A Rare Case of Multiple Myeloma Presenting as Evan’s Syndrome

Karapetians, Anthony; Bajaj, Tushar; Valdes, Amanda; Heidari, Arash

doi:10.1177/2324709619852760

Cited by 5 publications

(3 citation statements)

References 6 publications

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“…The concurrence of Evan’s syndrome with proteinuria is relatively infrequent. However, it has been reported previously along with other comorbidities [ 37 , 38 ]. Three Evan’s syndrome patients died of large intracranial haemorrhage (ICH) and one due to pulmonary embolism [ 6 ].…”

Section: Immune Thrombocytopenia and Autoimmune Diseasesmentioning

confidence: 81%

A Review on Secondary Immune Thrombocytopenia in Malaysia

et al. 2021

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Immune thrombocytopenia (ITP) is an acquired autoimmune disease that occurs in adults and children. In Malaysia, the clinical practice guideline (CPG) for the management of ITP was issued in 2006, which focused almost exclusively on primary ITP (pITP), and only a few secondary ITP (sITP) forms were addressed. All published (twenty-three) sITP articles among children and adults in Malaysia, identified on the academic databases were retrieved. The articles were published between 1981 and 2019, at a rate of 0.62 publications per year. The publications were considered low and mainly focused on rare presentation and followed-up of secondary diseases. This review revealed that sITP in Malaysia is commonly associated with autoimmune diseases (Evan’s syndrome, SLE and WAS), malignancy (Kaposi’s sarcoma and breast cancer) and infection (dengue haemorrhagic fever, Helicobacter pylori and hepatitis C virus). The relationship between ITP and autoimmune diseases, malignancy and infections raise the question concerning the mechanism involved in these associations. Further studies should be conducted to bridge the current knowledge gap, and the further information is required to update the existing CPG of management of ITP in Malaysia.

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Section: Immune Thrombocytopenia and Autoimmune Diseasesmentioning

confidence: 81%

A Review on Secondary Immune Thrombocytopenia in Malaysia

et al. 2021

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“…40  Case reports of multiple myeloma with Evans syndrome There have been case reports of ES associated with MM. [41][42][43][44][45][46] All reported cases had IgG subtype. A previous study demonstrated that among AIHA patients associated with MM, the subclass of the antibody binding to RBC was fully linked with that of M protein in all patients.…”

Section: Multiple Myelomamentioning

confidence: 99%

Evans Syndrome Associated with Hematological Malignancies: A Literature Review

Shibusawa

2021

MRAJ

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Evans syndrome (ES) is a rare disorder in which the immune system produces antibodies that accidentally destroy red blood cells and platelets. The diagnosis of ES is made by the simultaneous presence of autoimmune hemolytic anemia and immune thrombocytopenia. However, the diagnosis of ES associated with hematologic malignancies necessitates a comprehensive evaluation of clinical course, clinical findings, and laboratory test results. Hematological malignancies are the most significant underlying diseases factors impacting ES and the prognosis, but there is no established standard therapy for autoimmune cytopenia associated with hematological malignancies. In ES associated with hematologic malignancies, achieving remission of the underlying disease seems to be the key to long-term remission.

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“…Patients still have a high possibility of recurrence after complete remission [ 3 , 4 ], so that the system of recurrence prediction is very important in the prevention and treatment of MM. According to the immunoglobulin types secreted by myeloma cells, MM is divided into Ig A type, Ig G type, Ig M type, and light chain type in clinic, and further divided into κ type and λ type according to light chain type [ 5 , 6 ]. There are differences in the secretion levels of immune factors and inflammatory factors in patients with different immune classifications, but patients can still find the same markers to evaluate the prognosis; for example, Dong Yi et al have found that the expression of p53 protein, bcl-2 protein, and soluble interleukin-2 receptor (sIL-2R) in patients with MM at the first diagnosis and subsequent visit is positively correlated with β 2 -microglobulin ( β 2 -MG), speculating that p53 protein, bcl-2 protein, and sIL-2R can be used to predict the recurrence of MM [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Predictive Value Analysis of Serum Ig A, Ig G, and TNF-α in Recurrence of Multiple Myeloma

2022

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Objective. The study is aimed at analyzing the predictive value of serum Ig A, Ig G, and TNF-α in the recurrence of multiple myeloma (MM). Methods. 136 patients with MM treated in our hospital from January 2010 to January 2017 were followed up for 5 years. Finally, 100 patients who met the inclusion and exclusion criteria and had the complete follow-up visit were selected as the study subjects, with the recurrence of MM as endpoint event, and the observation was taken until the occurrence of endpoint event in patients or the termination of this study. They were divided into the recurrence group (RG) and the nonrecurrence group (NRG) according to whether the endpoint event occurred. The venous blood of patients was collected at the first diagnosis and subsequent visit (at the time of recurrence or termination of the study) to measure the Ig A and Ig G using a full automatic special protein analyzer and the TNF-α level by enzyme-linked immunosorbent assay. The data obtained in this study were analyzed by univariate analysis to choose the factors with difference in statistical significance to draw the ROC curve, and the areas under the curve (AUC) were recorded to analyze the potential mechanism of Ig A, Ig G, and TNF-α in predicting the recurrence of MM. Results. After follow-up visit, there were 62 patients with recurrence (62.0%) and 38 patients without recurrence (38.0%), with no obvious difference in gender, age, body weight, and immune classification between the two groups ( P > 0.05 ). Compared with the NRG, the levels of soluble interleukin-2 receptor (sIL-2R) and β2-microglobulin (β2-MG) in the RG at the first diagnosis were distinctly higher ( P < 0.001 ); the levels of Ig A, Ig G, and TNF-α in the RG at the first diagnosis were visibly higher ( P < 0.05 ); and the levels of Ig A, Ig G, and TNF-α in the RG at the subsequent visit were clearly higher ( P < 0.05 ). There was a correlation between Ig G, Ig A, and TNF-α and β2-MG at the first diagnosis and the subsequent visit ( P < 0.05 ); there was a correlation between Ig G and TNF-α, and sIL-2R at the first diagnosis and the subsequent visit ( P < 0.05 ); and there was a correlation between Ig A and sIL-2R at the subsequent visit ( P < 0.05 ). The AUC of Ig G, Ig A, and TNF-α in predicting the MM at the first diagnosis were 0.772, 0.776, and 0.778, respectively. Conclusion. The serum Ig A, Ig G, and TNF-α had a predictive value in the recurrence of MM, and TNF-α was correlated with sIL-2R and β2-MG, with the highest AUC and the best predictive value.

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A Rare Case of Multiple Myeloma Presenting as Evan’s Syndrome

Cited by 5 publications

References 6 publications

A Review on Secondary Immune Thrombocytopenia in Malaysia

A Review on Secondary Immune Thrombocytopenia in Malaysia

Evans Syndrome Associated with Hematological Malignancies: A Literature Review

Predictive Value Analysis of Serum Ig A, Ig G, and TNF-α in Recurrence of Multiple Myeloma

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