Multiple myeloma. A clinical review

Neuropathy and motor neuron syndromes associated with plasma cell disease

Increasing numbers of patients are being recognized with neurological abnormalities associated with the immunochemical changes of plasma cell disease. To illustrate the wide spectrum of clinical disorders that can be found, I discuss in detail 5 patients: 2 with neuropathy, 3 with amyotrophic lateral sclerosis (ALS), all of whom had serum monoclonal paraproteinemia. In addition, I report in tabular form 6 patients with paraproteinemia and the following clinical presentations: 1) systemic lupus with polyneuropathy and severe cerebritis, 2) myasthenia gravis with thymoma, 3) polymyositis, 4) polymyositis, arthritis and Grave's disease, 5) relapsing polyneuritis (one of the original patients diagnosed by Austin) and 6) ALS, dystonia and parkinsonism. Major improvements in clinical condition occurred sometimes, but not always, coincident with reductions in the levels of the paraprotein using prednisone, cyclophosphamide, chlorambucil and plasma exchange treatments even in some of the patients who had the clinical appearance of ALS. Patients with neuromuscular diseases should be routinely screened with serum immunoelectrophoresis for monoclonal gammopathy. If a monoclonal gammopathy is found and if the disease is serious, then those patients should be treated as if they had an autoimmune disorder.

Ocular manifestations of multiple myeloma, Waldenström's macroglobulinemia and benign monoclonal gammopathy

Multiple myeloma, Waldenström's macroglobulinemia and benign monoclonal gammopathy are examples of diseases in which there is an uncontrolled proliferation of cells involved in antibody synthesis. Myeloma and macroglobulinemia are considered malignant diseases, whereas monoclonal gammopathy is benign or possibly a pre-myelomatous condition. Following a brief review of the immunoglobulins the various clinical manifestations of these disorders are described. The ophthalmic signs of these disorders can be seen in every ocular structure.

A comparative cytogenetic study of melphalan-sensitive and -resistant murine L1210 leukemia cells

A cytogenetic analysis of melphalan-sensitive and -resistant murine L1210 leukemia cells maintained in vivo indicated that the drug-resistant tumor had a modal number of 40 chromosomes while the sensitive tumor possessed a mode of 41 chromosomes. Two marker chromosomes were present in both the sensitive and the resistant tumors. One was of medium length with secondary constrictions, and the other was a minute chromosome. A single in vitro exposure of the sensitive tumor cells to a cytotoxic concentration of melphalan was not accompanied by a change in modal number but resulted in chromatid exchange. No alterations were found in resistant tumor cells which were exposed to the same drug concentration. However, exposure of resistant tumor cells to higher doses of melphalan resulted in chromatid breaks, chromatid gaps and the formation of acentric chromosomes. The resistant tumor, transplanted once without drug injection, maintained a sharp mode of 40 chromosomes.