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Myeloma And Renal Failure

A Keith Stewart, Amrita Y Krishnan, Seema Singhal, Ralph V Boccia, Manish R Patel, Ruben Niesvizky, Asher A Chanan-Khan, Sikander Ailawadhi, Jochen Brumm, Kirsten E Mundt, Kyu Hong, Jacqueline McBride, Quyen Shon-Nguyen, Yuanyuan Xiao, Vanitha Ramakrishnan, Andrew G Polson, Divya Samineni, Douglas Leipold, Eric W Humke, James Scott McClellan, Jesus G Berdeja
FcRH5 is a cell surface marker enriched on malignant plasma cells when compared to other hematologic malignancies and normal tissues. DFRF4539A is an anti-FcRH5 antibody-drug conjugated to monomethyl auristatin E (MMAE), a potent anti-mitotic agent. This phase I study assessed safety, tolerability, maximum tolerated dose (MTD), anti-tumor activity, and pharmacokinetics of DFRF4539A in patients with relapsed/refractory multiple myeloma. DFRF4539A was administered at 0.3-2.4 mg/kg every 3 weeks or 0.8-1.1 mg/kg weekly as a single-agent by intravenous infusion to 39 patients...
February 4, 2019: Blood Cancer Journal
Fransico Galeano-Valle, F J Díaz-Crespo, R Melero-Martín, J E Apaza-Chávez, J Del-Toro-Cervera, P Demelo-Rodríguez
Crystal-storing histiocytosis (CSH) is a rare disorder characterized by the accumulation of nonneoplastic histiocytes containing intracytoplasmic crystallized immunoglobulins. In most cases, there is an associated underlying lymphoplasmacytic neoplasm expressing Ig kappa light chain. About 131 cases of CSH have been identified. There is a localized and a generalized form of CSH and it can involve several sites including bone marrow, lungs, lymph nodes, liver, spleen, gastrointestinal tract, and kidney. Generalized CSH is less frequent and involves multiple organs and tends to have a worst prognosis than localized CSH...
February 2, 2019: CEN Case Reports
E Riva, V Bove, F Villano, M Mori, C Córdoba, A Noria, P Petruskevicius, A Cardeza, L Díaz
INTRO: In the last decade, substantial improvements in the understanding of the biology of multiple myeloma and the development of novel therapeutic options have led to increased response rates, progression free survival and overall survival. In underdeveloped countries, it is a huge challenge to adapt for this evolution, both in diagnostic and therapeutic aspects. METHODS: We conducted a retrospective, national analysis of all patients with newly diagnosed multiple myeloma in a recent period...
January 8, 2019: Current Medical Research and Opinion
Idris Boudhabhay, Chérif Titah, Alexis Talbot, Stéphanie Harel, Jérôme Verine, Guy Touchard, Sihem Kaaki, Eric Gabison, Vivien Vasseur, Martine Mauget-Faÿsse, Thomas Sené
RATIONALE: Crystal sorting histiocytosis (CSH) is a rare disorder that is morphologically characterized by the accumulation of monoclonal immunoglobulin crystals, predominantly of a kappa light chain type, within lysosomes of macrophages. CSH may result in a variety of clinical manifestations depending on the involved organs. In this case report, we aim to describe a patient with ophthalmic manifestations which lead to the diagnosis of multiple myeloma with crystal-storing histiocytosis, crystalline podocytopathy, and light chain proximal tubulopathy...
December 2018: Medicine (Baltimore)
Alexandre Favà, Xavier Fulladosa, Nuria Montero, Juliana Draibe, Joan Torras, Montse Gomà, Josep M Cruzado
Renal injury is a common complication in multiple myeloma (MM). In fact, as many as 10% of patients with MM develop dialysis-dependent acute kidney injury related to increased free light chain (FLC) production by a plasma cell clone. Myeloma cast nephropathy (MCN) is the most prevalent pathologic diagnosis associated with renal injury, followed by light chain deposition disease and light chain amyloidosis. Several FLC removal techniques have been explored to improve kidney disease in MM but their impact on renal clinical outcomes remains unclear...
December 2018: Clinical Kidney Journal
Yingwei Liu, Andrés Ricardo Pérez-Riera, Raimundo Barbosa-Barros, Rodrigo Daminello-Raimundo, Luiz Carlos de Abreu, Kjell Nikus, Adrian Baranchuk
An otherwise healthy 64-year-old man with recently diagnosed multiple myeloma was admitted to hospital with hypercalcemia and renal failure. Despite his electrocardiogram showing short QT/QTc intervals, he was admitted without cardiac monitoring. He died suddenly a few hours later, likely from a fatal arrhythmia. This case illustrates that pronounced QT shortening from hypercalcemia is an underappreciated malignant finding that can portend a significant risk for arrhythmia and sudden cardiac death. In addition, we also discuss the causes of hypercalcemia associated short QT/QTc intervals and its ECG features...
