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Schwartz B, Schou M, Ruberg FL, Rucker D, Choi J, Siddiqi O, Monahan K, Køber L, Gislason G, Torp-Pedersen C, Andersson C. Cardiovascular Morbidity in Monoclonal Gammopathy of Undetermined Significance: A Danish Nationwide Study. JACC CardioOncol 2022; 4:313-322. [PMID: 36213365 PMCID: PMC9537076 DOI: 10.1016/j.jaccao.2022.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 11/14/2022] Open
Abstract
Background Monoclonal gammopathy of undetermined significance (MGUS) is associated with renal dysfunction, inflammation, and increased cardiovascular mortality, but the cardiovascular risks are not fully understood. Objectives The authors explored the association of MGUS with a spectrum of cardiovascular diseases using the Danish nationwide databases. Methods Between 1995 and 2018, patients 18 years and older with MGUS were age- and sex-matched (1:10) with control patients and followed prospectively until December 31, 2018, for the occurrence of cardiovascular diseases. Patients diagnosed with multiple myeloma, lymphoma, or amyloidosis were excluded. Multivariable adjusted hazard ratios (HRs) for cardiovascular outcomes were estimated using Cox proportional hazard regression. Results Patients with MGUS (n = 8,189; mean age 69.8 ± 11.7 years; 51.2% male) had higher prevalence of cardiovascular risk factors at baseline, including hypertension (48.0% vs 38.5%) and type 2 diabetes (13.0% vs 9.3%), compared with control patients. Outcomes included an increased risk of heart failure (HR: 1.55; 95% CI: 1.41-1.69), acute myocardial infarction (HR: 1.22; 95% CI: 1.06-1.40), ischemic stroke (HR: 1.16; 95% CI: 1.03-1.30), atrial fibrillation (HR: 1.32; 95% CI: 1.23-1.42), aortic aneurysm (HR: 1.55; 95% CI: 1.28-1.89), aortic stenosis (HR: 1.60; 95% CI: 1.41-1.82), aortic regurgitation (HR: 1.67; 95% CI: 1.34-2.07), heart block (HR: 1.32; 95% CI: 1.08-1.61), peripheral artery disease (HR: 1.69; 95% CI: 1.47-1.95), cor pulmonale (HR: 2.06; 95% CI: 1.55-2.73), and venous thromboembolism (HR: 1.43; 95% CI: 1.24-1.65). A sensitivity analysis including only patients without certain comorbidities (type 2 diabetes, hypertension, acute myocardial infarction, and chronic kidney disease) yielded similar results. Conclusions MGUS is associated with a broad spectrum of cardiovascular diseases, with greater relative risks observed for diseases previously associated with infiltrative and inflammatory disorders. Further studies are warranted to explore the underlying mechanisms.
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Affiliation(s)
- Brian Schwartz
- Department of Medicine, Section of Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA,Address for correspondence: Dr Brian Schwartz, Department of Medicine, Section of Internal Medicine, 72 East Concord Street, Boston, Massachusetts 02118, USA. @BSchwarMD@ca_heart_dk
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University, Hellerup, Denmark
| | - Frederick L. Ruberg
- Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Dane Rucker
- Department of Medicine, Section of Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jihoon Choi
- Department of Medicine, Section of Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Omar Siddiqi
- Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Kevin Monahan
- Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Lars Køber
- The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University, Hellerup, Denmark,The Danish Heart Foundation, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Hillerød Hospital, Hillerød, Denmark,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Andersson
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University, Hellerup, Denmark,Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
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Sano M, Iseki T, Sasaki M, Tsukune Y, Yasuda H, Kanazawa K, Arakawa A, Yokoyama K, Komatsu N, Hattori N, Nishioka K. Improvement in the Symptoms and VEGF Levels after Resection of an Extrame Dullary Spinal Tumor and Additional Chemotherapy in a Patient with Multiple Myeloma Complicated with POEMS Syndrome. Intern Med 2021; 60:3625-3630. [PMID: 34776466 PMCID: PMC8666231 DOI: 10.2169/internalmedicine.6929-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a case of multiple myeloma and polyneuropathy, organomegaly, endocrinopathy, myeloma protein, and skin changes (POEMS) syndrome. The patient experienced exacerbated gait disturbance due to weakness and numbness in the lower limbs. Thoracic magnetic resonance imaging revealed an extramedullary tumor with spinal compression that required surgical resection. Plasmacytoma was diagnosed based on a biopsy. Radiation, betamethasone, and chemotherapy were therefore administered. Surgical removal of extramedullary tumors improved his symptoms, motor conduction velocity, and amplitude of the muscle action potential in the peroneal and tibial nerves, as shown by the nerve conduction study. Surgery also decreased the serum vascular endothelial growth factor levels. The patient required additional chemotherapy due to multiple myeloma and showed better outcomes nine months after discharge. The benefits of some treatments remain controversial due to the small number of patients. However, our findings reveal that an early diagnosis and comprehensive treatment may result in better outcomes in such patients.
