Risk of infections associated with the use of bispecific antibodies in multiple myeloma: a pooled analysis.

The use of bispecific antibodies (BsAbs) in the treatment of relapsed/refractory multiple myeloma (MM) is showing early promising overall response rates in heavily pretreated patients. Infectious complications related to the use of BsAbs are not well described. We conducted a pooled analysis that included all single-agent BsAbs used in MM with no prior use of different BsAbs. A total of 1185 patients with MM were treated with a BsAb in the studied period (71.6% of the patients treated with an agent targeting B-cell maturation antigen (BCMA). Pooled median follow-up was short at 6.1 months (7.5 vs 5.2 months for BCMA vs non-BCMA BsAbs, respectively). Adverse events of interest included all grade neutropenia in 38.6%, all grade infections in 50% (n = 542/1083), all grade cytokine release syndrome in 59.6% (n = 706/1185), grade III/IV neutropenia in 34.8% (n = 372/1068), grade III/IV infections in 24.5% (n = 272/1110), grade III/IV pneumonia in 10% (n = 52.4/506), and grade III/IV coronavirus disease 2019 in 11.4% (n = 45.4/395) of the patients. Non-BCMA-targeted BsAbs were associated with lower grade III/IV neutropenia (25.3% vs 39.2%) and lower grade III/IV infections (11.9% vs 30%) when compared with BCMA-targeted BsAbs. Hypogammaglobulinemia was reported in 4 studies, with a prevalence of 75.3% (n = 256/340) of the patients, with IV immunoglobulin used in 48% (n = 123/256) of them. Death was reported in 110 patients, of which 28 (25.5%) were reported to be secondary to infections. Certain precautions should be used when using BsAbs to mitigate the risk and/or identify and treat infections promptly.

Fine-needle aspiration cytology for the diagnosis of plasma cell neoplasms in the head and neck region: A systematic analysis of the literature.

BACKGROUND: Cytopathologic analysis is feasible and provides detailed morphological characterisation of head and neck lesions. AIMS: To integrate the available data published on fine-needle aspiration cytology (FNAC) used for the diagnosis of plasma cell neoplasms (PCN) of the head and neck region. MATERIALS AND METHODS: Searches on PubMed, Web of Science, Embase, and Scopus were performed to compile data from case reports/case series published in English. The Joanna Briggs Institute tool was used for the critical appraisal of studies. RESULTS: A total of 82 studies comprising 102 patients were included in this review. There was a predilection for men (68.6%) (male/female ratio: 2.1:1). Individuals in their 50s (29.4%), 60s (22.5%), and 70s (22.5%) were more often affected. The thyroid gland (26.2%) was the main anatomical location, followed by scalp (15.5%), neck/cervical region (15.5%), jaws (13.6%), and major salivary glands (13.6%). For FNAC analysis, a smear was employed in 41 (40.6%) cases and a cell block was used in four (3.9%). In 56 (55.4%) reports, no cytological methods were available. Morphologically, 34 (56.7%) cases had a diagnosis of PCN with agreement between cytopathology and histopathology. The rate of wrong diagnoses when using cytology was 27.5%. Immunophenotyping was performed in 49 (48%) of the cases. The 69-month disease-free survival rate was 60.2%, while the 27-month overall survival rate was 64.1%. CONCLUSION: This study reinforces that FNAC can be an ancillary tool in the first step towards the diagnosis of PCN of the head and neck region, especially when applying a cell block for cytological analysis.

Plasmacytoma and plasma cell myeloma affecting the jaws: A multi-institutional collaborative study.

