Aggregation phenomenon in an IgG multiple myeloma resulting in the hyperviscosity syndrome

Benninger, George W.; Kreps, Sidney I.

doi:10.1016/0002-9343(71)90247-6

Cited by 26 publications

(6 citation statements)

References 16 publications

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“…Binding of IgA to the platelet FcαRI receptor has also been demonstrated to stimulate release of pro‐inflammatory cytokines, interleukin (IL)‐1β and tissue factor 63 . The finding of PAIg in subsets of patients with SM/MM, and PAIg in patients with MGUS with relatively low paraprotein levels, supports reports that disease‐specific changes affect paraprotein specificity or aggregation to facilitate PAIg 60,64,65 . Various mechanisms for PAIg may be involved and could be assessed in future work.…”

Section: Discussionmentioning

confidence: 55%

“…63 The finding of PAIg in subsets of patients with SM/MM, and PAIg in patients with MGUS with relatively low paraprotein levels, supports reports that disease-specific changes affect paraprotein specificity or aggregation to facilitate PAIg. 60,64,65 Various mechanisms for PAIg may be involved and could be assessed in future work. Although reported as elevated, 3,[6][7][8][9][10] assessing the risk of VTE due to MGUS status is complicated by the frequent presence of comorbidities in this population due to advanced age.…”

Section: Figmentioning

confidence: 99%

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Platelet hyperactivation in multiple myeloma is also evident in patients with premalignant monoclonal gammopathy of undetermined significance

et al. 2020

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Thrombotic events are common in patients with multiple myeloma (MM), smouldering myeloma (SM) and monoclonal gammopathy of undetermined significance (MGUS). Previous studies have indicated platelet hyperactivation as a feature of thrombotic risk in MM, but there is a dearth of data in MGUS. In the present study, multiparameter analysis of platelet activation and responsiveness was investigated by flow cytometry in patients with MGUS, SM/MM and healthy controls (HCs). The median platelet surface CD63 levels, annexin V and PAC-1 antibody (specific for activated integrin aIIbb3) binding were significantly elevated in patients with MGUS versus the HCs. These markers were also elevated in SM/MM, but not significantly. In all, 74% of MGUS and 38% of SM/MM patients had one or more elevated marker of platelet activation, compared to 19% of the HCs. Marker-specific hyporesponsiveness of platelets to agonist [adenosine diphosphate (ADP), thrombin receptor-activating peptide 6] stimulation in vitro was observed, with significantly reduced surface levels of Pselectin in response to ADP in patients with MGUS. Platelet-leucocyte aggregates were not altered in patients, while platelet-associated immunoglobulins were elevated in a subset of patients. Overall, we found that platelet hyperactivation is prevalent in both MGUS and SM/MM patients and is potentially related to hyporesponsiveness. These observations suggest that further investigation of the predictive and prognostic value of platelet hyperactivation in such patients is warranted.

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Section: Discussionmentioning

confidence: 55%

Section: Figmentioning

confidence: 99%

Platelet hyperactivation in multiple myeloma is also evident in patients with premalignant monoclonal gammopathy of undetermined significance

et al. 2020

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“…Although rare, HVS has been reported previously in patients with MM. [18][19][20][21][22][23][24][25][26][27][28][29][30][31] Because previous reports of HVS dated back > 50 years 18 and owing to its low incidence, the clinical characteristics of HVS remain largely unknown. A total of 19 additional cases of HVS in association with MM reported between 1967 and 2015 were identified.…”

Section: Discussionmentioning

confidence: 99%

Ixazomib Treatment of IgA Multiple Myeloma With Hyperviscosity Syndrome

Boiten

Buijze

Levin

2020

Clinical Lymphoma Myeloma and Leukemia

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“…8,9 This phenomenon was described in a case report in which the low molecular weight IgG molecules aggregated to form trimers and tetramers resulting in larger molecules and clinical hyperviscosity syndrome. 10 Regardless of the threshold and quantity of immunoglobulins, the American Society for Apheresis defines hyperviscosity syndrome as a category I indication for TPE. 11 Our patient received 2 sessions of TPE as well as 4 doses of dexamethasone which overlapped with TPE and showed good response to treatment.…”

Section: Discussionmentioning

confidence: 99%

Hyperviscosity in Non-IgM Lymphoplasmacytic Lymphoma

Fonseca-Paricio¹,

Chmire²,

Binder³

2019

TMF

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HEMATOLOGY & ONCOLOGY dL) and 140 mg/dL (40-230 mg/dL) respectively. Serum protein electrophoresis showed a monoclonal protein band in the gamma region at 5.9 g/dL (0.5-1.6 g/dL), which was further classified as IgG kappa. Kappa/ lambda ratio was calculated at 3.7. His blood repeatedly clotted in the tube despite multiple attempts. Some tests were unable to be performed due to increased serum viscosity. He had inconsistent sodium levels ranging between 113-150 mEq/L without intervention. Hepatic function tests were normal, hepatitis B and C were negative, and cryoglobulin testing was negative. Peripheral flow cytometry showed no abnormal population of B or T cells. CT of the chest, abdomen, and pelvis showed bilateral axillary, subpectoral, mediastinal, upper abdominal, and retroperitoneal lymphadenopathy with no hepatomegaly or ascites. Skin biopsy of the right thigh showed granular deposition of IgM and C3 in the superficial vessels of the skin consistent with leukocytoclastic vasculitis. Excisional biopsy of the left axillary lymph node showed a small B-cell lymphoma with plasmacytic differentiation. Flow cytometry demonstrated a CD20 +, CD5-, CD10-, monoclonal population. CD138 staining showed a separate abundant plasma cell population and kappa light chain restriction. Ki 67 was 10 percent. Bone marrow biopsy showed no evidence of disease. These findings are consistent with lymphoplasmacytic lymphoma (LPL).

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Aggregation phenomenon in an IgG multiple myeloma resulting in the hyperviscosity syndrome

Cited by 26 publications

References 16 publications

Platelet hyperactivation in multiple myeloma is also evident in patients with premalignant monoclonal gammopathy of undetermined significance

Platelet hyperactivation in multiple myeloma is also evident in patients with premalignant monoclonal gammopathy of undetermined significance

Ixazomib Treatment of IgA Multiple Myeloma With Hyperviscosity Syndrome

Hyperviscosity in Non-IgM Lymphoplasmacytic Lymphoma

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