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Clinical analysis of multiple myeloma with pleural effusion |
XU Huiying ZHOU Weiwei LIN Lianjun LIU Xinmin |
Department of Geriatrics, Peking University First Hospital, Beijing 100034, China |
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Abstract Objective To analyze the clinical characteristics of multiple myeloma (MM) with pleural effusion. Methods This was a retrospective study. Patients diagnosed of MM from January 2000 to December 2016 in Peking University First Hospital were included. Demographic, clinical and laboratory tests data were collected prospectively and analyzed statistically. Results The overall rate of pleural effusion was 37.4%(130/348) in MM patients, and myelomatous pleural effusion(MPE) rate showed to be 2.6%(9/348). The levels of total protein (TP), albumin, calcium, and complement 3 (C3) in the pleural effusion group were lower than those in the non-pleural effusion group, and the LDH level in the pleural effusion group was higher than that in the non-pleural effusion group (P < 0.05). Hypocomplementemia of C3(OR=0.282, 95%CI 0.096-0.830, P < 0.01) and lower level of TP(OR=0.979, 95%CI 0.966-0.993, P < 0.01) were independent risk factors of pleural effusion production according to multiple Logisitic regression. The levels of LDH and adenosine deaminase (ADA) were higher level in the MPE group than those in the non-MPE group (P < 0.05). Conclusion Pleural effusion is one of the complications of MM, in which MPE is rare. Hypocomplementemia of C3 and lower level of TP seem to be independent risk factors of pleural effusion production in MM. High level of LDH and ADA in pleural effusion remind the high risk of MPE. The pathophysiology of pleural effusion, especially MPE in MM needs further research in the future.
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[1] Mangla A,Agarwal N,Kim GJ,et al. Primary malignant myelomatous pleural effusion [J]. Clin Case Rep,2016,4(8):803-806.
[2] Cho YU,Chi HS,Park CJ,et al. Myelomatous pleural effusion:a case series in a single institution and literature review [J]. Korean J Lab Med,2011,31(4):225-230.
[3] 中国医师协会血液科医师分会,中华医学会血液学分会,中国医师协会多发性骨髓瘤专业委员会.中国多发性骨髓瘤诊治指南(2015年修订)[J].中华内科杂志,2015,54(12):1066-1070.
[4] Dhakal B,Girnius S,Hari P. Recent advances in understanding multiple myeloma [J]. F1000Res,2016,8(23):5.
[5] Babu KA,Sundararajan L,Prabu P,et al. Disseminated plasma cell myeloma presenting as massive pleural effusion [J]. Eur Clin Respir J,2015,2:10.3402/ecrj.v2.27028.
[6] Wang Z,Xia G,Lan L,et al. Pleural effusion in multiple myeloma [J]. Intern Med,2016,55(4):339-345.
[7] Zurlo JJ,Schechter GP,Fries LF. Complement abnormalities in multiple myeloma [J]. Am J Med,1989,87(4):411-420.
[8] Lugassy G,Platok I,Schlesinger M. Hypocomplementemia in multiple myeloma [J]. Leuk Lymphoma,1999,33(3-4):365-370.
[9] Bridoux F,Desport E,Frémeaux BV,et al. Glomerulonephritis with isolated C3 deposits and monoclonal gammopathy:a fortuitous association?[J]. Clin J Am Soc Nephrol,2011, 6(9):2165.
[10] Zand L,Kattah A,Fervenza FC,et al. C3 glomerulonephritis associated with monoclonal gammopathy:a case series [J]. Am J Kidney Dis,2013,62(3):506-514.
[11] Yin G,Cheng Z,Zeng CH,et al. C3 glomerulonephritis in multiple myeloma:a case report and literature review [J]. Medicine,2016,95(37):e4843.
[12] Agarwal A,Singla S,Bansal M,et al. Bilateral pleural effusions due to pulmonary amyloidosis as the presenting manifestation of multiple myeloma [J]. Mediterranean J Hematol Infect Dis,2012,4(1):e2012010.
[13] Kim YJ,Kim SJ,Min K,et al. Multiple myeloma with myelomatous pleural effusion:a case report and review of the literature [J]. Acta Haematol,2008,120(2):108-111.
[14] Oudart JB,Maquart FX,Semouma O,et al. Pleural effusion in a patient with multiple myeloma [J]. Clin Chem,2012,58(4):672-674.
[15] Aghaei M,Karami TF,Salami S,et al. Adenosine deaminase activity in the serum and malignant tumors of breast cancer:the assessment of isoenzyme ADA1 and ADA2 activities [J]. Clin Biochem,2005,38(10):887-891.
[16] Xu XL,Shen YH,Shen Q,et al. A case of bilateral pleural effusion as the first sign of multiple myeloma [J]. Eur J Med Res,2013,18(1):1-4.
[17] Liu YC, Shinjung LS,Chen YS,et al. Differential diagnosis of tuberculous and malignant pleurisy using pleural fluid adenosine deaminase and interferon gamma in Taiwan [J]. J Microbiol Immunol Infect,2011,44(2):88-94.
[18] LightRW. Update on tuberculous pleural effusion [J]. Respirology,2010,15(3):451-458.
[19] Zhang LL,Li YY,Hu CP,et al. Myelomatous pleural effusion as an initial sign of multiple myeloma-a case report and review of literature [J]. J Thorac Dis,2014,6(7):152-159.
[20] Keklik M,Sivgin S,Pala C,et al. Flow cytometry method as a diagnostic tool for pleural fluid involvement in a patient with multiple myeloma [J]. Mediterranean J Hematol Infect Dis,2012,4(1):e2012063. |
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