BACKGROUND: Plasma cell neoplasms are characterized by the proliferation of a single clone of plasma cells with production of a monoclonal immunoglobulin. They can manifest as a single lesion (plasmacytoma) or as multiple lesions (multiple myeloma). METHODS: Paraffin-embedded tissue blocks of patients microscopically diagnosed with plasma cell neoplasms in the jaws were retrieved from five pathology files. Data including clinical, radiographic, microscopic and immunohistochemical findings, treatment employed and follow-up status were retrieved from the pathology reports. RESULTS: Fifty-two cases were retrieved (mean age: 59.4 years) without sex predilection. The mandible was the most affected site (67.3%), usually associated with pain and/or paresthesia (53.8%). Lesions in other bones besides the jaws were reported for 24 patients (46.2%). Radiographically, tumours usually presented as poorly defined osteolytic lesions with unilocular or multilocular images, while microscopy revealed diffuse proliferation of neoplastic plasma cells with nuclear displacement and abundant eosinophilic cytoplasm. Two cases were classified as anaplastic, and amyloid deposits were found in two other cases. Immunohistochemistry was positive for plasma cell markers and negative for CD20 and CD3, and monoclonality for kappa light chain predominated. The overall survival rate after 5 years of follow-up was 26.6%. CONCLUSION: Plasma cell neoplasms are aggressive tumours with a poor prognosis and involvement of the jaws may be the first complaint of the patient. Thus, oral pathologists, head and neck surgeons and dentists should be aware of their clinical, radiographic and microscopic manifestations.

Síndrome de hiperviscosidade em paciente com mieloma múltiplo / Hyperviscosity syndrome in multiple myeloma patients

O mieloma múltiplo é uma neoplasia progressiva e incurável de células B, caracterizado pela proliferação desregulada e clonal de plasmócitos na medula óssea. A síndrome de hiperviscosidade é uma das complicações relacionadas às gamopatias monoclonais, sendo considerada emergência oncológica. O objetivo deste estudo foi descrever o quadro clínico de um paciente diagnosticado com mieloma múltiplo que apresentou síndrome de hiperviscosidade, avaliando a prevalência de sinais e sintomas, bem como características fisiopatológicas dessa entidade clínica. Foi revisado o prontuário de um paciente internado na enfermaria da Clínica Médica do Hospital Regional do Cariri (CE) no período de junho a julho de 2018. Além disso, foi realizada revisão de literatura em base de dados (PubMed®) direcionada ao tema proposto. O diagnóstico de mieloma múltiplo foi comprovado por mielograma, sendo prontamente iniciada a corticoterapia e avaliada a resposta clínica após essa terapêutica. Apesar de incomum e menos frequentemente relacionada ao mieloma múltiplo, a síndrome de hiperviscosidade está relacionada a uma grande taxa de mortalidade quando apresenta diagnóstico tardio. A terapia de primeira linha indicada para a síndrome de hiperviscosidade foi a plasmaferese, no entanto, as condições clínicas (instabilidade hemodinâmica) impossibilitaram sua realização. O desfecho deste caso foi o óbito do paciente. Concluiu-se que o diagnóstico precoce e a intervenção terapêutica estão diretamente relacionados à ocorrência de menor incidência de complicações relacionadas ao mieloma múltiplo e à síndrome de hiperviscosidade.

Multiple myeloma is a progressive and incurable B-cell neoplasm characterized by unregulated and clonal proliferation of plasmocytes in the bone marrow. Hyperviscosity syndrome is one of the complications related to monoclonal gammopathies and is considered an oncological emergency. The aim of this study was to describe the clinical condition of a patient diagnosed with multiple myeloma who presented hyperviscosity syndrome, evaluating the prevalence of symptoms and signs, as well as the pathophysiological characteristics of this clinical entity. The medical records of a patient admitted to the Internal Medicine ward of the Hospital Regional do Cariri (CE) from June to July of 2018 were reviewed. In addition, we conducted a literature review in a database (PubMed®) directed to the theme proposed. The diagnosis of multiple myeloma was confirmed by myelogram, and corticosteroid therapy was promptly initiated and the clinical response was evaluated after this therapy. Although uncommon and less frequently related to multiple myeoloma, hyperviscosity syndrome is related to a high mortality rate when diagnosed late. The first line therapy indicated to hyperviscosity syndrome was plasmapheresis; however, the clinical conditions (hemodynamic instability) precluded its performance. The outcome of this case was the patient's death. Thus, it was concluded that early diagnosis and therapeutic intervention are directly related to the occurrence of lower incidence of complications related to multiple myeloma and hyperviscosity syndrome.

