Unusual myelomas: a review of IgD and IgE variants.

Immunoglobulin D multiple myeloma (IgD MM) accounts for almost 2% of all myeloma cases. It is associated with an increased frequency of undetectable or small monoclonal (M)-protein levels on electrophoresis; osteolytic lesions; extramedullary involvement; amyloidosis; a lambda (lambda) light chain predilection; renal failure; hypercalcemia; and, often, advanced disease at diagnosis. Immunoglobulin E (IgE) MM is rare, with fewer than 50 cases reported in the literature. IgE MM presents with features similar to those of IgD MM, along with a higher incidence of plasma cell leukemia. The hallmark of IgE MM is t(11;14) (q13;q32). IgD and IgE levels are generally very low and hence may escape detection; thus, it is important that, when myeloma is suspected, patients be screened for the presence of IgD and IgE if they have an apparently free monoclonal immunoglobulin light chain in the serum. Although survival of patients with IgD MM or IgE MM is shorter in comparison to those with immunoglobulin G (IgG) MM or immunoglobulin A (IgA) MM, the outcome for patients with IgD and IgE subtypes is improving with the use of novel agents and autologous transplantation.

Delineation of the etiology of a mass-like echo density in the left ventricle using three-dimensional transthoracic echocardiography.

Live/real time three-dimensional transthoracic echocardiography (3DTTE) provides an incremental value in the delineation of various cardiac pathologies. In this study, two-dimensional transthoracic echocardiography (2DTTE) of a 56-year-old patient showing a prominent echo density suggestive of a mass in the left ventricle probably attached to the ventricular side of the anterior mitral leaflet, is reported. Systematic cropping of the 3DTTE dataset showed the mass to be a calcified mitral strut chord viewed in cross section. This is well visualized in the accompanying movie clip. This case highlights the advantage of 3DTTE in which the whole of the ventricle including the mitral valve apparatus is captured in the dataset facilitating cropping at any desired angulation.

Trends and outcomes in allogeneic hematopoietic stem cell transplant for multiple myeloma at Mayo Clinic.

BACKGROUND: Allogeneic transplant in myeloma remains controversial. PATIENTS AND METHODS: We performed a retrospective review of 76 patients in the Mayo Clinic database from 1993 to 2013 who underwent allogeneic hematopoietic stem cell transplant (HSCT) for myeloma. RESULTS: After excluding ineligible patients, among the remaining 66 patients, median age at transplant was 42 years and 87% had residual disease at the time of transplant. Myeloablative (71%) versus reduced intensity conditioning (29%), matched sibling donors (70%) versus unrelated donors showed no outcome difference. Median overall survival from the time of diagnosis and transplant were 75 and 24 months, respectively. Median time to disease progression (TTP) was 15 months and treatment-related mortality was 20% at day 100. Acute and chronic graft versus host disease (cGVHD) developed in 61% and 48% patients, respectively. In univariate analysis of overall survival (OS), factors predicting adverse outcome were pretransplant 24-hour total urinary protein (P = .035), peripheral blood versus bone marrow (OS 18 vs. 41 months; P = .02), number of previous therapies (P = .014), time from autologous to allogeneic HSCT (P = .019), and cGVHD (P = .01). TTP was adversely affected by number of previous regimens (P = .036) and PB as graft source (P = .016). In multivariate analysis for progression-free survival, number of previous regimens (P = .04), and for OS, time between autologous and allogeneic HSCT was significant (P = .009). CONCLUSION: In 162 matched control subjects who were human leukocytoe antigen-typed, there were no survivors at 12 years compared with 20% in the group who received a transplant. In a second control group with 197 second autologous transplants, 10-year OS was 8%.