Multiple myeloma-associated amyloidosis is an independent high-risk prognostic factor.
Several prognostic factors have been recognized in patients with multiple myeloma (MM). Among the most important are: the serum levels of beta2-microglobulin, albumin, and LDH; the labeling index; and an abnormal karyotype. Patients with amyloidosis (AL) have poor prognosis; however, little is known concerning the prognostic significance of AL associated to MM. In 201 consecutive patients with de novo MM, we performed a fat-pad biopsy needle aspiration (FPBNA) that was stained with Congo red. Sixty eight (34%) patients had AL and a poorer prognosis disease: lower performance status, presence of B symptoms, higher LDH and calcium values, and worse response to chemotherapy. Cox regression model for overall survival detected three variables having independent prognostic significance: the presence of AL (RR = 3.4, P < 0.004), serum albumin levels <3.5 g/dl (RR 3.2, p < 0.005), and patients not achieving complete remission or very good partial remission (RR 2.9, p < 0.02). In 28% of patients with de novo MM, FPBNA was useful to detect incidental amyloidosis. During follow-up, 69% of these patients had symptoms of AL. Excluding 16 patients with obvious symptoms of AL at diagnosis, overall survival was worse in patients who developed later symptoms of AL. MM-associated AL represents a poorer prognosis disease even in the absence of symptoms at diagnosis, and this specific association may be considered as an independent high-risk prognostic factor. The routine study of periumbilical fat-pad tissue should be mandatory in all patients with MM.
Vela-Ojeda
J
J
Hematology Department, Unidad Médica de Alta Especialidad, Hospital de Especialidades Centro Médico Nacional La Raza, IMSS, México DF, México. velaj12x@prodigy.net.mx
García-Ruiz Esparza
M A
MA
Padilla-González
Y
Y
Sánchez-Cortes
E
E
García-Chávez
J
J
Montiel-Cervantes
L
L
Reyes-Maldonado
E
E
Majluf-Cruz
A
A
Mayani
H
H
D000273:Adipose Tissue / Q000473:pathology; D000328:Adult; D000368:Aged; D000686:Amyloidosis / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001706:Biopsy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012074:Remission Induction; D012307:Risk Factors
D000970:Antineoplastic Agents