melphalan and Dyspnea

Topics: Adrenal Cortex Hormones; Animals; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Breast Neoplasms; Cyclophosphamide; Dacarbazine; Doxorubicin; Drug Therapy, Combination; Dyspnea; Fluorouracil; Hodgkin Disease; Humans; Hypercalcemia; Leukemia; Leukemia, Lymphoid; Lymphoma; Mechlorethamine; Melphalan; Methotrexate; Multiple Myeloma; Palliative Care; Prednisone; Procarbazine; Receptors, Glucocorticoid; Vinblastine; Vincristine; Vomiting

Topics: Antineoplastic Agents, Alkylating; Dyspnea; Fatigue; Humans; Immunoglobulin Light-chain Amyloidosis; Melphalan; Pain; Prospective Studies; Quality of Life; Sleep Initiation and Maintenance Disorders; Treatment Outcome

Polyneuropathy, Organomegaly, Endocrinopathy, M-protein and Skin changes syndrome is a rare paraneoplastic syndrome from a plasma cell dyscrasia, which most commonly presents with peripheral neuropathy. We report a 30-year-old female with blurred vision and vision loss as reasons for her initial treatment; the patient was diagnosed with bilateral opticneuritis. Five months later, the patient started to have lower extremity numbness and fatigue. Initial laboratory tests did not reveal positive monoclonal immunoglobulin. Therefore, simple peripheral neuropathy was considered for diagnosis, and the patient was treated in the Department of Neurology in our hospital; however, the symptom was not alleviated. Seven months later, the patient showed symptoms of cough, dyspnea, along with rough skin, pigmentation and drooping of both feet. Chest CT revealed bronchiectasis and infection of lungs, destruction of thoracic bones and ribs. Further examination indicated that the patient had splenomegaly, hypothyroidism and monoclonal IgA-λ chain zone, which led to a clear diagnosis of Polyneuropathy, Organomegaly, Endocrinopathy, M-protein and Skin changes syndrome.

Topics: Adult; Antineoplastic Agents, Alkylating; Diagnosis, Differential; Disease Progression; Dyspnea; Female; Humans; Melphalan; Optic Neuritis; Paresis; Peripheral Blood Stem Cell Transplantation; POEMS Syndrome; Treatment Outcome

The described report deals with the case of a patient with diagnosis of ischemic-hypertensive cardiomyiopathy based on the history of angina and inducible myocardial ischemia with normal coronary arteries. However, after cardiac magnetic resonance, the typical amyloidotic pattern is found and the final diagnosis of multiple myeloma is made at osteomedullary biopsy.

Topics: Amyloidosis; Angina Pectoris; Antineoplastic Agents, Alkylating; Biopsy; Bone Marrow Examination; Cardiomyopathies; Combined Modality Therapy; Diagnostic Errors; Dyspnea; Electrocardiography; Humans; Hypertrophy, Left Ventricular; Magnetic Resonance Imaging; Male; Melphalan; Middle Aged; Multiple Myeloma; Myocardial Ischemia; Peripheral Blood Stem Cell Transplantation

Immunoglobulin D (IgD) multiple myeloma is rare, accounting for less than 2% of all patients with multiple myeloma. The main presenting features are bone pain in 70% of patients. Extramedullary involvement is less common. We report a case of Ig D lambda multiple myeloma in a 74-year-old man that was revealed by pleural effusion and dyspnea. This effusion was found to be caused by multiple myeloma after electrophoretic and cytologic assays. The patient received a course of chemotherapy with melphalan and prednisone. The patient died one month later with signs of septic shock. Pleural effusion as a first sign of Ig D multiple myeloma is rarely described and the prognosis associated with such a localisation is very poor.

Topics: Aged; Anti-Inflammatory Agents; Antineoplastic Agents, Alkylating; Drug Therapy, Combination; Dyspnea; Humans; Immunoelectrophoresis; Immunoglobulin D; Immunoglobulin lambda-Chains; Male; Melphalan; Multiple Myeloma; Pleural Effusion; Prednisone; Time Factors

We describe here an extremely rare case of primary amyloidosis which presented moderate pleural effusion and high fever. A 71-year-old man was admitted to our hospital because of exertional dyspnea, fatigue and fever. A chest X-ray showed right-sided moderate pleural effusion. A thoracocentesis revealed an exudative pleural effusion. Cytology and cultures of the effusion were negative. External drainage failed to control the effusion. To determine the etiology of the effusion and fever, bronchoscopy was performed. Biopsies of the tracheal wall showed amyloid deposition. The pleural effusion might have been due to the inflammation and the disturbed lymphatic drainage caused by the amyloid deposition. Treatment with melphalan (6 mg) and prednisolone (35 mg) for 4 days every 6 weeks decreased the fever and alleviated his symptoms.

Topics: Aged; Amyloidosis; Anti-Inflammatory Agents; Antineoplastic Agents, Alkylating; Bronchoscopy; Dyspnea; Exudates and Transudates; Fever; Humans; Lung Diseases; Male; Melphalan; Pleural Effusion; Prednisolone; Treatment Outcome

Systemic light-chain deposition due to plasma cell dyscrasias manifests as a form of restrictive cardiomyopathy with diastolic ventricular dysfunction. Although these manifestations are likely to be cardiac amyloidosis, whether these pathological conditions are reversible after treatment of the underlying plasma cell disorders is unknown. To our knowledge, we describe the first patient with cardiac light-chain deposition due to multiple myeloma in whom echocardiographic and biochemical factors of cardiac function were ameliorated dramatically after remission of this disorder. We emphasize that restrictive cardiomyopathy due to light-chain deposition may be reversible and have a relatively better prognosis after remission of plasma cell dyscrasias.

Topics: Adult; Anorexia; Antineoplastic Combined Chemotherapy Protocols; Biopsy; Bone Marrow Examination; Cardiomyopathy, Restrictive; Dyspnea; Echocardiography; Electrocardiography; Hemodynamics; Humans; Immunoglobulin Light Chains; Male; Melphalan; Multiple Myeloma; Nitrosourea Compounds; Prognosis; Remission Induction; Treatment Outcome; Vincristine

We present two cases of extramedullary plasmacytoma presenting as a mediastinal mass and preceding the onset of full-blown multiple myeloma. The patients are a 62-year-old woman who presented with progressive dyspnea and left-sided chest pain and a 59-year-old asymptomatic man. In both patients, radiographic studies revealed a posterior and anterior mediastinal mass, respectively. Surgical resection of the tumor was performed in the two cases. The tumors were characterized by a well-circumscribed proliferation of plasma cells surrounded by residual lymph nodal tissue. Immunohistochemical studies on paraffin sections demonstrated lambda light chain restriction. Follow-up in our patients revealed that both of them developed multiple myeloma after 6 months and 2 years, respectively. One patient received treatment with melphalan and prednisone and is currently alive and well without evidence of disease, 2 years after diagnosis. The second patient died 4 years after resection of his tumor with evidence of disease in lumbar spine, skull, and lungs. Extramedullary plasmacytoma presenting as a mediastinal mass may precede the onset of full-blown multiple myeloma; therefore, institution of early systemic therapy in these patients may be of value in preventing further progression of the disease.

Topics: Chest Pain; Combined Modality Therapy; Diagnosis, Differential; Dyspnea; Fatal Outcome; Female; Humans; Immunoglobulin lambda-Chains; Male; Mediastinal Neoplasms; Melphalan; Middle Aged; Multiple Myeloma; Plasma Cells; Plasmacytoma; Prednisone