vitamin-b-12 and Multiple-Myeloma

To evaluate the efficacy and safety of high-dose intravenous mecobalamin (HDIME) for the treatment of bortezomib-induced peripheral neuropathy(BIPN) in the patients with multiple myeloma (MM).. A total of 65 newly diagonsed patients with multiple myeloma receiving bortezomib in Tianjin Medical University General Hospital were enrolled in this single-centre randomized clinical trial from July 2012 to May 2016. Out of 65 patients 38 in control group received bortezomib-based chemotherapy and 27 patients in HDIME group received the additional high-dose intravenous mecobalamin.. The incidence of BIPN in HDIME group was lower than that in control group(29.63% vs 55.26%, χ. HDIME has a good efficacy for the prophylaxis BIPN and and without serious side effects.

Topics: Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Boronic Acids; Bortezomib; Humans; Multiple Myeloma; Peripheral Nervous System Diseases; Pyrazines; Vitamin B 12; Vitamins

Chemotherapy-induced peripheral neuropathy (CIPN) seriously affects the quality of life of patients with multiple myeloma (MM) as well as the response rate to chemotherapy. Acupuncture has a potential role in the treatment of CIPN, but at present there have been no randomized clinical research studies to analyze the effectiveness of acupuncture for the treatment of CIPN, particularly in MM patients.. The MM patients (104 individuals) who met the inclusion criteria were randomly assigned into a solely methylcobalamin therapy group (500 μg intramuscular methylcobalamin injections every other day for 20 days; ten injections) followed by 2 months of 500 μg oral methylcobalamin administration, three times per day) and an acupuncture combined with methylcobalamin (Met + Acu) group (methylcobalamin used the same way as above accompanied by three cycles of acupuncture). Of the patients, 98 out of 104 completed the treatment and follow-ups. There were 49 patients in each group. The evaluating parameters included the visual analogue scale (VAS) pain score, Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (Fact/GOG-Ntx) questionnaire scores, and electromyographic (EMG) nerve conduction velocity (NCV) determinations. We evaluated the changes of the parameters in each group before and after the therapies and made a comparison between the two groups.. After 84 days (three cycles) of therapy, the pain was significantly alleviated in both groups, with a significantly higher decrease in the acupuncture treated group (P < 0.01). The patients' daily activity evaluated by Fact/GOG-Ntx questionnaires significantly improved in the Met + Acu group (P < 0.001). The NCV in the Met + Acu group improved significantly while amelioration in the control group was not observed.. The present study suggests that acupuncture combined with methylcobalamin in the treatment of CIPN showed a better outcome than methylcobalamin administration alone.. China Clinical Trials Register (registration no. ChiCTR-INR-16009079 , registration date August 24, 2016).

Topics: Acupuncture Therapy; Aged; Antineoplastic Combined Chemotherapy Protocols; China; Combined Modality Therapy; Female; Humans; Male; Middle Aged; Multiple Myeloma; Neoplasm Staging; Peripheral Nervous System Diseases; Prognosis; Quality of Life; Surveys and Questionnaires; Survival Rate; Vitamin B 12

This study sought to examine the use of glutathione combined with mecobalamin in the prevention and treatment peripheral neuropathy (PN) in multiple myeloma (MM) patients, observe its effectiveness and safety, and explore the risk factors and prognostic factors of chemotherapy-induced peripheral neuropathy (CIPN).. Patients in the study group were administered 2.4 g of glutathione intravenously once daily 2-3 days before chemotherapy, combined with 500 µg of mecobalamin administered intravenously once every other day until the end of the chemotherapy cycle. Patients who did not use this regimen were selected as a control group. Differences in adverse reactions, treatment efficiency, progression-free survival (PFS), and overall survival (OS) between the two groups were retrospectively analyzed. PFS and OS curves were plotted using the Kaplan-Meier method. The univariate analysis rates were compared using the χ2 test. The multivariate analysis was performed by a logistic regression analysis. The proportional hazard regression model was used for the univariate and multivariate proportional hazards model analyses.. The incidence of PN, especially grade 2 and 3 PN, was more decreased in the study group than the control group. The history of diabetes (P=0.032) and the method of bortezomib injection (P=0.043) was found to affect the PN grade. The multivariate logistic regression analysis showed that diabetes was an independent risk factor of PN in MM patients [odds ratio (OR) =3.484, P=0.020]. The Proportional hazards model multivariate analysis showed that extramedullary disease (EMD) [hazard ratio (HR) =2.373, P=0.006] and elevated lactic dehydrogenase (LDH) (HR =1.934, P=0.009) were independent prognostic factors for MM patients.. Glutathione combined with mecobalamin significantly reduced the incidence and severity of CIPN in MM patients, and did not increase the adverse reactions of patients with MM. Diabetes and bortezomib intravenously increased the incidence and severity of PN in patients with MM.

