title: Multiple myeloma-associated amyloidosis is an independent high-risk prognostic factor.
abstract: 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.
authors.affiliation: Hematology Department, Unidad Médica de Alta Especialidad, Hospital de Especialidades Centro Médico Nacional La Raza, IMSS, México DF, México. velaj12x@prodigy.net.mx
authors.forename: J
authors.initials: J
authors.lastname: Vela-Ojeda
authors.forename: M A
authors.initials: MA
authors.lastname: García-Ruiz Esparza
authors.forename: Y
authors.initials: Y
authors.lastname: Padilla-González
authors.forename: E
authors.initials: E
authors.lastname: Sánchez-Cortes
authors.forename: J
authors.initials: J
authors.lastname: García-Chávez
authors.forename: L
authors.initials: L
authors.lastname: Montiel-Cervantes
authors.forename: E
authors.initials: E
authors.lastname: Reyes-Maldonado
authors.forename: A
authors.initials: A
authors.lastname: Majluf-Cruz
authors.forename: H
authors.initials: H
authors.lastname: Mayani
mesh_terms: 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
chemical_list: D000970:Antineoplastic Agents