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ABSTRACT: Renal dysfunction in plasma cell dyscrasias is common. It is the second most common cause of death in patients with myeloma.
We evaluated 77 sequential autopsies performed on patients dying from complications of plasma cell dyscrasias during an 11-year period at the University of Arkansas for Medical Sciences. These consisted of 15% of all the autopsies performed during this time.
The kidneys were evaluated by light microscopy using hematoxylin-eosin-stained sections as well as Congo red and thioflavin T stains when amyloidosis was in the differential diagnosis. Immunofluorescence was performed on selected cases.
The most common lesion identified was cast nephropathy (30%). Other findings included acute tubulopathy, AL-amyloidosis, light chain deposition disease, tubulointerstitial nephritis associated with monotypic light chain deposits, thrombotic microangiopathy, renal infarction, fungal infection, and plasma cell tumor nodules. Autolysis, an expected finding in autopsy evaluations, was significant in 25 cases.
Renal lesions are heterogeneous in these patients. In some cases, combined pathologic lesions were noted. Myeloma cast nephropathy predominated among all the renal lesions noted.
Archives of pathology & laboratory medicine 09/2004; 128(8):875-9. · 2.58 Impact Factor
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Joth Jacobson,
Bart Barlogie,
John Shaughnessy,
Johannes Drach,
Guido Tricot,
Athanasios Fassas,
Maurizio Zangari,
Dori Giroux,
John Crowley, Aubrey Hough,
Jeff Sawyer
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ABSTRACT: Cytogenetic abnormalities (CA), especially of chromosome 13, have been used to identify a subgroup of previously untreated multiple myeloma (MM) patients with very poor prognosis despite high-dose therapy (HDT). We examined the prognostic implications of CA in 1000 MM patients receiving melphalan-based tandem autotransplants (median follow-up, 5 years). Negative consequences for both overall survival (OS) and event-free survival (EFS) in the presence of any CA were confirmed, especially when detected within 3 months of HDT. In the context of standard prognostic factors (SPF), 'MM-MDS' (MM karyotype that contains, in addition, CA typical of MDS) imparted a poor OS and EFS, after adjusting for any CA and all individual CA. One-year mortality was also high, especially for the MM-MDS subgroup with trisomy 8 within a MM signature karyotype (87%vs 34% in its absence, P < 0.001). No patient remained event free 5 years post transplant in the presence of these baseline high-risk CA. However, certain trisomies (e.g. chromosomes 7 and 9) and del 20 had favourable clinical consequences. The higher risk that is associated with CA compared with SPF justifies routine cytogenetic studies in all patients with MM at diagnosis and whenever additional treatment decisions are considered, such as in planning HDT either for initial response consolidation, at the time of primary unresponsiveness to induction therapy, or at relapse.
British Journal of Haematology 08/2003; 122(3):430-40. · 4.94 Impact Factor
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Athanasios B-T Fassas,
Firas Muwalla,
Tanya Berryman,
Riad Benramdane,
Lija Joseph,
Elias Anaissie,
Rajesh Sethi,
Raman Desikan,
David Siegel,
Ashraf Badros,
Amir Toor,
Maurizio Zangari,
Christopher Morris,
Edgardo Angtuaco,
Sajini Mathew,
Carla Wilson, Aubrey Hough,
Sami Harik,
Bart Barlogie,
Guido Tricot
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ABSTRACT: Involvement of the central nervous system (CNS) by multiple myeloma, as defined by the detection of malignant plasma cells in the cerebrospinal fluid in the presence of suggestive symptoms, is considered extremely rare. We report on the characteristics of 18 such patients diagnosed and treated at the University of Arkansas over the last 10 years for an overall incidence of approximately 1%. Their evaluation revealed association of CNS involvement with unfavourable cytogenetic abnormalities (especially translocations and deletion of the chromosome 13), high tumour mass, plasmablastic morphology, additional extramedullary myeloma manifestations and circulating plasma cells. The presence of these features should alert clinicians to the possibility of CNS involvement. The outcome of these patients was extremely poor despite the use of aggressive local and systemic treatment including autologous stem cell transplants. Given this universally poor prognosis, the application of allogeneic transplants should be studied in this clinical setting.
British Journal of Haematology 05/2002; 117(1):103-8. · 4.94 Impact Factor
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Athanasios B.-T. Fassas,
Firas Muwalla,
Tanya Berryman,
Riad Benramdane,
Lija Joseph,
Elias Anaissie,
Rajesh Sethi,
Raman Desikan,
David Siegel,
Ashraf Badros,
Amir Toor,
Maurizio Zangari,
Christopher Morris,
Edgardo Angtuaco,
Sajini Mathew,
Carla Wilson, Aubrey Hough,
Sami Harik,
Bart Barlogie,
Guido Tricot
[show abstract]
[hide abstract]
ABSTRACT: Involvement of the central nervous system (CNS) by multiple myeloma, as defined by the detection of malignant plasma cells in the cerebrospinal fluid in the presence of suggestive symptoms, is considered extremely rare. We report on the characteristics of 18 such patients diagnosed and treated at the University of Arkansas over the last 10 years for an overall incidence of approximately 1%. Their evaluation revealed association of CNS involvement with unfavourable cytogenetic abnormalities (especially translocations and deletion of the chromosome 13), high tumour mass, plasmablastic morphology, additional extramedullary myeloma manifestations and circulating plasma cells. The presence of these features should alert clinicians to the possibility of CNS involvement. The outcome of these patients was extremely poor despite the use of aggressive local and systemic treatment including autologous stem cell transplants. Given this universally poor prognosis, the application of allogeneic transplants should be studied in this clinical setting.
British Journal of Haematology 03/2002; 117(1):103 - 108. · 4.94 Impact Factor
