Haematologica 2003 - Supplements

095
SMOLDERING MULTIPLE MYELOMA: PATTERN OF
PROGRESSION AND SUBSEQUENT OUTCOME IN 53
PATIENTS FROM A SINGLE INSTITUTION
L. Rosiñol, J. Bladé, J. Esteve, M. Aymerich, E. Giné, S.
Montoto, E. Nadal, M. Rozman, R. Queralt, X. Filella, A.
Carrió, E. Montserrat
Institute of Hematology & Oncology. IDIBAPS. Hospital Clínic.
Barcelona. Spain.
Background: The majority of the patients with multiple myeloma
(MM) have symptomatic disease and require therapy. Smoldering
multiple myeloma (SMM) was first recognized in six patients
who fulfilled the diagnostic criteria of MM with no symptoms
and who remained stable with no therapy for five or more years.
However, there are no further reports on patients with SMM
diagnosed according to the stringent criteria originally reported.
Objective: To describe the pattern of progression and the
outcome after transformation (response to therapy and survival)
in 53 patients fulfilling SMM criteria.
Patients and methods: From May 1978 to July 2001, 53 patients
(22 M/31F) with a median age of 61 yrs (range, 41-88) were
diagnosed with SMM (serum M-protein ≥ 30 g/L and > 10%
bone marrow plasma cells -BMPC-). The mean serum M-protein
and BMPC at diagnosis were 35 ±7.3 g/L and 29± 18%,
respectively. The M-protein type was IgG in 40 cases, IgA in 11
cases, and light-chain and biclonal one case each.
Results: The overall survival from diagnosis was 8.3 yrs. Two
subsets of SMM were identified: 1) patients with “evolving”
SMM (n=23), with a progressive increase in serum M-protein and
a previously recognized monoclonal gammopathy of
undetermined significance (MGUS) in most cases and 2) patients
with “non-evolving” SMM (n=25), with long lasting stable serum
M-protein that abruptly increases when symptomatic MM
develops. Patients with “evolving” disease had an earlier
transformation than those with “non-evolving” SMM (60% &
90% vs 16% & 55% at 2 & 5 yrs respectively, p=0.007).
However, no significant differences were observed in survival
between both groups (6.4 vs 8.9 yrs, p=0.25). Thirty-four of the
53 patients developed symptomatic MM. The pattern of
progression consisted of anemia (11 cases), bone lytic lesions
(6), anemia and bone lytic lesions (12) and bone pain due to
osteoporosis (5). No patient developed renal failure,
hypercalcemia or extramedullary plasmacytomas at progression.
Thirty-one patients were treated: 16 with single alkylating agents
plus prednisone and 15 with combination chemotherapy. The
partial response rate was 39%. The median survival from
trasformation was 3.5 yrs with no significant differences between
both groups.
Conclusions: Patients with SMM have a prolonged survival.
Patients with “evolving” disease usually have a previously
recognized MGUS and a significantly shorter time to progression
that those with “non-evolving” SMM. In both groups the pattern
of progression consists of anemia and/or lytic lesions with no
renal failure, hypercalcemia or extramedullary plasmacytomas.
Althought the response rate to therapy is poor, the survival from
transformation to symptomatic MM is 3.5 yrs.jblade@clinic.ub.es
4.5 Miscellaneous
096
Deep-vein thrombosis in multiple myeloma after firstline
chemotherapy without thalidomide.
Di Mario A, Rossi E, Garzia MG, De Stefano V.
Cattedra di Ematologia-Università Cattolica del S.Cuore-Rome-
Italy.
Vnous thrombotic episodes (VTE) are frequently observed in
cancer patients with a small proportion of these subjects
experiencing this event as the first manifestation of their
neoplastic disease. In multiple myeloma (MM) VTE has recently
emerged as the most single important complication of
thalidomide therapy. Acquired resistance to activated protein C
(APC) in the absence of factor V Leiden mutation has also
reported as a significant risk factor for VTE in MM patients.
We performed coagulation studies included prothrombin time
(PT), activated partial thromboplastin time (aPTT), fibrinogen
and APC resistance in patients with MM referred to our
hematological unit (untreated or with preceding chemotherapy).
Twenty patients (15 males and 5 females; median age 64 years,
range 38-85 years), without history of previous VTE preceding
the diagnosis of MM and not receiving anticoagulation were
enrolled in this study.
None of the tested patients demonstrated abnormalities of these
coagulation tests. Moreover 2 patients experienced VTE during
the course of their disease (one and three months after diagnosis
and after strting chemotherapy not including thalidomide. No
identifiable prothrombotic laboratory abnormalities were found in
these subjects.
The trombogenicity in MM patients could finally be related to
other abnormalities, i.e. elevated levels of the von Willebrand
factor antigen observed with the increase of angiogenesis.
097
Deep Venous Thrombosis (DVT) in Patients with
Monoclonal Gammopathy of Undetermined
Significance (MGUS)
Gordan Srkalovic, Marte A.Cameron, Lisa Rybicki and
Mohamad A. Hussein
Cleveland Clinic Foundation, Multiple Myeloma Research Program
Deep venous thrombosis (DVT) is recently recognized as a
complication of Thalidomide in combination therapy for multiple
myeloma (MM) patients. The incidence of DVT in patients with
MGUS has not been described. We evaluated frequency of DVT
and risk factors for DVT in 174 consecutive MGUS patients with
a documented disease evaluated and followed up at our Center
from 1991-2001. Data were collected in 5 categories: (a)
demographics, (b) disease and treatment, (c) thrombosis case
information, (d) major risk factors for thrombosis and (e) baseline
laboratory data. Uni- and multivariable correlates of DVT were
assessed using Kaplan-Meier analysis and Cox proportional
hazards analysis. Mean age was 66.3 (range 24 – 91). Male
female percentage ratio was 50/50. 22 % of the patients had high
creatinine level (>1.4 mg/dl). Personal or family history of DVT
was recorded in 5.4 and 1.3 % of patients, respectively. Known
hypercoagulable state was present in 3 patients (1.8%). Median
percentage of plasma cells in the bone marrow was 4% (range 0 –
27%). 63, 20 and 15% of patients had IgG, IgA and IgM,
respectively. Of 174 patients 13 developed DVT (7.5%).
Median time from diagnosis to DVT was 4 month (range 0-67).
Primary sites of DVT were lower extremities (76.9 %). 1 case
S131