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Affiliation(s)
- Mariko Sano
- Department of Neurology, Juntendo University School of Medicine, Japan
| | - Tatou Iseki
- Department of Neurology, Juntendo University School of Medicine, Japan
| | - Makoto Sasaki
- Department of Hematology, Juntendo University School of Medicine, Japan
| | - Yutaka Tsukune
- Department of Hematology, Juntendo University School of Medicine, Japan
| | - Hajime Yasuda
- Department of Hematology, Juntendo University School of Medicine, Japan
| | - Kazo Kanazawa
- Department of Neurology, Juntendo University School of Medicine, Japan
| | - Atsushi Arakawa
- Department of Human Pathology, Juntendo University School of Medicine, Japan
| | - Kazumasa Yokoyama
- Department of Neurology, Juntendo University School of Medicine, Japan
| | - Norio Komatsu
- Department of Hematology, Juntendo University School of Medicine, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Japan
| | - Kenya Nishioka
- Department of Neurology, Juntendo University School of Medicine, Japan
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Kreidy M, Al-Hilli A, Yachoui R, Resnick J. Severe but reversible pulmonary hypertension in scleromyxedema and multiple myeloma: a case report. BMC Pulm Med 2020; 20:8. [PMID: 31918690 PMCID: PMC6953266 DOI: 10.1186/s12890-019-1020-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 12/06/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Scleromyxedema is a progressive, systemic connective tissue disorder characterized by fibro-mucous skin lesions and increased serum monoclonal immunoglobulin levels. Pulmonary involvement occurs in a subset of patients, though the overall prevalence of pulmonary lesions in scleromyxedema is unknown. Since pulmonary hypertension presumably occurs in these patients due to disease progression and development of additional conditions, treatment of the underlying plasma cell dyscrasia and connective tissue disorder may improve pulmonary hypertension symptoms. CASE PRESENTATION An elderly patient with scleromyxedema developed pulmonary hypertension refractory to vasodilator and diuretic therapy and subsequently multiple myeloma that responded to a combination therapy of bortezomib, cyclophosphamide, and dexamethasone treatment. CONCLUSIONS Treatment of the underlying disease(s) that contributed to pulmonary hypertension development with anti-neoplastic agents like bortezomib may improve cardiopulmonary symptoms secondary to reducing abnormal blood cell counts and paraprotein levels.
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Affiliation(s)
- Mazen Kreidy
- Department of Pulmonary and Critical Care Medicine, Marshfield Clinic, Marshfield, WI USA
- Present affiliation: Christiana Care Health System, PO Box 1668, Wilmington, DE 19899 USA
| | - Ali Al-Hilli
- Department of Internal Medicine, Marshfield Clinic, Marshfield, WI USA
| | - Ralph Yachoui
- Department of Rheumatology, Ronald Reagan UCLA Medical Center, Santa Monica, California, USA
| | - Jeffrey Resnick
- Department of Pathology, Marshfield Clinic, Marshfield, WI USA
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Ohashi K, Nishimura R, Sugimoto S, Sakao S, Tanabe N, Tatsumi K. Effectiveness of pulmonary vasodilators on pulmonary hypertension associated with POEMS syndrome. Respirol Case Rep 2019; 7:e00411. [PMID: 30847222 PMCID: PMC6391640 DOI: 10.1002/rcr2.411] [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: 12/04/2018] [Revised: 02/03/2019] [Accepted: 02/05/2019] [Indexed: 11/09/2022] Open
Abstract
Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome is a rare plasma cell disease. Patients with POEMS syndrome are considered to be at a high risk of developing pulmonary hypertension (PH). We report a 51-year-old woman diagnosed with PH associated with POEMS syndrome. She was started on dexamethasone and thalidomide. Although, the plasma vascular endothelial growth factor (VEGF) level decreased, systolic pulmonary artery pressure (sPAP) remained high. Auto-peripheral blood stem cell transplantation improved the plasma VEGF and sPAP levels. Four years later, she presented with dyspnoea on exertion, and elevated plasma VEGF and sPAP levels. Subsequently, on administering sildenafil and macitentan, the plasma VEGF and PH levels improved. Pulmonary vasodilators can be considered when PH remains after treatment of POEMS syndrome.