November 2018: Journal of Electrocardiology
Mélanie Tia Weu, Cyr Guei Monlet, Amidou Sawadogo, Albert Coulibaly Pessa, Amelie Lagou Delphine, Apollinaire Gnionsahé Daze
BACKGROUND: Renal involvement is common during monoclonal gammopathies and their occurrence impacts the survival of the patients. Our objective was to describe the renal features during monoclonal gammopathies from 2004 to 2016 at the University Hospital of Yopougon in Abidjan. METHODS: Renal failure was defined as blood creatinine level > 20 mg/L and/or proteinuria > 500 mg/24 hours. RESULTS: We identified 42 cases of monoclonal gammopathiesincluding multiple myeloma (n=40) and monoclonal gammopathy of underdetermined significance (n=2)...
2018: Le Mali Médical
Ilya Noginskiy, Abraham Samra, Kendra Nielsen, Madhumati R Kalavar
Multiple myeloma (MM), a plasma cell neoplasm, has a typical presenting pattern consisting of bone pain, renal failure, anemia, and/or hypercalcemia. Even though MM is a cancer that impairs the immune system, rarely is a systemic infection the first sign of disease. In this case report, our patient presented with altered mental status due to meningitis and was later diagnosed with MM. Furthermore, we display a case of a rare but emerging and serious fungus, Candida auris , that the patient developed during his inpatient stay...
September 2018: Case Reports in Oncology
Meletios Dimopoulos, David Siegel, Darrell J White, Ralph Boccia, Karim S Iskander, Zhao Yang, Amy S Kimball, Khalid Mezzi, Heinz Ludwig, Ruben Niesvizky
In ENDEAVOR, carfilzomib (56 mg/m2 ) and dexamethasone (Kd56) demonstrated longer progression-free survival (PFS) over bortezomib and dexamethasone (Vd) in patients with relapsed/refractory multiple myeloma (RRMM). Here we evaluated Kd56 vs Vd by baseline renal function in a posthoc exploratory subgroup analysis. The intent-to-treat population included 929 patients (creatinine clearance [CrCL] ≥15 to <50 mL/min: Kd56, n=85 and Vd, n=99; CrCL 50 to <80 mL/min: n=186 and 177; CrCL ≥80: n=193 and 189)...
November 26, 2018: Blood
Guido Kleine
HISTORY:  A healthy young woman comes to admission because of an acute renal failure with hypercalcemia. FINDINGS AND DIAGNOSIS:  An infective and a non-infective inflammation could be disclosed, as well as a granulomatosis and a myeloma. Drug history was essential for diagnosis. THERAPY AND COURSE:  By forced diuresis the patient recovered completely from hypercalcemia and kidney function improved. CONCLUSION:  For acute renal failure potentially nephrotoxic drugs are to be considered, including dietary supplements...
November 2018: Deutsche Medizinische Wochenschrift
Scott Schoninger, Yamen Homsi, Alexandra Kreps, Natasa Milojkvovic
Multiple myeloma (MM) is a malignant plasma cell proliferation producing large numbers of monoclonal immunoglobulins. Typical MM symptoms include anemia, renal failure, hypercalcemia, and bone pain. Atypical symptoms have rarely been reported in the literature. We report a case of a 58-year-old male who presented with symmetrical inflammatory polyarthritis and was misdiagnosed with seronegative rheumatoid arthritis (RA). After failing many RA treatments and with further workup, the diagnosis of MM was made...
2018: Case Reports in Rheumatology
F Hernández Pardines, M C Serra Verdú, A Bernal Vidal, J M Mayol Belda, E Mengual Verdú
The case concerns a 58 year-old female with no medical history of interest who consulted due to binocular diplopia of one week onset. It was associated with costal pain, dyspnoea, intense asthenia and weight loss of 2 months onset. In the blood analysis in the Emergency Department it showed hypercalcaemia, renal failure, and bicytopenia. The chest x-ray showed lytic bone lesions that initially lead to multiple myeloma with extra-osseous involvement. In addition to the corresponding study, in case of horizontal diplopia, a cranial CT scan without contrast was performed where an adjacent lesion to the lateral wall of the left orbit is observed...
October 22, 2018: Archivos de la Sociedad Española de Oftalmología
Abdul Rafae, Mustafa N Malik, Muhammad Abu Zar, Seren Durer, Ceren Durer
Light chain multiple myeloma (LCMM) constitutes approximately 15% of patients with multiple myeloma (MM). It has a poorer prognosis when compared to immunoglobulin (Ig) G or IgA variant. We performed a comprehensive literature search on LCMM and identified a total of 390 articles. After a detailed screening, six studies involving a total of 1054 LCMM patients were included. A literature review revealed bone pain and renal failure as the most common initial sign and symptoms while extramedullary disease (EMD) was acquired later during the progression of the disease...
August 15, 2018: Curēus
Juan Gonzalez, Ahsan Wahab, Kavitha Kesari
Dysphagia is an uncommon presentation of systemic immunoglobulin light-chain (AL) amyloidosis with multiple myeloma (MM). Gastrointestinal (GI) involvement usually manifests with altered motility, malabsorption or bleeding. Furthermore, patients identified with GI amyloidosis, without previous diagnosis of a plasma cell disorder, are extremely rare. We report an elderly woman who presented with acute on chronic cardiac dysfunction, sick sinus syndrome and acute renal failure. While admitted, she developed intermittent dysphagia to both solids and liquids...
