title: Type I cryoglobulinemia in multiple myeloma, a rare entity: analysis of clinical and biological characteristics of seven cases and review of the literature.
abstract: The type I cryoglobulins (CGs) account for 10-15% of all cryoglobulins and are found in patients with hematological disorders. We here describe the largest series of seven cases of type I cryoglobulinemia associated with multiple myeloma (MM) and provide a detailed review of the literature associated with this disorder, with the aim of improving the future diagnosis and therapeutic management of this rare disease. Six of the cases in our series were men aged 28-69 years, and most of the subject patients had an immunoglobulin G (IgG) monoclonal component and stage I indolent MM that manifested as cryoglobulin-related symptoms. The patients were all karyotypically normal. Clinical manifestations in this group were: skin lesions (five cases, 71.4%), rheumatologic failure (four cases, 57.1%), neurological abnormalities (two cases, 28.6%), mixed cutaneous/rheumatologic/renal defects (one case, 14.3%) and one case in which the cryoglobulinemia was asymptomatic. Two patients experienced acute renal failure but underwent a full recovery following treatment for MM. We conclude from our analysis that treatment approaches for severe type I cryoglobulinemia should involve plasmapheresis at the onset to achieve a rapid control of the CG-related symptoms, and that specific MM treatments should be introduced also at an early stage to avoid cryoglobulinemia relapse. In this context, bortezomib and lenalidomide are potentially the most effective therapeutic agents.
authors.affiliation: Rheumatology Department, Cochin Hospital, Paris, France.
authors.forename: Judith
authors.initials: J
authors.lastname: Payet
authors.forename: Joël
authors.initials: J
authors.lastname: Livartowski
authors.forename: Niloufar
authors.initials: N
authors.lastname: Kavian
authors.forename: Olivia
authors.initials: O
authors.lastname: Chandesris
authors.forename: Nicolas
authors.initials: N
authors.lastname: Dupin
authors.forename: Nadège
authors.initials: N
authors.lastname: Wallet
authors.forename: Alexandre
authors.initials: A
authors.lastname: Karras
authors.forename: Carine
authors.initials: C
authors.lastname: Salliot
authors.forename: Felipe
authors.initials: F
authors.lastname: Suarez
authors.forename: Hervé
authors.initials: H
authors.lastname: Avet-Loiseau
authors.forename: Marie Alexandra
authors.initials: MA
authors.lastname: Alyanakian
authors.forename: Chadi Al
authors.initials: CA
authors.lastname: Nawakil
authors.forename: Sophie
authors.initials: S
authors.lastname: Park
authors.forename: Jé
authors.initials: J
authors.lastname: Tamburini
authors.forename: Christian
authors.initials: C
authors.lastname: Roux
authors.forename: Didier
authors.initials: D
authors.lastname: Bouscary
authors.forename: Laetitia
authors.initials: L
authors.lastname: Sparsa
mesh_terms: D000328:Adult; D003449:Cryoglobulinemia / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D009336:Necrosis; D009367:Neoplasm Staging; D012867:Skin / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D007074:Immunoglobulin G; D007075:Immunoglobulin M