Malignant pleural effusion of multiple myeloma: Prognostic factors and outcome

Abstract

Malignant pleural effusion (MPE) in multiple myeloma (MM) is rare. Approximately 80 cases have been reported. To delineate optimal treatment and prognostic variables in these patients, we reviewed 11 MM patients with MPE. MPE developed at median of 12 months from diagnosis of MM. All the patients had high-risk disease based on complex karyotypic abnormalities including deletions of chromosome-13 (n=9), elevated beta-2 microglobulin (B2M) (n=9), high C-reactive protein (CRP) (n=8), high plasma cell labeling index (n=5) or high LDH (n=5). A significant increase in B2M, LDH, and CRP was observed at the onset of MPE. The initial diagnosis of MPE was based on positive cytology (n=9), pleural fluid cIg/DNA (n=9) or pleural fluid cytogenetics (n=4). Pleural tissue infiltration was found on pleural biopsy and autopsy in one patient each. Systemic chemotherapy comprising dexamethasone, cyclophosphamide, etoposide and cisplatin (DCEP) (n=7) and pleurodesis (n=7) were effective in resolving MPE but survival was short. High dose chemotherapy with peripheral blood stem cell support for MPE in six patients conferred no clear survival advantage. These patients died at median of four months from onset of MPE. Patients with bone marrow complex karyotypic abnormalities including deletion-13 (n=9) had a shorter (median--18 months) overall survival compared to patients with normal cytogenetics (median--38 months). MPE in patients with MM is often associated with high-risk disease including deletion 13 chromosomal abnormality and heralds a poor prognosis despite aggressive local and systemic treatment.

Pleural Effusion in a Patient with Multiple Myeloma

“…Areas other than bone marrow may be invaded as well, particularly the thorax. Pleural effusion, which may be a marker of thoracic involvement, affects about 6% of patients with MM (2,3 ).A wide range of etiologic factors may cause pleural effusion in MM (Table 1) (2, 4-7); however, actual myelomatous pleural effusions are very uncommon, with fewer than 100 cases having been reported worldwide (8,9 ). The most common causes of pleural effusion associated with MM are heart failure, renal failure, effusions related to pneumonia, and amyloidosis.…”

A Breathless Dilemma: Myelomatous Pleural Effusion

“…However, other case studies suggest that majority of MPE take place in patients with the most abundant, IgG myeloma. Case reviews also show that MPE occurs equally among both genders, is typically hemorrhagic and occurs more commonly on the left [15][16][17].…”

A Patient with IgA Monoclonal Gammopathy Presenting as Myelomatous Pleural Effusion with Axillary Node Involvement

“…IgA gammopathy is more frequently represented in MM cases with MPE, 12) implying a difference in propensity to 14) It has also been suggested that patients with a poorer prognosis or with late stage MM may be predisposed towards the development of LCV due to an increased immunologic response. 14) In conclusion, recognition of the malignant nature of the pleural effusion is of great importance for therapeutic and prognostic considerations and can be achieved by cytological examination, immunoelectrophoresis, and flow cytometric analysis of the pleural fluid.…”