October 21, 2018: BMJ Case Reports
Marlies Antlanger, Tobias Dust, Thomas Reiter, Alexandra Böhm, Wolfgang W Lamm, Max Gornicec, Ella Willenbacher, David Nachbaur, Roman Weger, Werner Rabitsch, Susanne Rasoul-Rockenschaub, Nina Worel, Daniel Lechner, Hildegard Greinix, Felix Keil, Heinz Gisslinger, Hermine Agis, Maria-Theresa Krauth
BACKGROUND: Renal impairment (RI) is a negative prognostic factor in Multiple Myeloma (MM) and affected patients are often excluded from autologous stem cell transplantation (ASCT). However, it remains unclear whether historically inferior outcome data still hold true. METHODS: From a total of 475 eligible MM patients who had undergone ASCT between 1998 and 2016, 374 were included in this multi-centric retrospective cohort study. Renal function was determined both at the time of MM diagnosis and ASCT by estimated glomerular filtration rate (eGFR according to the MDRD formula, RI defined as eGFR < 60 ml/min/1...
October 20, 2018: BMC Cancer
Romana Ryšavá
AL amyloidosis (light chain; previously also called primary amyloidosis) is a systemic disease characterized by an amyloid deposition process affecting many organs, and which still has unsatisfactory survival of patients. The monoclonal light chains kappa (κ) or lambda (λ) or their fragments form the fibrils that deposit and accumulate in different tissues. Renal involvement is very frequent in AL amyloidosis and can lead to the development of nephrotic syndrome followed by renal failure in some cases. AL amyloidosis ultimately leads to destruction of tissues and progressive disease...
October 8, 2018: Nephrology, Dialysis, Transplantation
Hasan Jalaeikhoo, Morteza Sharifzadeh, Mohsen Rajaeinejad, Manoutchehr Keyhani, Mohammad Zokaasadi
BACKGROUND: Multiple myeloma (MM) accounts for a substantial mortality rate among hematological cancers. The prognosis of the disease has been noticeably changed during the past 2 decades. This study reports a retrospective analysis of 345 MM cases from 2 cancer centers. METHODS: Medical records of 345 MM cases were analyzed in retrospect. Diagnosis of MM was defined in presence of at least 10% plasma cells in bone marrow biopsy and one of the CRAB findings (hypercalcemia, renal failure, anemia and myeloma bone lesions)...
September 1, 2018: Archives of Iranian Medicine
Sara Bringhen, Massimo Offidani, Salvatore Palmieri, Francesco Pisani, Rita Rizzi, Stefano Spada, Andrea Evangelista, Nicola Di Renzo, Pellegrino Musto, Magda Marcatti, Roberto Vallone, Sergio Storti, Annalisa Bernardini, Riccardo Centurioni, Enrico Aitini, Angelo Palmas, Ombretta Annibali, Emanuele Angelucci, Paola Ferrando, Anna Baraldi, Stefano Rocco, Alessandro Andriani, Agostina Siniscalchi, Valerio De Stefano, Vittorio Meneghini, Antonio Palumbo, Sara Grammatico, Mario Boccadoro, Alessandra Larocca
INTRODUCTION: Early toxic death (≤60 days of diagnosis) in elderly multiple myeloma (MM) patients is attributable to active disease, age and co-morbidities. Rate of early toxic deaths is 10% with conventional chemotherapy mainly due to infection and renal failure. Novel agents have improved MM outcome at the expense of newer toxicity. METHODS: We analyzed 1146 individual patient data to assess toxic deaths during induction treatment with first-generation novel agents thalidomide, lenalidomide, bortezomib...
October 2018: Critical Reviews in Oncology/hematology
Tobias Wehrhahn, Mario Bargetzi, Carlos Buitrago-Tellez, Gianni Cantelmi
Patients with plasma cell myeloma may initially present to their dentists or dental surgeons with toothache, loose teeth, or gingival masses. An X-ray of the jaw can reveal osteolyses. In addition, accumulation of monoclonal light chains in AL-amyloidosis can lead to macroglossia. It is prudent that the dentist or dental surgeon recognizes the underlying disease and refers the patient to the oncologist or hematologist for further workup to prevent the complications of plasma cell myeloma such as renal impairment, fractures, bone pain, infections, hypercalcemia, anemia, or heart failure...
July 2018: European Journal of Dentistry
Naresh Mullaguri, Anusha Battineni, Raviteja Guddeti
Multiple myeloma is an immunoglobulin-producing plasma cell neoplasm that commonly affects the bones, kidneys, the hematopoietic system, and rarely the nervous system. Peripheral nervous system involvement in the form of cranial neuropathy, radiculopathy, and polyneuropathy are common. Compressive myelopathy constitutes the majority of central nervous system disorders followed by cerebrovascular disorders, intracranial plasmacytomas, and leptomeningeal myelomatosis. Cerebrovascular complications such as acute ischemic stroke and transient ischemic attack are not uncommon...
June 19, 2018: Curēus
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