[Paraproteins. A review]. / Paraproteínas: claridad en la nebulosa.

Hematological neoplasms are tumors of cells in different states of maturation and differentiation. Since monoclonal gammopathies (MG) refer to B mature lymphocyte neoplasms, lymphogenesis should be well known. We must keep in mind that the last stage of maturation of these lymphocytes is the plasma cell. This is how a MG could appear in the context of a plasma cell neoplasm, such as multiple myeloma or amyloidosis, but also in relation to a lymphoma. A monoclonal peak is produced by mature B lymphocytes or plasma cells that secrete a monoclonal protein (Immunoglobulin), and represents a MG. But it must be emphasized that, in the correct clinical context, a hypogammaglobulinemia can represent a MG as well. Another important point is the understanding and interpretation of requested tests, such as protein electrophoresis (PEP), immunofixation (IFx) or serum free light chains (sFLC). The current MG screening panel includes these three studies (PEF, IFx, sFLC), although a simpler panel measuring PEF and sFLC has also been proposed, but not yet formally validated. Therefore, screening done only with PEP is insufficient.

Paraproteínas: claridad en la nebulosa / Paraproteins: a review

Hematological neoplasms are tumors of cells in different states of maturation and differentiation. Since monoclonal gammopathies (MG) refer to B mature lymphocyte neoplasms, lymphogenesis should be well known. We must keep in mind that the last stage of maturation of these lymphocytes is the plasma cell. This is how a MG could appear in the context of a plasma cell neoplasm, such as multiple myeloma or amyloidosis, but also in relation to a lymphoma. A monoclonal peak is produced by mature B lymphocytes or plasma cells that secrete a monoclonal protein (Immunoglobulin), and represents a MG. But it must be emphasized that, in the correct clinical context, a hypogammaglobulinemia can represent a MG as well. Another important point is the understanding and interpretation of requested tests, such as protein electrophoresis (PEP), immunofixation (IFx) or serum free light chains (sFLC). The current MG screening panel includes these three studies (PEF, IFx, sFLC), although a simpler panel measuring PEF and sFLC has also been proposed, but not yet formally validated. Therefore, screening done only with PEP is insufficient.

Evaluación imunohistoquímica de plasmocitoma cutáneo en un perro - reporte de un caso / Assessment immunohistochemistry of the cutaneous plasmacytoma in a dog - case report / Avaliação imunohistoquímica de plasmocitoma cutâneo em um cão: relato de caso

Los plasmacitomas son neoplasias poco comunes em los perros, procedentes de plasmocitos. Ocurre en cualquier tejido blando, pero principalmente em la piel, cavidad oral y el tracto digestivo. Se describe un caso de plasmocitoma anaplásico cutâneo em un perro, mestizo, de 16 años de edad. El animal mostro múltiples nódulos de color rosado, irregulares y de consistência blanda, extendidos em la piel. Em elexamen histopatológico se observo área circunscrita consistente en células redondas que muestran intensa anisocariosis, anisocitosis y número moderado de células gigantes, multinucleadas. La evaluación imunohistoquímica reveló expresión de CD79a y MUM1, lo que permite el diagnóstico de plasmocitoma anaplásico.

Plasmacytomas are uncommon neoplasms in dogs originating in the plasma cells.Occur in any soft tissue, but mainly in the skin, oral cavity and digestive tract. We reported a case of cutaneous anaplastic plasmocytoma in a dog, mixed breed, 16 years old. The animal showed multiple nodules of pinkish color, rough and smooth consistency, spread on the skin. In the histopathological examination revealed circumscribed area consisting of round cells showing intense anisocytosis, anisokaryosis and moderate number of giant cells, multinucleated. The immunohistochemical demonstrated expression for MUM1 and CD79a, allowing diagnosis of anaplastic plasmacytoma.