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Affiliation(s)
- Kana Ohashi
- Department of Respirology, Graduate School of MedicineChiba UniversityChibaJapan
| | - Rintaro Nishimura
- Department of Respirology, Graduate School of MedicineChiba UniversityChibaJapan
| | - Shunsuke Sugimoto
- Department of Respirology, Graduate School of MedicineChiba UniversityChibaJapan
| | - Seiichiro Sakao
- Department of Respirology, Graduate School of MedicineChiba UniversityChibaJapan
| | - Nobuhiro Tanabe
- Department of Respirology, Graduate School of MedicineChiba UniversityChibaJapan
- Department of Advanced Medicine in Pulmonary Hypertension, Graduate School of MedicineChiba UniversityChibaJapan
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of MedicineChiba UniversityChibaJapan
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Czeczok T, Lin P, Yi E. Plexogenic pulmonary hypertension associated with POEMS syndrome. Respir Med Case Rep 2017; 22:168-170. [PMID: 28856089 PMCID: PMC5565785 DOI: 10.1016/j.rmcr.2017.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/10/2017] [Accepted: 08/11/2017] [Indexed: 02/06/2023] Open
Abstract
Pulmonary hypertension is one of the well-known clinical manifestations of polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome, occurring in approximately 25–30% of the affected individuals. However, the histopathologic spectrum of pulmonary hypertension associated with POEMS syndrome has not been fully documented in the literature. Herein, we report an autopsy case of POEMS syndrome in a patient whose lung tissues showed histopathology indistinguishable from that of idiopathic pulmonary arterial hypertension with abundant plexiform lesions in the small pulmonary arteries.
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Affiliation(s)
| | - Peter Lin
- Mayo Clinic, Rochester MN, United States
| | - Eunhee Yi
- Mayo Clinic, Rochester MN, United States
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Hiyama K, Terashima H, Kuroda A, Harada K, Shibagaki Y, Hosaka A, Hayashi T, Horiguchi H. The first case of POEMS syndrome with synchronous breast cancer: What are the associated diagnostic challenges? Clin Case Rep 2016; 4:369-75. [PMID: 27099730 PMCID: PMC4831386 DOI: 10.1002/ccr3.528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/06/2016] [Accepted: 02/09/2016] [Indexed: 12/15/2022] Open
Abstract
Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy, Skin changes (POEMS) syndrome is a rare plasma cell disorder that causes a paraneoplastic syndrome. We report the first case of POEMS syndrome with synchronous breast cancer. The patient was at risk of being misdiagnosed with metastatic cancer, and it is important to emphasize that physical examinations provided vital diagnostic clues.
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Affiliation(s)
- Kazuhiro Hiyama
- Department of Surgery Hitachi Ltd. Hitachinaka General Hospital Hitachinaka Ibaraki Japan
| | - Hideo Terashima
- Hitachinaka Medical Education and Research Center University of Tsukuba Hospital Hitachinaka Ibaraki Japan
| | - Akihiro Kuroda
- Department of Hematology Hitachi Ltd. Hitachinaka General Hospital Hitachinaka Ibaraki Japan
| | - Kyoichi Harada
- Department of Hematology Hitachi Ltd. Hitachinaka General Hospital Hitachinaka Ibaraki Japan
| | - Yasuro Shibagaki
- Department of Neurology Hitachi Ltd. Hitachinaka General Hospital Hitachinaka Ibaraki Japan
| | - Ai Hosaka
- Hitachinaka Medical Education and Research Center University of Tsukuba Hospital Hitachinaka Ibaraki Japan
| | - Taichi Hayashi
- Hitachinaka Medical Education and Research Center University of Tsukuba Hospital Hitachinaka Ibaraki Japan
| | - Hisashi Horiguchi
- Department of Clinical Pathology Hitachi Ltd. Hitachinaka General Hospital Hitachinaka Ibaraki Japan
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Krishnan U, Mark TM, Niesvizky R, Sobol I. Pulmonary hypertension complicating multiple myeloma. Pulm Circ 2015; 5:590-7. [PMID: 26401262 PMCID: PMC4556512 DOI: 10.1086/682430] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 04/08/2015] [Indexed: 12/15/2022] Open
Abstract
Pulmonary hypertension (PH) is an infrequently reported complication of multiple myeloma (MM). PH has been more commonly associated with amyloidosis, myeloproliferative diseases, and the POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes) syndrome. PH in MM is typically mild to moderate and may be secondary to a variety of conditions, which include left ventricular dysfunction, high-output cardiac failure, chronic kidney disease, treatment-related toxicities, and precapillary involvement. We describe 3 patients with MM and severe PH. Each patient underwent right heart catheterization. All patients demonstrated elevated pulmonary pressures, transpulmonary gradients, and pulmonary vascular resistance. Each patient was ultimately treated with pulmonary vasodilator therapy with improvement in cardiopulmonary symptoms. Additional studies are needed to define the prevalence, prognosis, and pathogenesis of PH in this complex population and to help clarify who may benefit from targeted PH therapy.
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Affiliation(s)
- Udhay Krishnan
- Division of Cardiology, Weil Cornell Medical College, New York Presbyterian Hospital-Cornell Medical Center, New York, New York, USA
| | - Tomer M. Mark
- Division of Hematology and Medical Oncology, Weil Cornell Medical College, New York Presbyterian Hospital-Cornell Medical Center, New York, New York, USA
| | - Ruben Niesvizky
- Division of Hematology and Medical Oncology, Weil Cornell Medical College, New York Presbyterian Hospital-Cornell Medical Center, New York, New York, USA
| | - Irina Sobol
- Division of Cardiology, Weil Cornell Medical College, New York Presbyterian Hospital-Cornell Medical Center, New York, New York, USA
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