Positron emission tomography (PET) with 18fluorine-fluoro-deoxyglucose (FDG) integrated with computed tomography (PET/CT) is a functional imaging technique helping us to assess bone marrow infiltration as well as unsuspected disease sites involving the bones and/or extramedullary sites. PET/TC has proved to be an independent prognostic factor for overall survival (OS) in symptomatic multiple myeloma (MM)(Zamagni,2011). However, its role in other monoclonal gammopathies (MG) is still a matter of debate. We have prospectively analyzed the contribution of baseline PET/TC in a unselected consecutive series of 158 patients with MG, including 88 MM, 7 MM smoldering (MMS), 11 Waldenstršm's macroglobulinemia (WM), 3 WM smoldering (WMS), 3 solitary bone plasmacytoma (SBP) and 46 monoclonal gammopathy of uncertain significance (MGUS). Patients with only palliative care were excluded. The pattern of bone marrow uptake on PET/TC was described as negative (NEG), diffuse involvement (DI) or focal lesions (FLs). Patients with more than 3 FLs as well as the presence of extramedullary disease (EMD) were analyzed separately. Overall survival (OS) was estimated by the Kaplan-Meier method. The main characteristics of PET/TC findings according to the type of MG are shown in Table 1. PET/TC was positive in 70 (79,5 %) of MM and 8 (72,7%) of WM. PET/TC was NEG in 100 % of MMS, WMS and SBP (except for the primary lesion). In MGUS, the findings reflect the clinical heterogeneity of this group: 19,6 % had bone disease (all but one case of probable inflammatory etiology), 17,4 % positive lymphadenopathy, 15,2 % lung disease (infection, fibrosis, pulmonary nodules), 6,5 % splenomegaly, 6,5 % liver disease, 6,5 % positive uptake in adrenal gland and other organs such as thyroid, stomach, colon or skin were affected less frequently. Median age of MM patients was 62 years (12-91), 51 men and 37 women (42%), the distribution according ISS was I (36,5 %), II (28,2 %) and III (35,3%). Among PET-positive MM, 39 (55,7 %) had >3 FLs, 17 (24,3 %) 3 or less FLs and 14 (24,3 %) DI. Median OS was 40 months, not reached (NR) and 85,7 months, respectively (p=ns). Mean bone marrow plasma cells in the >3 FLs group vs 3 or less FLs was 25 vs 12 (p=0,028). EMD was present in 13 (18,6 %) of PET-positive MM. Response with PET/CT was available in 32 patients: 18 achieved CR, 8 PR and 8 progressed. OS was NR for CR and PR vs 40 months (p <0,0001). In WM, patients with NEG or FL had NR OS vs 26 months in those with DI (p=0,16). PET/CT is positive in the majority of MM and WM patients, helping to separate patients with true indolent disease. At baseline, PET/TC is a useful tool to improve prognostic assessment in patients with MG. MM with >3 FLs or EMD at baseline had a trend towards lower OS. Negative serial PET/CT in MM is associated with favorable prognosis. Table SEQ Tabla \* ARABIC 1. Characteristics of main PET/TC findings according to the type of MG Type MM MMS WM WMS SBP MGUS n 88 7 11 3 3 46 Positive n /% 70/79,5 0 8/72,7 0 0 9/19,6 ->3 FLs 39/55,7 0 0 0 0 0 -3 or < FLs 17/24,3 0 1/12,5 0 0 1/2,2 -DI 14/20 0 5/62,5 0 0 1/2,2 -EMD 13/18,6 0 0 0 0 0 -Adenopathy 2/2,9 2/28,6 2/25 0 0 8/17,4 -Spleen 3/4,3 0 1/12,5 0 0 3/6,5 MG: Monoclonal gammopathy; MM: Multiple myeloma symptomatic; MMS: Smoldering myeloma; WM: Waldenstršm's macroglobulinemia; WMS: Smoldering Waldenstršm's macroglobulinemia; SBP: Solitary bone plasmocytoma; MGUS: Monoclonal gammopathy of uncertain significance; FL: Focal lesion; DI: Diffuse involvement; EMD: Extramedullary disease. Disclosures No relevant conflicts of interest to declare.