Plasmocitomas são neoplasias incomuns no cão, originárias dos plasmócitos. Ocorrem em qualquer tecido mole, mas principalmente na pele, cavidade oral e trato digestivo. Relata-se um caso de plasmocitoma anaplásico cutâneo em um cão, mestiço, de 16 anos. O animal apresentava vários nódulos de coloração rósea, irregulares e de consistência macia, distribuídos na pele. Na análise histopatológica observou-se área circunscrita constituída de células redondas exibindo intensa anisocitose, anisocariose e moderada quantidade de células gigantes, multinucleadas. A avaliação imunohistoquímica revelou expressão para MUM1 e CD79a, permitindo o diagnóstico de plasmocitoma anaplásico.

Evaluación imunohistoquímica de plasmocitoma cutáneo en un perro - reporte de un caso / Assessment immunohistochemistry of the cutaneous plasmacytoma in a dog - case report / Avaliação imunohistoquímica de plasmocitoma cutâneo em um cão: relato de caso

Los plasmacitomas son neoplasias poco comunes em los perros, procedentes de plasmocitos. Ocurre en cualquier tejido blando, pero principalmente em la piel, cavidad oral y el tracto digestivo. Se describe un caso de plasmocitoma anaplásico cutâneo em un perro, mestizo, de 16 años de edad. El animal mostro múltiples nódulos de color rosado, irregulares y de consistência blanda, extendidos em la piel. Em elexamen histopatológico se observo área circunscrita consistente en células redondas que muestran intensa anisocariosis, anisocitosis y número moderado de células gigantes, multinucleadas. La evaluación imunohistoquímica reveló expresión de CD79a y MUM1, lo que permite el diagnóstico de plasmocitoma anaplásico.(AU)

Plasmacytomas are uncommon neoplasms in dogs originating in the plasma cells.Occur in any soft tissue, but mainly in the skin, oral cavity and digestive tract. We reported a case of cutaneous anaplastic plasmocytoma in a dog, mixed breed, 16 years old. The animal showed multiple nodules of pinkish color, rough and smooth consistency, spread on the skin. In the histopathological examination revealed circumscribed area consisting of round cells showing intense anisocytosis, anisokaryosis and moderate number of giant cells, multinucleated. The immunohistochemical demonstrated expression for MUM1 and CD79a, allowing diagnosis of anaplastic plasmacytoma.(AU)

Plasmocitomas são neoplasias incomuns no cão, originárias dos plasmócitos. Ocorrem em qualquer tecido mole, mas principalmente na pele, cavidade oral e trato digestivo. Relata-se um caso de plasmocitoma anaplásico cutâneo em um cão, mestiço, de 16 anos. O animal apresentava vários nódulos de coloração rósea, irregulares e de consistência macia, distribuídos na pele. Na análise histopatológica observou-se área circunscrita constituída de células redondas exibindo intensa anisocitose, anisocariose e moderada quantidade de células gigantes, multinucleadas. A avaliação imunohistoquímica revelou expressão para MUM1 e CD79a, permitindo o diagnóstico de plasmocitoma anaplásico.(AU)

Plasmablastic lymphoma of the anal canal in an HIV-infected patient.

BACKGROUND: The advent of antiretroviral therapy increased the life expectancy of human immunodeficiency virus (HIV)-positive patients and, consequently, the morbidity and mortality due to neoplasms. Plasmablastic lymphoma is one such neoplasm that generally presents with involvement of the oral cavity; cases of extra-oral involvement are rare. CASE REPORT: We report a case of plasmablastic lymphoma in a 46-year-old woman for whom the initial clinical manifestation was a painless perineal tumor accompanied by fecal incontinence. CONCLUSIONS: The possibility of this neoplasm should be considered in patients with HIV/acquired immune deficiency syndrome (HIV/AIDS) because its early diagnosis is essential so that the start of the treatment is not delayed.

Crioglobulinemia tipo I asociada a mieloma múltiple en un paciente con hapatits C / Type I cryoglobulinemia associated with multiple myeloma in a patient with hepatitis C

La presencia de crioglobulinas asociadas a manifestaciones clínicas sistémicas constituyen el síndrome crioglobulinémico. Se describen tres subtipos de esta entidad con características serológicas, clínicas e histológicas distintivas. En todos los casos, el órgano más afectadoes la piel. La sospecha clínica y el abordaje multidisciplinario son fundamentales para arribar al diagnóstico correcto e iniciar el tratamiento correspondiente.A continuación se presenta un caso de crioglobulinemia tipo I asociada a mieloma múltiple de reciente diagnóstico en un paciente con antecedente de hepatitis C que presentó un extenso compromiso cutáneo...

