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Huang Y, Wang C, Wang H, Liu H, Zhou L. Rediscovering hemostasis abnormalities in multiple myeloma: The new era. Heliyon 2024; 10:e34111. [PMID: 39055831 PMCID: PMC11269926 DOI: 10.1016/j.heliyon.2024.e34111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/27/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024] Open
Abstract
Multiple myeloma (MM) is a malignancy arisen from the abnormal proliferation of clonal plasma cells. It has a high risk of developing bleeding and thrombotic complications, which are related to poor prognosis and decreased survival. Multiple factors are involved in the breaking of the hemostasis balance, including disease specific factors, patient-specific factors, and drug factors that change pro-and anticoagulant and fibrinolysis. Recently, with the introduction of new treatments such as monoclonal antibodies, chimeric antigen receptor modified T-cell therapy, antibody-drug conjugates directed against BCMA, programmed death-1 inhibitor, export protein 1 inhibitors, histone deacetylase inhibitors, immunomodulatory drugs, proteasome inhibitors and Bcl-2 inhibitors, the therapy of MM patients has entered into a new era. Furthermore, it arouses a question whether these new treatments would alter the hemostasis balance in MM patients, which highlights the importance of the underlying pathophysiology of hemostasis abnormalities in MM, and on prophylaxis approaches. In this review, we updated the mechanisms of hemostasis abnormalities in MM, the impact of the new drugs on hemostasis balance and reliable therapeutic strategies.
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Affiliation(s)
- Yudie Huang
- Department of Hematology, Affiliated Hospital of Nantong University, Jiangsu, 226001, China
- Nantong University, Jiangsu, 226001, China
| | | | - Hua Wang
- Department of Pediatrics, Loma Linda University School of Medicine, CA, 92350, USA
| | - Hong Liu
- Department of Hematology, Affiliated Hospital of Nantong University, Jiangsu, 226001, China
| | - Lu Zhou
- Department of Hematology, Affiliated Hospital of Nantong University, Jiangsu, 226001, China
- Nantong University, Jiangsu, 226001, China
- NHC Key Laboratory of Thrombosis and Hemostasis, The First Affiliated Hospital of Soochow University, Soochow, 215000, China
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2
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Czakó C, Gerencsér D, Kormányos K, Kéki-Kovács K, Németh O, Tóth G, Sándor GL, Csorba A, Langenbucher A, Nagy ZZ, Varga G, Gopcsa L, Mikala G, Kovács I, Szentmáry N. Evaluation of Retinal Blood Flow in Patients with Monoclonal Gammopathy Using OCT Angiography. J Clin Med 2023; 12:5227. [PMID: 37629268 PMCID: PMC10456010 DOI: 10.3390/jcm12165227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/28/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Monoclonal gammopathy (MG) is characterized by monoclonal protein overproduction, potentially leading to the development of hyperviscosity syndrome. OBJECTIVE To assess retinal circulation using optical coherence tomography angiography (OCTA) parameters in patients with monoclonal gammopathy. METHODS OCTA measurements were performed using the Optovue AngioVue system by examining 44 eyes of 27 patients with MG and 62 eyes of 36 control subjects. Superficial and deep retinal capillary vessel density (VD SVP and DVP) in the whole 3 × 3 mm macular and parafoveal area, foveal avascular zone (FAZ) area, and central retinal thickness (CRT) were measured using the AngioAnalytics software. The OCTA parameters were evaluated in both groups using a multivariate regression model, after controlling for the effect of imaging quality (SQ). RESULTS There was no significant difference in age between the subjects with monoclonal gammopathy and the controls (63.59 ± 9.33 vs. 58.01 ± 11.46 years; p > 0.05). Taking into account the effect of image quality, the VD SVP was significantly lower in the MG group compared to the control group (44.54 ± 3.22% vs. 46.62 ± 2.84%; p < 0.05). No significant differences were found between the two groups regarding the other OCTA parameters (p > 0.05). CONCLUSIONS A decreased superficial retinal capillary vessel density measured using OCTA in patients with MG suggests a slow blood flow, reduced capillary circulation, and consequent tissue hypoperfusion. An evaluation of retinal circulation using OCTA in cases of monoclonal gammopathy may be a sensitive method for the non-invasive detection and follow-up of early microcirculatory dysfunction caused by increased viscosity.
