melphalan and Paraneoplastic-Syndromes

Focal and segmental glomerulosclerosis (FSGS) is a common histological finding in patients with proteinuria. The natural history of the condition varies, and although it may be responsive to therapy, FSGS is an important cause of end-stage renal disease. FSGS can be caused by a variety of conditions, but it has been reported rarely in association with a plasma cell disorder.. Mayo Clinic databases were queried and cross-referenced for FSGS and plasma cell disorders. The diagnoses were confirmed, and relevant clinical and laboratory data were abstracted.. A cohort of 13 patients with "idiopathic" FSGS and a monoclonal plasma cell disorder were identified. Four patients had myeloma, and 9 patients had monoclonal gammopathy of undetermined significance. Patients treated for myeloma experienced improvement in their renal lesion, and the latter relapsed when the myeloma relapsed.. We show that FSGS and plasma cell disorders are temporally and epidemiologically linked. Therapy for the underlying plasma cell disorder can lead to resolution of FSGS. The emerging molecular pathogenesis of both FSGS and myeloma also provides potential mechanisms that link the 2 conditions together. Thus, physicians must rule out a plasma cell proliferative disorder in patients with FSGS before concluding that the renal lesion is idiopathic. Moreover, FSGS may respond favorably after the underlying plasma cell disorder is controlled.

Topics: Aged; Amyloidosis; Antibodies, Monoclonal; Antineoplastic Combined Chemotherapy Protocols; Biopsy; Cohort Studies; Combined Modality Therapy; Comorbidity; Cytokines; Databases, Factual; Dexamethasone; Female; Glomerulosclerosis, Focal Segmental; Humans; Immunoglobulin Light Chains; Kidney; Male; Melphalan; Metabolic Clearance Rate; Middle Aged; Multiple Myeloma; Myeloma Proteins; Paraneoplastic Syndromes; Paraproteinemias; Peripheral Blood Stem Cell Transplantation; Prednisone; Prevalence; Proteinuria; Recurrence; Remission Induction; Retrospective Studies; Time Factors; Vasculitis

Few studies have been performed regarding multiple myeloma (MM) in elderly patients. We report a retrospective series of 130 unselected patients with MM aged 75 yr or more at diagnosis. Presenting features were identical to those reported in younger patients, except for a higher rate of infection. Heavy comorbidity was characteristic of unselected geriatric patients. Ninety-four patients received conventional chemotherapy. The response rate was 62%. Treatment toxicity was mild. Median survival was 22 months. Durie-Salmon (DS) clinical stages II and III MM were severe and often led to death, while significantly more patients with DS stage I MM died from unrelated causes (p<0.0001). Univariate analysis showed that age > or = 85 yr, performance status > or = 2, creatinine level > or = 120 micromol/l, beta 2 microglobulin level > 4 mg/l, C-reactive protein level > 6 mg/l, platelet count < 100 x 10(9)/l, presence of infection and lack of response to chemotherapy were adverse prognostic factors for survival. In Cox multivariate regression analysis, age > or = 85 yr (p<0.0001), performance status > or = 2 (p<0.0001) and creatinine level > or = 120 micromol/l (p<0.0001) were independent factors in predicting short survival. This study provides evidence that in patients with symptomatic MM age should not be considered as a major obstacle to active treatment. Prospective clinical trials are needed in this population of patients and should include an assessment of quality of life.

Topics: Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Cause of Death; Comorbidity; Cyclophosphamide; Dexamethasone; Doxorubicin; Etoposide; Female; France; Humans; Interferon-alpha; Life Tables; Lomustine; Male; Melphalan; Multiple Myeloma; Myeloma Proteins; Neoplasm Staging; Paraneoplastic Syndromes; Prednimustine; Prednisone; Prognosis; Proportional Hazards Models; Retrospective Studies; Survival Analysis; Treatment Outcome; Vincristine

A patient with ovarian carcinoma who subsequently developed the paraneoplastic syndrome of cerebellar degeneration is presented. The literature is reviewed and possible explanations of the phenomenon are discussed.

Topics: Abdominal Neoplasms; Adenocarcinoma, Papillary; Autopsy; Cerebellar Diseases; Combined Modality Therapy; Female; Humans; Melphalan; Middle Aged; Neurologic Examination; Ovarian Neoplasms; Paraneoplastic Syndromes; Physical Therapy Modalities; Thiamine