Topics: Antineoplastic Agents; Glutathione; Humans; Multiple Myeloma; Peripheral Nervous System Diseases; Retrospective Studies; Vitamin B 12

In patients with multiple myeloma a variety of metabolic events may occur. One of these are changes in the serum cobalamin (vitamin B12) concentration. Elevated as well as decreased serum cobalamin levels have been reported. The prevalence and clinical consequences of low cobalamin levels are largely unknown.. To investigate the prevalence of low serum cobalamin levels in patients with multiple myeloma and to describe the clinical features, haematological parameters and outcome in patients with multiple myeloma with low and normal serum cobalamin levels.. A retrospective study was conducted in the Deaconess Hospital in Eindhoven. Thirty-two patients were identified who fulfilled the diagnostic criteria for multiple myeloma and had at least one serum cobalamin level tested during the diagnostic or treatment period. A number of clinical characteristics, haematological parameters and outcome were scored.. Twenty-one (66%) patients had a normal serum cobalamin level, nine (28%) patients had a low one and two (6%) patients had an elevated serum cobalamin level. Between the group with a normal and a low serum cobalamin level there were no differences in patients characteristics such as sex and age, tumour characteristics such as the type of paraprotein, tumour load or tumour stage nor in haematological parameters such as haemoglobin level, mean corpuscular volume and megaloblastic changes in the bone marrow. The median survival was not statistically different between both groups.

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Multiple Myeloma; Prevalence; Retrospective Studies; Vitamin B 12; Vitamin B 12 Deficiency

Many patients with multiple myeloma tend to have low serum cobalamin. The cause of this remains unclear. The important issue is whether cobalamin therapy should be used or not. We describe one case of megaloblastic erythropoiesis and multiple myeloma, and refer to some of the few studies describing the subject. Most of the patients with multiple myeloma are elderly, and the frequency of hypo- and achlorhydria is therefore increased. It has been demonstrated that cobalamin uptake and consumption is higher in myeloma cells than in normal bone marrow cells, and that cobalamin may be required for paraprotein synthesis. These facts may suggest that patients with multiple myeloma are more vulnerable to developing megaloblastic anemia than others. Our patient received cobalamin therapy in addition to cytostatic therapy for multiple myeloma without complications. However, we cannot exclude that cobalamin therapy may accelerate multiple myeloma; this should be considered when such therapy is given. However, accurate guidelines require more studies.

Topics: Aged; Antineoplastic Agents; Drug Therapy, Combination; Humans; Male; Multiple Myeloma; Risk Factors; Vitamin B 12

Topics: Aged; Anemia, Macrocytic; Contraindications; Erythropoiesis; Humans; Male; Megaloblasts; Multiple Myeloma; Vitamin B 12

Topics: Bone Marrow; Humans; Multiple Myeloma; Vitamin B 12

Topics: Folic Acid; Humans; Multiple Myeloma; Reagent Kits, Diagnostic; Vitamin B 12

Topics: Female; Humans; Male; Middle Aged; Multiple Myeloma; Transcobalamins; Vitamin B 12

Two patients are described who had evidence of both multiple myeloma and chronic neutrophilic leukaemia at or near the time of presentation. Descriptions of five similar patients were found in the literature supporting an association between the two disorders. This association is further evidence of a link between myeloproliferative and lymphoproliferative disorders. Cobalamin-binding studies of the plasma and neutrophils from one of these patients showed a gross elevation of plasma unsaturated TC I and abnormal neutrophils which contained TC I but not TC III.