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Affiliation(s)
- Cecilia Czakó
- Department of Ophthalmology, Semmelweis University, 1085 Budapest, Hungary
| | - Dóra Gerencsér
- Department of Ophthalmology, Semmelweis University, 1085 Budapest, Hungary
| | - Kitti Kormányos
- Department of Ophthalmology, Semmelweis University, 1085 Budapest, Hungary
| | | | - Orsolya Németh
- Department of Ophthalmology, Markusovszky University Teaching Hospital, 9700 Szombathely, Hungary
| | - Gábor Tóth
- Department of Ophthalmology, Semmelweis University, 1085 Budapest, Hungary
| | | | - Anita Csorba
- Department of Ophthalmology, Semmelweis University, 1085 Budapest, Hungary
| | | | - Zoltán Zsolt Nagy
- Department of Ophthalmology, Semmelweis University, 1085 Budapest, Hungary
| | - Gergely Varga
- 3rd Department of Internal Medicine and Haematology, Semmelweis University, 1085 Budapest, Hungary
| | - László Gopcsa
- Department of Haematology and Stem Cell-Transplantation, South-Pest Central Hospital-National Institute for Hematology and Infectious Diseases, 1097 Budapest, Hungary
| | - Gábor Mikala
- Department of Haematology and Stem Cell-Transplantation, South-Pest Central Hospital-National Institute for Hematology and Infectious Diseases, 1097 Budapest, Hungary
| | - Illés Kovács
- Department of Ophthalmology, Semmelweis University, 1085 Budapest, Hungary
- Department of Ophthalmology, Weill Cornell Medical College, New York City, NY 10065, USA
| | - Nóra Szentmáry
- Department of Ophthalmology, Semmelweis University, 1085 Budapest, Hungary
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research, Saarland University, 66424 Homburg, Germany
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Caimi G, Carlisi M. The unpredictable erythrocyte deformability alteration in some hematological disorders: How the classification of primary hyperviscosity syndromes could change. Clin Hemorheol Microcirc 2023; 83:341-349. [PMID: 36683502 DOI: 10.3233/ch-221549] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
According to Wells classification, it is possible to distinguish the primary hyperviscosity syndromes in polycythemic, sclerocythemic and sieric and/or plasmatic. In polycythemia vera, multiple myeloma, Waldenström's macroglobulinemia, and monoclonal gammopathy of undetermined significance, we have observed an unexpected behaviour of the erythrocyte deformability. This data highlights that the hemorheological alteration present in polycythemia vera has not been related to the increase of RBC mass only, as well as that present in plasmacellular dyscrasias has not been attributable to the increase of plasma viscosity only.The aim of this paper is to suggest some starting points for an accurate reflection, emphasizing the need of a revision of the current classification of primary hyperviscosity syndromes.
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Affiliation(s)
- G Caimi
- Department of Health Promotion and Child Care, Internal Medicine and Medical Specialties, Università degliStudi di Palermo, Palermo, Italy
| | - M Carlisi
- Department of Health Promotion and Child Care, Internal Medicine and Medical Specialties, Università degliStudi di Palermo, Palermo, Italy
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4
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Debureaux PE, Harel S, Parquet N, Lemiale V, Siguret V, Goubeau L, Morin F, Royer B, Cuccuini W, Elessa D, Theves F, Brignier AC, Azoulay E, Arnulf B, Talbot A. Prognosis of hyperviscosity syndrome in newly diagnosed multiple myeloma in modern-era therapy: A real-life study. Front Immunol 2022; 13:1069360. [PMID: 36569885 PMCID: PMC9771682 DOI: 10.3389/fimmu.2022.1069360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
Hyperviscosity syndrome (HVS) is a rare complication of newly diagnosed multiple myeloma (NDMM) related to high tumour burden. Studies about the prognosis of HVS in modern-era therapy for NDMM are missing. We investigated a retrospective cohort study of NDMM with HVS between 2011-2021. Thirty-nine NDMM patients with HVS were included. HVS presentation was heterogeneous, with asymptomatic, mild, and neurological forms in 23%, 59%, and 18% of cases, respectively. No thrombosis or major bleeding was observed. Therapeutic plasma exchanges were used in 92% of patients, which were effective and well tolerated. No rebound effect was observed. All patients except one had at least one CRAB criterion. Most of the patients received bortezomib and high-dose steroids (95%) associated with an immunomodulatory drug (43%) or alkylating agents (42%). HVS in NDMM patients had dismal overall survival matched to multiple myeloma patient controls (without HVS) in our center (median: 3.6 vs. 7.7 years, p=0.01), as confirmed by multivariate analysis. Early deaths (in the first two months) occurred in 21% of older patients (>65 years). HVS in NDMM patients is a rare but life-threatening complication associated with high lethality in older patients and be a potential dismal prognosis factor in the modern treatment era.
