSS was then successfully modified by dividing WSS I patients in two substages, WSS IA: beta(2)m < 2.5 mg/l and WSS IB: 2.5 mg/l < or = beta(2)m < 3.5 mg/l, thus designating a low-risk and a low-intermediate-risk subgroup, respectively. CONCLUSION: Albumin appears to lose its prognostic value at high cut-off levels of beta(2)m, while it enhances the prognostic significance of beta(2)m at low cut-off levels of the latter. Albumin cannot be eliminated from the ISS, since it is absolutely necessary in order to identify true low-risk patients. The only possibility for albumin exclusion from the model, could be to decrease the beta(2)m low-risk cut-off from 3.5 to 2.5 mg/l.
Subject(s)
Multiple Myeloma/pathology , Neoplasm Staging/methods , Serum Albumin/analysis , beta 2-Microglobulin/blood , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Multiple Myeloma/diagnosis , Multiple Myeloma/mortality , Prognosis , Survival RateSubject(s)
Multiple Myeloma/complications , Pyoderma Gangrenosum/complications , Dexamethasone/therapeutic use , Humans , Male , Middle Aged , Multiple Myeloma/diagnosis , Multiple Myeloma/drug therapy , Pyoderma Gangrenosum/diagnosis , Pyoderma Gangrenosum/drug therapy , Thalidomide/therapeutic use , UlcerABSTRACT
We evaluated the prognostic significance of five staging systems in 470 consecutive, previously untreated patients with multiple myeloma diagnosed between 1989 and 2006. The five staging systems were those proposed by Durie and Salmon, Bataille et al., the South West Oncology Group, Weber et al. and the International Staging System. This last proved to be superior to the others.
Subject(s)
Multiple Myeloma/pathology , Neoplasm Staging/methods , Humans , Neoplasm Staging/mortality , Neoplasm Staging/standards , Prognosis , Reproducibility of Results , Retrospective Studies , Survival Analysis , Time FactorsABSTRACT
The incidence, characteristics and risk factors for the development of osteonecrosis of the jaw (ONJ) were evaluated among 303 myeloma patients. Only patients who received bisphosphonates developed ONJ (28/254; 11%). Zoledronic acid produced 9.5-fold greater risk for developing ONJ than pamidronate alone (P = 0.042) and 4.5-fold greater risk than subsequent use of pamidronate + zoledronic acid (P = 0.018). Use of thalidomide and number of bisphosphonate infusions also increased the risk for ONJ by 2.4-fold (P = 0.043), and 4.9-fold respectively (P = 0.012). ONJ developed earlier among patients receiving zoledronic acid. Our data indicates that administration of zoledronic acid for more than 2 years or in combination with thalidomide requires caution in myeloma.