Topics: Aged; Carrier Proteins; Chronic Disease; Female; Humans; Leukemia, Myeloid; Middle Aged; Multiple Myeloma; Neoplasms, Multiple Primary; Neutrophils; Vitamin B 12

Our information about cobalamin transport in the blood is largely based on studies of unsaturated cobalamin-binding proteins. Therefore, the distribution of endogenous cobalamin among these proteins was examined. Normally, R binder (transcobalamin I) carries most of the cobalamin circulating at any given moment, but the proportion varies greatly. Transcobalamin II carries a larger fraction of the cobalamin present in portal vein blood than in hepatic and axillary vein blood. In disease, transcobalamin II occasionally holds the bulk of the vitamin present in peripheral blood. Such was observed in three patients showing quantitative changes of unsaturated binder (either diminished R binder or increased transcobalamin II), but in two cases of chronic liver disease this was independent of unsaturated transcobalamin levels. Four patients with low serum cobalamin levels maintained normal distribution, indicating proportional cobalamin depletion from both binder pools. Small amounts of vitamin were attached in many sera to minor binders, and occasionally seemed to circulate free. These results demonstrate that assumptions that cobalamin is always attached largely to transcobalamin I are not warranted. Cobalamin distribution appears to be governed by many factors, of which the amounts of the binding proteins is only one.

Topics: Axillary Vein; Health Status; Hematologic Diseases; Hepatic Veins; Humans; Liver Diseases; Multiple Myeloma; Myeloproliferative Disorders; Portal Vein; Transcobalamins; Vitamin B 12

Topics: Aged; Anemia; Anemia, Macrocytic; Blood Cell Count; Blood Transfusion; Chlorambucil; Erythrocyte Indices; Hematocrit; Hematologic Diseases; Hemoglobins; Humans; Leukemia, Lymphoid; Middle Aged; Multiple Myeloma; Platelet Count; Polycythemia Vera; Reticulocytes; Thalassemia; Vitamin B 12

Cobalamin and folate metabolism was investigated in 43 patients with myelomatosis, in 8 control subjects of similar age and 22 younger controls. Plasma total cobalamin was lower in myeloma patients than in either of the control groups and methylcobalamin (Me-Cbl) was disproportionately reduced. Erythrocyte levels of total cobalamin were very similar in patients and elderly controls but were half the levels in younger controls. Erythrocyte levels of Me-Cbl were slightly higher in patients than in the dlderly controls. FIGLU excretion after L-histidine was elevated in 53% of the patients but values did not correlate with serum or erythrocyte folate or with plasma total cobalamin. FIGLU excretion decreased after DL-methionine or Me-Cbl only in patients whose FIGLU excretion was initially high. The results are discussed in the light of the 'methylfolate trap hypothesis' and suggest that some patients with myelomatosis have insufficient activity of methionine synthetase to meet the additional metabolic demand for one carbon compounds.

Topics: Adolescent; Adult; Age Factors; Aged; Cobamides; Edetic Acid; Erythrocytes; Female; FIGLU Test; Histidine; Humans; Male; Methionine; Methylmalonic Acid; Middle Aged; Multiple Myeloma; Tetrahydrofolates; Vitamin B 12

The percentage of fat-cell areas in bone marrow particles from 22 patients with untreated myelomatosis was estimated. In only 1 patient was the mean fat cell area below 25% of the bone marrow area measured. A negative correlation was found between the area of fat cells and plasma cells, indicating a displacement of the fat cell area by the plasma cells. 28% of the patients had empty bone marrow deposits of iron. However, based on a normal iron saturation of S-transferrin and a normal sideroblast count in the bone marrow, the supply of iron to the erythropoiesis was considered sufficient. All patients but one had normoblastic bone marrows. Using a deoxyuridine suppression test in 10 patients, no biochemical defect could be demonstrated. To judge from the correlation coefficient a minor degree (9-14%) of the variation in Hb values could be predicted from the cellularity in the bone marrow while a major degree (70%) could be predicted from the renal glomerular filtration rate. The results do not support a displacement of blood-forming elements, iron deficiency, vitamin B12 or folic acid deficiency to be of general significance in the pathogenesis of anaemia, but agrees with a causal relationship between anaemia and renal failure.