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Affiliation(s)
| | | | | | - Virginie Lemiale
- Medical Intensive Care Unit (ICU) unit, Saint Louis Hospital, Paris, France
| | | | - Laurie Goubeau
- Hematology Laboratory, Lariboisière Hospital, Paris, France
| | - Florence Morin
- Immunology Laboratory, Saint Louis Hospital, Paris, France
| | - Bruno Royer
- Immuno-Hematology, Saint Louis Hospital, Paris, France
| | - Wendy Cuccuini
- Cytogenetic laboratory, Saint Louis Hospital, Paris, France
| | | | | | | | - Elie Azoulay
- Medical Intensive Care Unit (ICU) unit, Saint Louis Hospital, Paris, France,Medical School, Université Paris Cité, Paris, France
| | - Bertrand Arnulf
- Immuno-Hematology, Saint Louis Hospital, Paris, France,Medical School, Université Paris Cité, Paris, France
| | - Alexis Talbot
- Immuno-Hematology, Saint Louis Hospital, Paris, France,Medical School, Université Paris Cité, Paris, France,*Correspondence: Alexis Talbot,
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Dammacco R, Lisch W, Kivelä TT, Terpos E, Kastritis E, Sisto D, Mavilio A, Ria R, Alessio G, Vacca A, Dammacco F. The Spectrum of Ocular Manifestations in Patients with Waldenström's Macroglobulinemia. Ocul Immunol Inflamm 2022; 30:1659-1668. [PMID: 34270382 DOI: 10.1080/09273948.2021.1933068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate the ocular manifestations in 91 Waldenström's macroglobulinemia (WM) patients. METHODS Retrospective, cross-sectional, observational analysis. RESULTS Ocular impairments, detected in 19 patients, included flame-shaped hemorrhages, venous sausaging, papilledema, macular detachments, or central retinal vein occlusion in 16 patients; paraproteinemic keratopathy in 2; and a CANOMAD syndrome in 1. Best-corrected visual acuity was ≥0.5 logMAR units in 11 of 38 eyes. Intraocular pressure was increased in seven eyes. Genetic analysis in seven patients showed a mutation in the MYD88 gene in six patients and a nonsense mutation in the CXCR4 gene in five patients. Plasmapheresis followed by chemotherapy with or without the addition of rituximab resulted in improvement or normalization of the ophthalmological findings in 15 patients. CONCLUSION The ocular manifestations of WM are protean and potentially sight threatening. Recent advances in genomic profiling and chemotherapy have remarkably improved the hematological and ophthalmological outcomes of these patients.