Extramedullary plasmacytoma of the larynx

Introduction: The extramedullary plasmocytoma is one of the localized forms of malignancy of the plasma cells, which has multiple myeloma main diagnosis. Its main site to the head and neck, but with a rare presentation in the larynx. Objective: To describe a case of extramedullary plasmocytoma of the larynx, with literature review. Case Report: Patient female, 49, referring to intermittent dysphonia for 01 years with progressive worsening associated with vocal fatigue and vocal effort, with reddish lesion, smooth edges fold left ventricular endoscopy. Being subjected to excisional biopsy diagnosed with extramedullary histopathological plasmocytoma. Conclusion: Extramedullary Plasmocytoma must be considered in the differential diagnosis of rare tumors of the larynx. It is essential after the diagnosis of multiple myeloma research and a "follow up" appropriate...

Mieloma múltiple: Clínica, paraclínica y principales esquemas de tratamiento Hospital de San José de Bogotá DC. 2003 a 2010 / Multiple myeloma: Clinical and laboratory manifestations and main treatment regimens Hospital de San José de Bogotá dc. 2003 to 2010

El mieloma múltiple es una neoplasia de células plasmáticas incurable, con morbilidad discapacitante por la gran sintomatología y una alta mortalidad. Afecta todas las razas y áreas geográficas, y su edad media de diagnóstico es de 66 años con solo 10% menores de 50 años y 2% por debajo de 40. Objetivo: describir las características clínicas, paraclínicas y los principales esquemas de tratamiento en primera línea de los pacientes manejados y tratados en el Hospital de San José de Bogotá DC, entre enero 2003 y diciembre 2010. Método: cohorte retrospectiva de mayores de 18 años de edad con diagnóstico de mieloma múltiple sintomático. Los datos fueron extraídos de las historias clínicas. Resultados: 39 pacientes se diagnosticaron durante ocho años, 59% hombres cuya edad promedio fue de 59,7 años (DE de 10,7). El 70% fue considerado candidato a trasplante y en el 33,0% (n=7/21) de estos se efectuó el procedimiento. El esquema de quimioterapia más usado fue talidomida-dexametasona (23%); la respuesta al tratamiento más común fue muy buena parcial (40,9%) y el 23,7% alcanzaron por lo menos una completa.

Multiple myeloma is an incurable cancer of the plasma cells featuring disabling morbidity due to its many possible symptoms and high mortality rate. It affects all races and geographic regions. The average age at diagnosis is 66 years. Only 10% are under age 50 and 2% under 40. Objective: to describe the clinical and laboratory manifestations and main first-line therapies of patients managed and treated at Hospital de San José, Bogotá DC, between January 2003 and December 2010. Method: a retrospective cohort study of patients with diagnosed symptomatic multiple myeloma aged more than 18 years based on data compiled from clinical records. Results: thirty-nine (39) patients were diagnosed in an 8-year period, 59% were men with a mean age of 59.7 years (SD 10.7). Seventy percent (70%) were considered candidates for a transplant and this procedure was actually performed in 33.0% (n= 7/21). The chemotherapy regimen most commonly used was a thalidomide–dexamethasone combination (23%). The most frequently observed response to therapy was a very good partial response (40.9%) and 23.7% achieved at least one complete response.

Plasmocitoma extramedular nasal: presentacíon de un caso y revisión de literatura / Extramedullary plasmocytoma: case report and literature review

Extramedullary plasmocytoma is a rare plasmatic cell neoplasia which mostly compromises the head and neck (80-90%). On initial presentation they must be differentiated from multiple myeloma This may prove to be difficult because a varying percentage may be associated at a later date with the development of multiple myeloma. We describe a case of extramedullary plasmacytoma in the nose and we discussed and review the literature.