Topics: Adult; Aged; Bone Marrow; Deoxyuridine; Female; Folic Acid; Formiminoglutamic Acid; Glomerular Filtration Rate; Humans; Iron; Male; Middle Aged; Multiple Myeloma; Plasma Cells; Vitamin B 12

In 38 patients with myelomatosis the serum cobalamin varied from 34 pmol/1 to 404 pmol/1, median 181.5 pmol/1, which is significantly lower than the levels in 22 control persons with range 173-535 pmol/1, median 265 pmol/1. In spite of low serum cobalamin no symptoms of vitamin B12 deficiency could be demonstrated in any of the patients, except for the one patient who had a serum cobalamin of 34 pmol/1. Mean values for Hb, MCV, PCV, serum lactate-dehydrogenase, adjested red cell folate and nucleated neutrophil count were similar in a group of patients with a serum cobalamin below 160 pmol/1 and a group of patients with higher serum cobalamin values. The decrease in serum cobalamin is due in part to a reduction in the major cobalamin binder (TC-I) in serum. Measuring serum cobalamin in relationship to gastric acis secretion, we found a significantly higher frequency of hypo- and achlorhydria in patients with serum cobalamin below 160 pmol/1 although the intestinal absorption of vitamin B12 was normal by a Schilling test. Although our finding of low saturation of TC-I in serum seems to demonstrate decreased vitamin B12 content in the body in myelomatosis, the lack of evidence for a functional vitamin B12 deficiency speaks against giving a supplement to patients with myelomatosis.

Topics: Aged; Female; Folic Acid; Gastric Juice; Glomerular Filtration Rate; Humans; Male; Middle Aged; Multiple Myeloma; Plasma Volume; Transcobalamins; Vitamin B 12

Addisonian pernicious anemia (PA) usually develops after age 50. These PA patients are immunocompetent and usually manifest gastric autoimmunity. The prevalence of PA is increased about 10-fold with multiple myeloma and 250-fold in adults with primary immunoglobulin deficiency. Atrophic gastritis develops at an unusually early age with primary immunoglobulin deficiency but not with myeloma. Family history with myeloma is often relevant to PA. Atrophic gastritis develops in both syndromes without gastrict autoantibody production.

Topics: Aging; Anemia, Pernicious; Antibodies; Binding, Competitive; Child, Preschool; Fluorescent Antibody Technique; Gastric Juice; Gastric Mucosa; Gastritis; Hemagglutination Tests; Humans; Hypersensitivity, Delayed; Immunodiffusion; Immunoglobulins; Infant; Intestinal Secretions; Intrinsic Factor; Multiple Myeloma; Radioimmunoassay; Thyroid Gland; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adrenal Gland Neoplasms; Adult; Binding Sites; Cells, Cultured; Centrifugation; Cobalt Radioisotopes; Dialysis; Female; Granulocytes; Hodgkin Disease; Humans; Leukemia, Lymphoid; Leukemia, Myeloid; Leukocytes; Lung Neoplasms; Male; Melanoma; Multiple Myeloma; Protein Binding; Proteinuria; Pyelonephritis; Time Factors; Vitamin B 12

Topics: Cyclophosphamide; Depression, Chemical; Erythrocytes; Folic Acid; Humans; Male; Middle Aged; Multiple Myeloma; Plasma Volume; Prednisone; Protein Binding; Radioisotope Dilution Technique; Schilling Test; Stimulation, Chemical; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Anemia, Pernicious; Chronic Disease; Female; Humans; Infant, Newborn; Leukemia, Myeloid; Male; Maternal-Fetal Exchange; Multiple Myeloma; Myeloproliferative Disorders; Placenta; Polycythemia Vera; Pregnancy; Primary Myelofibrosis; Vitamin B 12

Topics: Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Pernicious; Blood Proteins; Female; Hematologic Diseases; Humans; Leukemia, Lymphoid; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Leukocyte Count; Liver Cirrhosis; Lupus Erythematosus, Systemic; Lymphoma; Male; Multiple Myeloma; Neoplasms; Polycythemia; Primary Myelofibrosis; Protein Binding; Uremia; Vitamin B 12

Topics: Adult; Anemia, Pernicious; Antibody Formation; Arthritis, Rheumatoid; Autoantibodies; Female; Fluorescent Antibody Technique; Folic Acid; Gastric Juice; Hemagglutination Tests; Hodgkin Disease; Humans; Immunodiffusion; Intrinsic Factor; Leukemia, Lymphoid; Lymphoma; Lymphoma, Large B-Cell, Diffuse; Lymphoma, Non-Hodgkin; Male; Middle Aged; Multiple Myeloma; Pyrazoles; Radioimmunoassay; Vitamin B 12