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Affiliation(s)
- Rosanna Dammacco
- Department of Ophthalmology and Neuroscience, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Walter Lisch
- Department of Ophthalmology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Tero T Kivelä
- Department of Ophthalmology, University of Helsinki, Helsinki, Finland
| | - Evangelos Terpos
- Department of Clinical Therapeutics, National and Kapodistrian School of Medicine, University of Athens, Athens, Greece
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian School of Medicine, University of Athens, Athens, Greece
| | - Dario Sisto
- Department of Ophthalmology and Neuroscience, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Alberto Mavilio
- Social Health District, Glaucoma Center, Azienda Sanitaria Locale, Brindisi, Italy
| | - Roberto Ria
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Giovanni Alessio
- Department of Ophthalmology and Neuroscience, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Angelo Vacca
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Franco Dammacco
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Medical School, Bari, Italy
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Hu Y, Yang H, Fu S, Wu J. Therapeutic Plasma Exchange: For Cancer Patients. Cancer Manag Res 2022; 14:411-425. [PMID: 35140519 PMCID: PMC8818550 DOI: 10.2147/cmar.s340472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/25/2021] [Indexed: 11/23/2022] Open
Abstract
Therapeutic plasma exchange is used as a trial method for the treatment of cancer patients. Therapeutic plasma exchange uses in vitro technology to remove pathogenic factors in the plasma, returning the replacement and remaining components to the patient to facilitate cure. In the effort to explore new methods of cancer treatment, the introduction of therapeutic plasma exchange brings new hope for cancer treatment; however, the current evidence supporting therapeutic plasma exchange is controversial, and most of the evidence comes from observational studies, lacking large prospective randomized trials. Therefore, this review attempts to focus on the main indications of therapeutic plasma exchange for the treatment of tumors and their complications, including hematological tumors (multiple myeloma cast nephropathy and hyperviscosity syndrome), nervous system tumors (myasthenia gravis associated with thymoma, paraneoplastic neurological syndrome, Lambert–Eaton myasthenia syndrome, and anti-N-methyl-D-aspartate receptor encephalitis), overdose of chemotherapy drugs. In addition, the issues of side-effects and safety in the use of therapeutic plasma exchange are also discussed. However, well-designed prospective trials are needed to better define the role of therapeutic plasma exchange in cancer.
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Affiliation(s)
- Yuru Hu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Hanshan Yang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Shaozhi Fu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Jingbo Wu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
- Correspondence: Jingbo Wu; Shaozhi Fu, Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China, Tel +8613980257136, Email ;
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High Output Heart Failure in Multiple Myeloma: Pathogenetic Considerations. Cancers (Basel) 2022; 14:cancers14030610. [PMID: 35158878 PMCID: PMC8833382 DOI: 10.3390/cancers14030610] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Multiple myeloma is a plasma cell disorder that accounts for around 10% of all haematological malignancies. This neoplasia is often associated with a significant prevalence of cardiovascular complications resulting from several factors, unrelated and/or related to the disease. Among cardiovascular complications, the high output heart failure is of great importance as it is related to a worse prognosis for patients. It is important to point out that, despite the availability of more and more numerous and effective drugs, myeloma remains an incurable disease, with frequent relapses and several treatment lines, with the need, therefore, for a careful evaluation of patients, especially from a cardiological point of view. For this reason, we are proposing a comprehensive overview of different pathogenetic mechanisms responsible for high output heart failure in multiple myeloma, including artero-venous shunts, enhanced angiogenesis, glutamminolysis, hyperammonemia and hemorheological alterations, with the belief that a multidisciplinary approach, in clinical evaluation is critical for the optimal management of the patient. Abstract The high output heart failure is a clinical condition in which the systemic congestion is associated to a high output state, and it can be observed in a non-negligible percentage of hematological diseases, particularly in multiple myeloma, a condition in which the risk of adverse cardiovascular events may increase, with a worse prognosis for patients. For this reason, though an accurate literature search, we provided in this review a complete overview of different pathogenetic mechanisms responsible for high output heart failure in multiple myeloma. Indeed, this clinical finding is present in the 8% of multiple myeloma patients, and it may be caused by artero-venous shunts, enhanced angiogenesis, glutamminolysis, hyperammonemia and hemorheological alterations with increase in plasma viscosity. The high output heart failure in multiple myeloma is associated with significant morbidity and mortality, emphasizing the need for a multidisciplinary approach.
