Pleural effusions in hematologic malignancies and their management with indwelling pleural catheters

Vakil, Erik; Jiménez, Carlos A.; Faiz, Saadia A.

doi:10.1097/mcp.0000000000000490

Cited by 4 publications

(3 citation statements)

References 43 publications

(74 reference statements)

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“…In addition, recent evidence suggests that indwelling pleural catheters are safe in hematologic malignancies. 35 Therefore, a diagnostic thoracentesis or further evaluation of PE should be performed widely in MM patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Risk Factors for Pleural Effusion in Patients with Multiple Myeloma

Kang¹,

Hou²,

Yang³

et al. 2021

IJGM

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Purpose Pleural effusion (PE) is prevalent in “real-life” populations of multiple myeloma (MM), a common hematologic malignancy. Development of PE likely has prognostic implications. The aim of this study was to investigate the characteristics and identify risk factors for occurrence of PE in MM. Patients and Methods We reviewed electronic medical records of 907 patients diagnosed with MM. Results Incidence of PE in MM patients was 42.7%. Small and bilateral PE in most cases. PE developed in all MM subtypes, the median time from diagnosis of multiple myeloma to pleural effusion was 6.8 months (range 0.8–33.6 months). Patients with PE showed worse survival than those without PE (unadjusted hazard ratio with 95% confidence interval: 2.249 [1.774–2.852]). No difference in survival was found between patients with small PE and those with moderate to large PE (unadjusted HR, 1.402; 95% CI, 1.037–1.896). Plasma cell proportion (OR, 1.373; 95% CI, 1.153–1.634; P = 0.009) and amyloidosis (OR, 1.791; 95% CI, 1.408–2.279; P = 0.024) were risk factors for the occurrence of PE at the initial diagnosis of MM. Plasma cell proportion (OR, 1.853; 95% CI, 1.451–2.368; P = 0.038), pneumonia (OR, 1.309; 95% CI, 1.143–1.498; P = 0.008) and heart failure (OR, 1.815; 95% CI, 1.387–2.374; P = 0.031) were risk factors for the occurrence of PE at relapse of MM. Conclusion The incidence of PE in MM patients is notable and PE can occur in all MM subtypes. PE indicates a poor prognosis, even small amounts of effusion. PE is a problem worthy of attention, especially in patients with high plasma cell proportion, amyloidosis or complicated with pneumonia and heart failure.

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Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Risk Factors for Pleural Effusion in Patients with Multiple Myeloma

Kang¹,

Hou²,

Yang³

et al. 2021

IJGM

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“…Effusion can be the presenting symptom or can occur in the course of various epithelial and hematopoietic malignancies. [1][2][3]…”

Section: Discussionmentioning

confidence: 99%

“…Up to 10% of malignant pleural effusions with a positive cytologic examination are due to non-Hodgkin lymphoma (NHL). 3 4 Gilbert et al noted that among 91 patients with hematologic disease requiring placement of an indwelling pleural catheter, 62% had a diagnosis of a lymphoma, 21% had leukemia, and 13% had multiple myeloma. 4 5 The presence of cells of a hematologic malignancy in effusion indicates advanced and generalized disease.…”

Section: Discussionmentioning

confidence: 99%

Hematolymphoid Neoplasms in Serous Effusions: Morphological Spectrum, Distribution, and Role of Ancillary Techniques—A Retrospective Analysis of 75 cases

Saxena

Nayak

Nair

et al. 2021

Indian J Med Paediatr Oncol

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Introduction Involvement of body fluids can occur at the time of diagnosis or during the disease course of hematolymphoid neoplasms. Cytodiagnosis of malignant effusion is important in effective clinical management. Objectives (1) The aims of the study were to determine the frequency of distribution of various hematolymphoid neoplasms involving body fluids, (2) to study the morphology of hematolymphoid neoplasms in fluids, and (3) to assess the role of ancillary techniques in the diagnosis. Materials and Methods In this retrospective study, all cases of hematolymphoid neoplasms involving body fluids diagnosed from January 2016 to December 2018 were evaluated. Results During the 3-year period, there were 75 cases of hematological malignancies involving body fluids. These included 48 male patients and 27 female patients. Pleural fluid was involved in majority of cases (56 cases; 74.67%), followed by ascitic fluid (17 cases; 22.67%), and pericardial fluid (2 cases; 2.67%). High cellularity, monotonous population of cells, high nuclear-cytoplasmic (N/C) ratio, indentation/irregularity of nuclear membrane, immature chromatin/irregular clumping of chromatin, increased mitosis, and karyorrhexis were the key features which helped to differentiate between reactive and neoplastic processes. There were 35 cases of B-cell neoplasms, 33 cases of T-cell neoplasms, and seven cases of myeloid neoplasms involving body cavity fluids. T-lymphoblastic lymphoma was the most common subtype (29 cases; 38.7%), followed by diffuse large B-cell lymphoma (DLBCL) (12 cases; 16%). In 53 cases, effusion was present in the initial presentation itself. Initial diagnosis was made in effusion cytology in 25 cases (33.33% of the total), with the help of flow cytometry in 20 cases, and immunohistochemistry (IHC) in cell blocks in five cases. Conclusion Diagnosis of hematolymphoid neoplasms in body fluids based on correlation with clinical details, critical evaluation of cytology findings, and comparison with previous diagnosis along with the judicious use of ancillary techniques helps in deciding an early treatment plan.

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Management of Malignant Pleural Effusions

Jiménez

Shannon

2023

Interventions in Pulmonary Medicine

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Pleural effusions in hematologic malignancies and their management with indwelling pleural catheters

Cited by 4 publications

References 43 publications

Clinical Characteristics and Risk Factors for Pleural Effusion in Patients with Multiple Myeloma

Clinical Characteristics and Risk Factors for Pleural Effusion in Patients with Multiple Myeloma

Hematolymphoid Neoplasms in Serous Effusions: Morphological Spectrum, Distribution, and Role of Ancillary Techniques—A Retrospective Analysis of 75 cases

Management of Malignant Pleural Effusions

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