Topics: Aged; Anemia, Hypochromic; Anemia, Sideroblastic; Blood Platelets; Bone Marrow Cells; Erythrocyte Count; Female; Folic Acid; Hemoglobinometry; Humans; Iron; Leukemia; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Leukocyte Count; Male; Middle Aged; Multiple Myeloma; Reticulocytes; Vitamin B 12

Topics: Adult; Age Factors; Aged; Cyclophosphamide; Female; Humans; Injections, Intravenous; Intestinal Absorption; Intestine, Small; Intrinsic Factor; Lung Neoplasms; Lymphoma, Large B-Cell, Diffuse; Lymphoma, Non-Hodgkin; Male; Middle Aged; Multiple Myeloma; Ovarian Neoplasms; Sex Factors; Stomach Neoplasms; Vitamin B 12; Xylose

Topics: Adult; Blood Proteins; Female; Humans; Immunoelectrophoresis; Immunoglobulin G; Immunoglobulin M; Male; Middle Aged; Multiple Myeloma; Radiography; Vitamin B 12

Topics: Anemia; Biopsy; Blood Transfusion; Bone Marrow Examination; Female; Humans; Joint Diseases; Middle Aged; Multiple Myeloma; Vitamin B 12

Topics: Aged; Anemia, Pernicious; Bence Jones Protein; Diagnosis, Differential; Electrophoresis; Female; gamma-Globulins; Humans; Immunoelectrophoresis; Male; Melphalan; Middle Aged; Multiple Myeloma; Paper; Plasmacytoma; Prednisone; Vitamin B 12

Topics: Aged; Anemia, Pernicious; Animals; Bone Marrow; Bone Marrow Cells; DNA; Erythrocytes; Female; Goats; Humans; Isoenzymes; L-Lactate Dehydrogenase; Male; Middle Aged; Milk; Multiple Myeloma; Tetrahydrofolate Dehydrogenase; Thymidine Kinase; Vitamin B 12; Vitamin B 12 Deficiency

Intermediate megaloblastic changes occurred in six (19%) of 32 patients with multiple myeloma and trivial megaloblastic changes in a further ten (31%). Folate deficiency was the predominant cause of these changes and in at least two patients was sufficiently severe to contribute to anaemia. Folate deficiency appeared to be due to exćess folate utilization by the tumour and was related to the amount of paraprotein produced daily. Five of the 32 patients had subnormal serum B(12) levels. Reduction in the serum B(12) level was related to the reduction in the normal circulating immunoglobulins and occurred despite normal B(12) absorption. Possible explanations for this finding are discussed.

Topics: Adult; Aged; Anemia, Macrocytic; Erythropoiesis; Female; Folic Acid; Folic Acid Deficiency; Humans; Intestinal Absorption; Male; Middle Aged; Multiple Myeloma; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Blood Chemical Analysis; FIGLU Test; Folic Acid; Humans; Leukemia; Lymphatic Diseases; Lymphoma; Lymphoma, Large B-Cell, Diffuse; Lymphoma, Non-Hodgkin; Multiple Myeloma; Neoplasms; Urine; Vitamin B 12

Topics: Blood; Folic Acid; Hodgkin Disease; Humans; In Vitro Techniques; Leukemia; Leukemia, Myeloid; Lymphoma; Lymphoma, Non-Hodgkin; Multiple Myeloma; Vitamin B 12

Topics: Adolescent; Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Breast Neoplasms; Bronchopneumonia; Child; Deficiency Diseases; Female; Folic Acid; Gastroenterology; Geriatrics; Hemorrhage; Humans; Liver Diseases; Liver Extracts; Multiple Myeloma; Nucleosides; Postpartum Hemorrhage; Postpartum Period; Rheumatic Fever; Sepsis; Toxicology; Virus Diseases; Vitamin B 12; Vitamin B Complex

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Blood Cell Count; Blood Protein Electrophoresis; Calcium; Drug Therapy; Geriatrics; Humans; Immunoelectrophoresis; Iron; Multiple Myeloma; Osteoporosis; Plasmacytoma; Pneumonia; Vitamin B 12; Vitamin B 12 Deficiency; Waldenstrom Macroglobulinemia

Topics: Hematinics; Humans; Multiple Myeloma; Plasma Cells; Vitamin B 12