Cases reported "Multiple Myeloma"

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1/172. Co-incidental presentation of IgA lambda multiple myeloma and pleural involvement with IgM kappa non-Hodgkin's lymphoma.

    Pleural effusions occur in approximately 6% of patients with myeloma. The aetiology is multifactorial and effusions due to pleural myelomatous involvement are rare, occurring in < 1% of cases. We report the case of a 68-year-old lady who presented with IgA myeloma and a concurrent pleural effusion due to a second IgM kappa producing B cell neoplasm. The former responded but the latter was resistant to standard myeloma therapy.
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2/172. plasmacytoma and upper airway obstruction.

    Extramedullary plasmacytomas are hematologic malignancies that occur primarily in the head and neck region. They usually involve the submucosal lymphoid tissue of the nasopharynx or paranasal sinuses and present as soft tissue masses, but have not been previously reported to cause airway obstruction. In general, detection of plasmacytoma antedates the eventual development of the systemic hematologic malignancy, multiple myeloma, by months or years. We describe a unique case of acute upper respiratory tract obstruction secondary to compression by an extramedullary plasmacytoma occurring in the neck of a patient with history of long-standing multiple myeloma. Upper airway obstruction may be a manifestation of untreated plasmacytoma. It is imperative for otolaryngologists and head and neck surgeons to be familiar with this entity because total excision, as well as radiation therapy, for plasmacytomas can be curative in patients without underlying overt plasma cell dyscrasias.
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ranking = 0.59481618940608
keywords = malignancy
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3/172. Combined histocompatibility leukocyte antigen-matched donor bone marrow and renal transplantation for multiple myeloma with end stage renal disease: the induction of allograft tolerance through mixed lymphohematopoietic chimerism.

    BACKGROUND: Experimental and clinical evidence has demonstrated that the establishment of allogeneic chimerism after bone marrow transplantation may provide donor-specific tolerance for solid organ allografts. methods: Based on the preliminary results of a clinical trial using nonmyeloablative preparative therapy for the induction of mixed lymphohematopoietic chimerism, we treated a 55-year-old woman with end stage renal disease secondary to multiple myeloma with a combined histocompatibility leukocyte antigen-matched bone marrow and renal transplant after conditioning with cyclophosphamide, antithymocyte globulin, and thymic irradiation. RESULTS: The posttransplant course was notable for early normalization of renal function, the absence of acute graft-versus-host disease, and the establishment of mixed lymphohematopoietic chimerism. cyclosporine, which was the only posttransplant immunosuppressive therapy, was tapered and discontinued on day 73 posttransplant. No rejection episodes occurred, and renal function remains normal on day 170 posttransplant (14 weeks after discontinuing cyclosporine). Although there is presently no evidence of donor hematopoiesis, there is evidence of an ongoing antitumor response with a recent staging evaluation showing no measurable urine kappa light chains. The patient remains clinically well and is off all immunosuppressive therapy. CONCLUSION: This is the first report of the deliberate induction of mixed lymphohematopoietic chimerism after a nonmyeloablative preparative regimen to treat a hematological malignancy and to provide allotolerance for a solid organ transplant.
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ranking = 0.59481618940608
keywords = malignancy
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4/172. Acute leukemia following prolonged cytotoxic agent therapy.

    1. Nine patients in whom acute non-lymphoblastic leukemia (ANLL) developed following prolonged alkylating agent therapy are described. Five of the patients received no radiotherapy. The conditions treated were: Hodgkin's disease (four patients), primary amyloidosis, primary macroglobulinemia, malignant lymphoma, multiple myeloma, and carcinoma of the tonsil. 2. Prior to the advent of chemotherapy, this complication was not observed in large series of patients with lymphoproliferative disorders and multiple myeloma. However, the medical literature now contains at least 125 other detailed reports of ANLL developing after prolonged cytotoxic agent therapy. 3. multiple myeloma and Hodgkin's disease, both of which commonly have good responses to chemotherapy, predominate as the underlying diseases. However, 35% of the case reports involve patients with other illnesses, including 12 patients who did not have neoplasms. 4. More than half of the patients developing ANLL have received chemotherapy alone without radiotherapy. 5. At least half of the patients developing ANLL experienced long periods of significant cytopenia during therapy, often with documentation of bone marrow dysplasia. 6. The wide variety of drugs associated with this complication suggests that any cytotoxic agent may be leukemogenic. However, alkylating agents overwhelmingly predominate as the class of compounds which are most often associated with terminal ANLL. 7. The vast majority of patients reported in the literature with ANLL complicating underlying malignancies have received cytotoxic drugs for prolonged periods (median 3 1/2 years) and leukemia developed most commonly 3 to 5 years after the diagnosis of the underlying disease. Most of these patients benefited from therapy and survived longer (median 5 years) than historical control of untreated patients. 8. The leukemogenic potential in man of prolonged cytotoxic agents therapy, especially with alkylating agents, seems to be well established. This evidence admonishes against the prolonged use of these drugs in non-fatal disorders. 9. More accurate assessment of risk: benefit ratios awaits the results of prospective controlled studies. The results of these studies could also lead to significant modifications in recommendations for long-term maintenance therapy with cytotoxic agents.
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5/172. Two cases of inflammatory bowel disease with multiple myeloma.