sions evident on both lower extremities were related to the presence antimycobacterial therapy points to an infectious process rather than a hypersensitivity reaction. A traumatic catheterization re-of leukocytoclastic vasculitis. Findings on examination of a bonemarrow aspirate and on chest radiographs and results of a urinalysis sulting in systemic BCG absorption, additional courses of BCG therapy notwithstanding intolerance symptoms, and delayed spewere normal. There was no proteinuria. Extensive investigations cific therapy may have furthered dissemination of BCG. revealed no signs of an underlying infectious or malignant disease, This case reaffirms the potential for major infectious complicaand disseminated infection with M. bovis was suspected. All cultures tions of bladder instillation of BCG in immunocompetent hosts of blood, bone marrow, sputum, and urine remained negative for [1]. BCG has proved to be more effective in the prophylaxis and Mycobacterium species. Histopathological evaluation of the bone treatment of superficial bladder tumors and carcinoma in situ than marrow and rectal ulcer revealed numerous nonnecrotizing granulomost chemotherapeutic agents [4]. A granulomatous reaction outmas with many epithelioid cells and giant cells. Special stains for side the urinary tract is rare, and pneumonitis or granulomatous mycobacteria, fungi, and bacteria were negative.hepatitis has been reported in only 0.9% of patients in large studies The patient received treatment with isoniazid (300 mg/d), ethambu-[1]. Recognition of risk factors, particularly traumatic catheterizatol (1,200 mg/d), and rifampin (600 mg/d). The patient's condition tion or concurrent cystitis, as well as the prompt treatment of improved within 1 week, and he was discharged. Purpura reappeared early side effects, should decrease the incidence of severe toxicity within 24 hours of exposure to cold. Purpuric lesions resolved within significantly. Our case illustrates that disseminated infection with 1 week and did not recur. When seen 3 and 6 months later, he was M. bovis after intravesical BCG instillation may be associated with completely well; findings on clinical examination and funduscopy cryoglobulinemia, monoclonal gammopathy, and an increase in and laboratory values were normal.the anticardiolipin antibody level. In our case, leukocytoclastic vasculitis was associated with cryoglobulinemia, monoclonal gammopathy, an elevated anti-J. M. Durand, C. Roubicek, F. Retornaz, E. Cretel, cardiolipin antibody level, and evidence of dissemination of BCG M. J. Payan, J. P. Bernard, G. Kaplanski, infection. The development of cryoglobulinemia has been deand J. Soubeyrand scribed during the course of different types of acute and chronic There have been only a few reports of cryoglobulinemia related to Mycobacterium tuberculosis infection [2, 3]. Cryoglobulinemia References has never been associated with M. bovis infection. Because we 1. Lamm DL, Van der Meijden APM, Morales A, et al. Incidence and treatment did not identify any chronic infla...

Introduction All symptomatic multiple myeloma (MM) patients are virtually preceded by a precursor disease (PD). However, the PD is rarely known at the time of diagnosis of MM. Several PD can progress to MM: monoclonal gammopathy of undetermined significance (MGUS), smoldering MM (SMM) and solitary plasmacytoma (SP). Sigurdardottir et al have recently demonstrated that only 2.7% in a series of 14798 MM patients had prior knowledge of MGUS. This group had better overall survival (OS), stressing the importance of clinical follow-up in MGUS and suggesting that earlier treatment of MM leads to better OS. Nonetheless, we have recently shown that diagnostic delay in MM have a paradoxical effect on OS. Furthermore, little is known about the outcome of MM with prior knowledge of other PD. Methods All symptomatic MM patients diagnosed between January 1993 and July 2015 in our MM population-based registry, excluding palliative patients, were selected. Information about any prior PD was checked, as well as baseline common prognostic factors such as age, sex, lactate dehydrogenase (LDH), creatinine (Cr), International Staging System (ISS), high-risk FISH, and diagnostic delay. Comparisons among groups were made with the χ2-testfor categorical and t-test for quantitative variables. OS was estimated in months (m) by the Kaplan-Meier method in patients with or without specific PD or any PD as a whole. Log-rank test was used to compare curves. A Cox proportional hazard model was used to assess the simultaneous impact on survival of prior PD and other predictors. Results 473 MM patients fulfilled the inclusion criteria. 383 of them (81%) had available data concerning prior PD. There were 233 men and 240 women (50.7%), median age 67 years (12-87). 19 patients (5%), 10 (2.6%) and 5 (1.3%) had prior MGUS, SP and SMM, respectively. The group without prior PD had significantly higher values of serum Cr (2.09 vs 1.09 mg/dL, p<0.001), LDH (317.3 vs 256.2 U/L, p=0.09), ISS3 (49.6% vs 22.2, p=0.02), but less delay (5.6 vs 10.9 m, p=0.002). Median OS of patients with prior MGUS was 87.7 m (57.1-118.2) vs 34.4 (27.8-41.1)(p=0.112), with prior SP 88 m (46.9-129) vs 34.9 (28.4-41.5)(p=0.101) and prior SMM 104.1 m vs 36 (29.9-42.1)(p=0.102). Median OS of any PD (Fig 1) was 88 m (82.6-93.3) vs 32.7 (26.2-39.2)(p=0.006). In the multivariate model, age, LDH and Cr are significantly associated with survival. The presence of prior PD, when adjusting for these factors, is also significantly associated with survival, acting as a protective factor. When ISS is added to the model, prior PD remains only marginally significant. Conclusion Prior knowledge of PD is infrequent at the moment of MM diagnosis. MM with any previously documented PD seems to have better outcome. The reason for this finding is not an earlier diagnosis, but rather a better prognostic profile. However, we cannot rule out other underlying biological mechanisms. More and larger studies are warranted to confirm our results. Disclosures No relevant conflicts of interest to declare.