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Caimi G, Lo Presti R, Carlisi M. Reflections on the unexpected laboratory finding of hemorheological alterations observed in some haematological disorders. Microvasc Res 2021; 136:104171. [PMID: 33862043 DOI: 10.1016/j.mvr.2021.104171] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/23/2021] [Accepted: 04/07/2021] [Indexed: 11/26/2022]
Abstract
Hyperviscosity syndrome is a clinical condition characterized by the slowing of blood flow through the vessels and it may be associated with several diseases. The nosographic classification of primary hyperviscosity conditions (Wells classification 1970) divided the primary hyperviscosity syndromes in polycythaemic, sclerocytemic and sieric. Recent and personal laboratory observations have highlighted an unexpected behaviour of the erythrocyte deformability observed in some haematological disorders such as polycythemia vera, multiple myeloma and monoclonal gammopathy of undetermined significance. The interest of this observation depends on the fact that up to now, according to the Wells classification, the hemorheological alteration present in PV was related to the increase of RBC mass while that present in MM and MGUS was attributable to the abnormality of plasma or serum viscosity only. Through an extensive research among the literature, using MEDLINE/PubMed to identify all published reports on the hyperviscosity syndromes, issues that until now have been dealt with separately will therefore be analyzed in a unique paper, allowing a global view. The aim of this paper is to provide some suggestions for reflection and emphasizing the need of a nosographic framework of hyperviscosity that, probably, deserves to be reviewed.
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Affiliation(s)
- Gregorio Caimi
- Department of Health Promotion and Child Care, Internal Medicine and Medical Specialties, Università degli Studi di Palermo, Palermo, Italy
| | - Rosalia Lo Presti
- Department of Psychology, Educational Science and Human Movement, Università degli Studi di Palermo, Palermo, Italy
| | - Melania Carlisi
- Department of Health Promotion and Child Care, Internal Medicine and Medical Specialties, Università degli Studi di Palermo, Palermo, Italy.
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Li J, Zhang R, Gu F, Liu ZL, Sun P. Optical coherence tomography angiography characteristics in Waldenström macroglobulinemia retinopathy: A case report. World J Clin Cases 2020; 8:6071-6079. [PMID: 33344607 PMCID: PMC7723702 DOI: 10.12998/wjcc.v8.i23.6071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/11/2020] [Accepted: 10/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Waldenström macroglobulinemia (WM) is a distinct clinicopathologic entity characterized by the infiltration of the bone marrow by clonal lymphoplasmacytic cells that produce monoclonal immunoglobulin M (IgM) in the blood, and patients may present with symptoms related to the infiltration of the hematopoietic tissues or the effects of monoclonal IgM in the blood. Funduscopic abnormalities were noted in some of the patients due to hyperviscosity or other retinal lesions. Optical coherence tomography angiography (OCTA) as a non-invasive imaging tool can give qualitative and quantitative information about the status of retinal and choroidal vessels, which might be useful for diagnosing patients with WM-associated retinopathy.
CASE SUMMARY The patient was a 67-year-old man who presented with sudden visual disturbance in both eyes. Ophthalmic tests showed that best corrected visual acuity (BCVA) for this patient was 20/100 in the right eye and 20/1000 in the left eye. Fundus examination, optical coherence tomography (OCT), and OCTA revealed substantial bilateral optic disc edema, dilated and tortuous retinal veins, and diffuse intraretinal blot hemorrhages and edema which were consistent with bilateral central retinal vein occlusion (CRVO). Meanwhile, remarkable bilateral serous macular detachments (SMD) were noticed on OCT. Systemic examinations showed that the patient had anemia and extremely high level of monoclonal IgM and infiltration of clonal lymphoplasmacytic cells in bone marrow. The diagnosis of WM with hyperviscosity and retinopathy was made based on the clinical manifestation and laboratory findings. He was subsequently treated with intravitreal ranibizumab injection, plasmapheresis, and bortezomib plus rituximab with dexamethasone. Six months after treatments, the central macular volume decreased by 16.1% in the right eye and 28.6% in the left eye on OCT, and the patient’s BCVA was improved to 20/60 in the right eye and 20/400 in the left eye. Very good partial response was obtained after systemic treatment.
CONCLUSION WM may affect visual function and present as bilateral CRVO. OCTA can show characteristic changes in both retina and choroid vasculatures, which might be of great value for diagnosing or following patients with WM retinopathy. Intravitreal anti-vascular endothelial growth factor treatment combined with systemic therapy might be beneficial for WM patients with retinopathy (SMD and CRVO).
