PURPOSE: Pleural effusions in MM are rare, and malignant effusions signify poor prognosis. Our purpose is to characterize pleural effusions of all etiologies and to define their impact on survival.
METHODS: Patients with MM who underwent thoracenteses from January 1997 to December 2010 were identified. Clinical history and laboratory data were reviewed retrospectively.
RESULTS: Forty-seven patients (M=24, F=23) had a pleural procedure. IgG myeloma (n=25) was the most common isotype. Amyloidosis was present in 6 patients, and 15 patients had plasmacytoma. Disease status varied from active (n=38), presentation (n=3), remission (n=2), and post-hematopoietic stem cell transplant (n=4). Most procedures were unilateral, but 6 patients required bilateral pleural interventions. Multiple pleural procedures were required in 24 patients. Two pleural biopsies, 11 chest tubes, 16 pleural catheters, and 63 thoracenteses were performed. Twenty-four patients had exudative effusions, and 19 patients had transudative effusions. Etiologies of the pleural effusions included malignancy (n=18), volume (n=18), infection (n=10) and other (n=1). Pleural biopsies revealed multiple myeloma and inflammation in two patients respectively. There were 2 complications associated with pleural catheters (empyema, catheter occlusion). Nine patients remain alive, of which 2 had malignant effusions. In the remainder of patients, median survival from time of diagnosis to death was 38 months (0.2-98), and median survival from time of pleural effusion to death was 6.5 months (0.03-75).
CONCLUSIONS: Pleural procedures in MM patients may significantly impact clinical management, since the cause of these effusions, including infection, volume overload, and disease, may be easily identified.
CLINICAL IMPLICATIONS: Pleural procedures are safe and informative in MM patients. Further evaluation with pleural biopsy for effusions of unclear etiology may provide definitive diagnosis.
DISCLOSURE: The following authors have nothing to disclose: Mark Warner, Lara Bashoura, George Eapen, Carlos Jimenez, Rodolfo Morice, Saadia Faiz
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