    A significant increase has been reported in reticuloendothelial neoplasms in patients with inflammatory bowel diseases. We present two rare cases of multiple myeloma in patients with inflammatory bowel diseases. One was in a 58-year-old woman with ulcerative colitis, and the other was in a 59-year old woman with Crohn's disease. In both patients, multiple myeloma occurred during long-term observation of inflammatory bowel disease and during the inactive stage of intestinal inflammation. The multiple myeloma appeared to have resulted from monoclonal gammopathy of undertermined significance in both patients, and was diagnosed by characteristic serum and bone marrow findings. Our findings suggested that multiple myeloma should be particularly considered in women of middle or advanced age with ulcerative colitis or Crohn's colitis and serum monoclonal gammopathy.
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6/172. Ultrastructure of acute myeloid leukemia arising in multiple myeloma.

    Bone marrow from a case of multiple myeloma in which acute myeloid leukemia supervened four years after diagnosis was examined with the electron microscope. Two distinct populations of neoplastic cells, one plasmacytoid and the other myeloid, were identified in the marrow. It is concluded that the acute leukemia that developed in this patient was a distinctly new neoplasm arising from the myeloid series of cells. Since in nearly all previously reported cases, and in our patient, alkylating agents had been administered, it is thought that this may have been a factor in the development of acute myeloid leukemia.
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7/172. Hematologic neoplasia and the central nervous system.

    central nervous system (CNS) involvement with malignant cells is a well recognized complication of hematologic neoplasms. A number of disorders such as acute lymphoblastic leukemia and high grade lymphoma frequently involve the CNS and prophylactic therapy is advised. Disorders such as acute myeloid leukemia (AML) and multiple myeloma are less likely to be associated with CNS involvement. This series describes three cases of CNS involvement by malignant hematologic disease: myelomatous meningitis, CNS chloromas complicating AML, and primary lymphomatous meningitis.
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8/172. Clinically significant cardiac infiltration in acute leukemia, lymphocytic lymphoma, and plasma cell myeloma.

    Cardiac infiltration by hematologic neoplasms leading to clinically significant cardiovascular disease is rare. Three such cases are described in this report, and it is suggested that rare manifestations of hematologic neoplasms may become more common in the future since these diseases are more amenable to therapy than heretofore. Cardiac involvement with hematologic neoplasms is of more than academic interest since this complication is likely to respond to radiotherapy.
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9/172. Plasma cell neoplasms in the young.

    multiple myeloma, a disease of the elderly, is extremely rare in those below 30 years of age. Two patients with multiple myeloma diagnosed at 20 years and 18 years are described. Both presented with extradural cord compression, lytic bone lesions and bone marrow plasmacytosis. One patient received combination chemotherapy and radiotherapy and survived for 14 years. A literature review is presented.
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10/172. Epstein-Barr virus-associated high-grade anaplastic plasmacytoma in a renal transplant patient.

    Allograft transplant patients have an increased risk of developing polyclonal or monoclonal lymphoproliferative disorders, but high-grade anaplastic plasmacytomas are extremely rare in these patients. We present a renal transplant patient who developed multiple extramedullary high-grade anaplastic plasmacytomas in the oral cavity, the left maxillary antrum, the scalp, the thigh and the upper abdominal wall with no evidence of diffuse bone marrow infiltration. Epstein-Barr virus (EBV) mRNA transcripts were detected within the myeloma cells by in situ hybridization using EBER1-2 probes. Following discontinuation of immunosuppression applied, the patient was treated with a cyclophosphamide-prednisone regimen followed by local irradiation, and a complete remission was achieved within four weeks. We concluded that EBV-associated high-grade anaplastic plasmacytomas constitute one more type of post-transplant lymphoproliferative disorder, and that despite their characterization as highly malignant neoplasms, their clinical behavior is not always aggressive.
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