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Affiliation(s)
- Jun Li
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Rui Zhang
- Department of Hematology, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Feng Gu
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Zhe-Li Liu
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Peng Sun
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
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Li J, Zhang R, Gu F, Liu ZL, Sun P. Optical coherence tomography angiography characteristics in Waldenström macroglobulinemia retinopathy: A case report. World J Clin Cases 2020. [DOI: 10.12998/wjcc.v8.i23.6065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Dušek O, Fichtl M, Rezková L, Dubská Z, Heissigerová J, Růžičková E, Vráblík M, Špička I, Svozílková P. Acute elevation of intraocular pressure in patient with hyperlipidemic myeloma. CESKA A SLOVENSKA OFTALMOLOGIE : CASOPIS CESKE OFTALMOLOGICKE SPOLECNOSTI A SLOVENSKE OFTALMOLOGICKE SPOLECNOSTI 2020; 76:172-180. [PMID: 33297702 DOI: 10.31348/2020/27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE To introduce a rare case of patient with hyperlipidemic myeloma and ocular manifestation in form of masquerade syndrome with acute elevation of intraocular pressure (IOP) and hyperviscous retinopathy. RESULTS 55-year-old man with newly diagnosed hyperlipidemic myeloma and hyperviscous syndrome was acutely referred to our glaucoma outpatient clinic due to problems with his left eye: sudden pain, blurred vision, redness of the eye and IOP of 44 mm Hg. We excluded attack of angle closure glaucoma and found presence of whitish material in the anterior chamber and blood obstructing the iridocorneal angle. Glaucoma therapy was initiated and lavage of the anterior chamber of the left eye with sampling of the aqueous humour for biochemical and cytological examination was performed. Identification of trace amount of cryoprotein in the samples of humour proved diagnosis of masquerade syndrome. Finding of the hyperviscous retinopathy and nonperfusion of wide peripheral areas of retina in both eyes was indicated to laser coagulation of these areas. The patient underwent in the meantime three times plasmapheresis, four cycles of biological therapy and autologous stem cell transplantation reaching complete remission of the myeloma. Local and systemic therapy led to significant clinical finding improvement on the anterior segment and fundus of both eyes. CONCLUSIONS Masquerade syndrome can be complicated by acute elevation of IOP. Diagnostic lavage of the anterior chamber, local therapy, systemic therapy and close interdisciplinary cooperation contributed to right diagnosis, IOP normalisation, ocular and general condition improvement.
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Valade S, Lemiale V, Mariotte E. Syndrome d’hyperviscosité : mise au point pour les réanimateurs. MEDECINE INTENSIVE REANIMATION 2018. [DOI: 10.3166/rea-2018-0046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Le syndrome d’hyperviscosité (SH) est une entité clinique composée de signes variables non spécifiques et dont le diagnostic repose sur un faisceau d’arguments contextuels, anamnestiques et clinicobiologiques. En dehors de la mesure de la viscosité plasmatique, l’examen le plus spécifique pour confirmer le diagnostic semble être le fond d’œil. L’incidence du SH est inconnue, mais il s’agit d’une complication rare d’un grand nombre de pathologies. La physiopathologie est en rapport avec une augmentation de la viscosité plasmatique ou avec une augmentation du nombre d’éléments figurés du sang et/ou une altération de la capacité de ces cellules à circuler dans le lit capillaire. Le SH relève toujours d’un traitement de la pathologie sous-jacente et d’un traitement symptomatique visant à diminuer la viscosité sanguine. Dans les formes les plus sévères, il peut être nécessaire de recourir à un traitement par aphérèse thérapeutique en urgence. Le pronostic dépend principalement de la pathologie sous-jacente.
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Caimi G, Carlisi M, Montana M, Gallà E, Lo Presti R, Hopps E, Siragusa S. Erythrocyte deformability and hemorheological profile in multiple myeloma. Clin Hemorheol Microcirc 2018; 68:25-34. [DOI: 10.3233/ch-170267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- G. Caimi
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Palermo, Italy
| | - M. Carlisi
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Palermo, Italy
| | - M. Montana
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Palermo, Italy
| | - E. Gallà
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Palermo, Italy
| | - R. Lo Presti
- Dipartimento di Scienze Psicologiche, Pedagogiche e della Formazione, Università degli Studi di Palermo, Palermo, Italy
| | - E. Hopps
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Palermo, Italy
| | - S. Siragusa
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Palermo, Italy
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Belarj B, El Alaoui A, Dahraoui S, Uwingabiye J, Owusu EM, Rochdi A, Biaz A, Dami A, Bouhsain S, Ouzzif Z, Doghmi N, El Machtani Idrissi S. A clinical picture of pulmonary embolism revealing light-chain myeloma. Clin Case Rep 2017; 5:2044-2046. [PMID: 29225853 PMCID: PMC5715419 DOI: 10.1002/ccr3.1234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 08/19/2017] [Indexed: 11/29/2022] Open
Abstract
We are highlighting on the particularity of a clinical picture of pulmonary embolism revealing light‐chain myeloma in a 56‐year‐old male patient. Myeloma remains a rare affection. Even though its revelation through pulmonary embolism remains rare, it can be explained by hyperviscosity syndrome accompanying it.
