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Multiple myeloma-associated amyloidosis is an independent high-risk prognostic factor

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Abstract

Several prognostic factors have been recognized in patients with multiple myeloma (MM). Among the most important are: the serum levels of β2-microglobulin, albumin, and LDH; the labeling index; and an abnormal karyotype. Patients with amyloidosis (AL) have poor prognosis; however, little is known concerning the prognostic significance of AL associated to MM. In 201 consecutive patients with de novo MM, we performed a fat-pad biopsy needle aspiration (FPBNA) that was stained with Congo red. Sixty eight (34%) patients had AL and a poorer prognosis disease: lower performance status, presence of B symptoms, higher LDH and calcium values, and worse response to chemotherapy. Cox regression model for overall survival detected three variables having independent prognostic significance: the presence of AL (RR = 3.4, P < 0.004), serum albumin levels <3.5 g/dl (RR 3.2, p < 0.005), and patients not achieving complete remission or very good partial remission (RR 2.9, p < 0.02). In 28% of patients with de novo MM, FPBNA was useful to detect incidental amyloidosis. During follow-up, 69% of these patients had symptoms of AL. Excluding 16 patients with obvious symptoms of AL at diagnosis, overall survival was worse in patients who developed later symptoms of AL. MM-associated AL represents a poorer prognosis disease even in the absence of symptoms at diagnosis, and this specific association may be considered as an independent high-risk prognostic factor. The routine study of periumbilical fat-pad tissue should be mandatory in all patients with MM.

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Acknowledgments

We thank Dr. Sergio Giralt from M.D. Anderson Cancer Center, for his contribution in the critical review of the manuscript. The authors declare that the treatments described in the article comply with the current law of the Mexican Republic including all ethical aspects.

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Correspondence to J. Vela-Ojeda.

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Vela-Ojeda, J., García-Ruiz Esparza, M.A., Padilla-González, Y. et al. Multiple myeloma-associated amyloidosis is an independent high-risk prognostic factor. Ann Hematol 88, 59–66 (2009). https://doi.org/10.1007/s00277-008-0554-0

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  • DOI: https://doi.org/10.1007/s00277-008-0554-0

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