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Affiliation(s)
- Badia Belarj
- Department of Clinical Biochemistry and Toxicology; Faculty of Medicine and Pharmacy; Mohammed V Military Teaching Hospital; Mohammed V University; Rabat Morocco
| | - Amine El Alaoui
- Department of Intensive Care Units; Faculty of Medicine and Pharmacy; Mohammed V Military Teaching Hospital; Mohammed V University; Rabat Morocco
| | - Souhail Dahraoui
- Department of Clinical Biochemistry and Toxicology; Faculty of Medicine and Pharmacy; Mohammed V Military Teaching Hospital; Mohammed V University; Rabat Morocco
| | - Jean Uwingabiye
- Department of Clinical Biochemistry and Toxicology; Faculty of Medicine and Pharmacy; Mohammed V Military Teaching Hospital; Mohammed V University; Rabat Morocco
| | - Emmanuel Millbank Owusu
- Department of Clinical Biochemistry and Toxicology; Faculty of Medicine and Pharmacy; Mohammed V Military Teaching Hospital; Mohammed V University; Rabat Morocco
| | - Anas Rochdi
- Department of Clinical Biochemistry and Toxicology; Faculty of Medicine and Pharmacy; Mohammed V Military Teaching Hospital; Mohammed V University; Rabat Morocco
| | - Asmaa Biaz
- Department of Clinical Biochemistry and Toxicology; Faculty of Medicine and Pharmacy; Mohammed V Military Teaching Hospital; Mohammed V University; Rabat Morocco
| | - Abdellah Dami
- Department of Clinical Biochemistry and Toxicology; Faculty of Medicine and Pharmacy; Mohammed V Military Teaching Hospital; Mohammed V University; Rabat Morocco
| | - Sanae Bouhsain
- Department of Clinical Biochemistry and Toxicology; Faculty of Medicine and Pharmacy; Mohammed V Military Teaching Hospital; Mohammed V University; Rabat Morocco
| | - Zohra Ouzzif
- Department of Clinical Biochemistry and Toxicology; Faculty of Medicine and Pharmacy; Mohammed V Military Teaching Hospital; Mohammed V University; Rabat Morocco
| | - Nawfel Doghmi
- Department of Intensive Care Units; Faculty of Medicine and Pharmacy; Mohammed V Military Teaching Hospital; Mohammed V University; Rabat Morocco
| | - Samira El Machtani Idrissi
- Department of Clinical Biochemistry and Toxicology; Faculty of Medicine and Pharmacy; Mohammed V Military Teaching Hospital; Mohammed V University; Rabat Morocco
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15
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Caimi G, Carlisi M, Urso C, Lo Presti R, Hopps E. Clinical disorders responsible for plasma hyperviscosity and skin complications. Eur J Intern Med 2017; 42:24-28. [PMID: 28390781 DOI: 10.1016/j.ejim.2017.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 03/30/2017] [Accepted: 04/03/2017] [Indexed: 12/17/2022]
Abstract
In this brief review, we have examined some clinical disorders which are associated to an altered hemorheological profile and at times accompanied by skin ulcers. This skin condition may be, in fact, observed in patients with primary plasma hyperviscosity such as multiple myeloma, Waldenstrom macroglobulinemia, cryoglobulinemia, cryofibrinogenemia, dysfibrinogenemia and connective tissue diseases. It must be underlined that the altered hemorheological pattern is not the only responsible for this skin complication but, as it worsens the microcirculatory flow, it contributes to determine the occurrence of the skin ulcers.
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Affiliation(s)
- Gregorio Caimi
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Italy.
| | - Melania Carlisi
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Italy
| | - Caterina Urso
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Italy
| | - Rosalia Lo Presti
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Italy
| | - Eugenia Hopps
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Italy
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16
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Diagnostic et prise en charge du syndrome de fuite capillaire idiopathique (SFCI). MEDECINE INTENSIVE REANIMATION 2017. [DOI: 10.1007/s13546-017-1275-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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17
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Grall M, Miranda S, Cailleux-Talbot N, Cardinael N, Contentin N, Grangé S, Girault C, Benhamou Y, Lévesque H, Armengol G. [An unusual cause of digital ischemia]. Rev Med Interne 2016; 38:282-283. [PMID: 27062099 DOI: 10.1016/j.revmed.2016.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 01/04/2016] [Indexed: 12/28/2022]
Affiliation(s)
- M Grall
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - S Miranda
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Inserm U1096, université de Rouen, Rouen, France
| | - N Cailleux-Talbot
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - N Cardinael
- Département d'hématologie, centre Henri-Becquerel, Rouen, France
| | - N Contentin
- Département d'hématologie, centre Henri-Becquerel, Rouen, France
| | - S Grangé
- Département de réanimation médicale, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - C Girault
- Département de réanimation médicale, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - Y Benhamou
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Inserm U1096, université de Rouen, Rouen, France
| | - H Lévesque
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Inserm U1096, université de Rouen, Rouen, France
| | - G Armengol
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
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18
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de Moreuil C, Ianotto JC, Eveillard JR, Carrier M, Delluc A. [Multiple myeloma and venous thrombosis. Which thromboprophylaxis should be given?]. Rev Med Interne 2016; 37:473-9. [PMID: 26833146 DOI: 10.1016/j.revmed.2015.12.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 11/24/2015] [Accepted: 12/29/2015] [Indexed: 01/06/2023]
Abstract
Multiple myeloma is a malignant plasma cells dyscrasia that mainly affects patients older than 65 years. These patients are at a higher risk for venous thromboembolism (VTE) because of cancer status, intrinsic risk factors, and exposure to prothrombotic therapies. The risk for VTE appears higher during the first months of myeloma treatment and decreases over time. Exposure to immunomodulatory drugs (IMIDs) such as thalidomide or lenalidomide in association with high doses of dexamethasone or anthracyclin-based chemotherapy is associated with a four-fold increased risk for VTE. Low-dose aspirin, preventive-dose of low molecular weight heparin (LMWH) or vitamin K antagonists were tested for primary prevention of VTE in myeloma patients receiving chemotherapy. The International Myeloma Working Group (IMWG) suggests stratifying VTE risk to decide which patients should receive VTE prevention. Then, the IMWG suggests giving low-dose aspirin to low VTE risk patients and LMWH or vitamin K antagonists to patients at high risk for VTE. For daily practice, it seems reasonable to start preventive doses of LMWH for 3 to 6 months in ambulatory myeloma patients receiving combined therapy with IMID and in all myeloma patients admitted to hospital.
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Affiliation(s)
- C de Moreuil
- EA 3878 (GETBO), département de médecine interne et de pneumologie, hôpital de la Cavale-Blanche, CHRU de Brest, 29609 Brest cedex, France
| | - J-C Ianotto
- EA 3878 (GETBO), département de médecine interne et de pneumologie, hôpital de la Cavale-Blanche, CHRU de Brest, 29609 Brest cedex, France; Service d'hématologie clinique, institut de cancéro-hématologie, hôpital Morvan, CHRU de Brest, 29609 Brest cedex, France
| | - J-R Eveillard
- Service d'hématologie clinique, institut de cancéro-hématologie, hôpital Morvan, CHRU de Brest, 29609 Brest cedex, France
| | - M Carrier
- Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, 501, Smyth Road, K1H 8 L6 Ottawa, Ontario, Canada
| | - A Delluc
- EA 3878 (GETBO), département de médecine interne et de pneumologie, hôpital de la Cavale-Blanche, CHRU de Brest, 29609 Brest cedex, France.
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