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Characteristics and Prognostic Significance of Pleural Effusions in Multiple Myeloma
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A5025 - Characteristics and Prognostic Significance of Pleural Effusions in Multiple Myeloma
Author Block: S. Dogra1, M. T. Warner2, G. A. Eapen3, L. Bashoura3, C. A. Jimenez3, S. A. Faiz4; 1McGovern Medical School, Houston, TX, United States, 2Pulmonary and Critical Care Medicine, University of Texas Houston McGovern Medical School, Houston, TX, United States, 3The University of Texas MD Anderson Cancer Center, Houston, TX, United States, 4Pulmonary Department, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
Rationale Pleural effusion may occur for a myriad of reasons in multiple myeloma (MM) given its’ systemic involvement. Malignant pleural effusions (MPEs) are reportedly rare in this population and portend limited survival. Purpose The purpose of our study was to characterize pleural effusions in multiple myeloma and to evaluate their impact on survival and outcomes. Methods A retrospective review of consecutive cases of patients with MM undergoing pleural intervention between September 1997 to August 2015 at MD Anderson Cancer Center. Clinical history and laboratory data were extracted and analyzed. Results Preliminary data identified 92 patients with 46 females and 45 males. Median age was 61 years (42 to 84). Some (24%) had amyloid involvement. Most patients (83%) were undergoing active chemotherapy, and many (53%) underwent autologous stem cell transplant. This cohort underwent 94 thoracentesis, 30 indwelling pleural catheters (IPCs), and 19 chest tube placements. Four patients underwent pleural biopsy. Most patients had respiratory symptoms (87%) with cough (45%) and dyspnea (87%), and some (35%) had fever. Procedures were unilateral (69%), and many (74%) had multiple pleural interventions. Pleural fluid etiology included malignancy (42%), volume (38%), infection (12%) and other (8%). In those with MPE and IPC placement, the median duration of catheter was 122 days (range 20-311) which included patients who had an IPC removed due to complication, but excluded patients who expired with IPC in place. Rate of complications for all procedures was 3.5%. Thirty-four patients expired within 100 days of first pleural intervention, and etiologies for those included infection (59%), malignancy (20%), volume overload (18%), and other (3%). Conclusions In our cohort, pleural effusion in multiple myeloma occurred due to malignancy, volume overload and infection. Survival in pleural effusions related to infection was poor. Further study is warranted.
Author Block: S. Dogra1, M. T. Warner2, G. A. Eapen3, L. Bashoura3, C. A. Jimenez3, S. A. Faiz4; 1McGovern Medical School, Houston, TX, United States, 2Pulmonary and Critical Care Medicine, University of Texas Houston McGovern Medical School, Houston, TX, United States, 3The University of Texas MD Anderson Cancer Center, Houston, TX, United States, 4Pulmonary Department, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
Rationale Pleural effusion may occur for a myriad of reasons in multiple myeloma (MM) given its’ systemic involvement. Malignant pleural effusions (MPEs) are reportedly rare in this population and portend limited survival. Purpose The purpose of our study was to characterize pleural effusions in multiple myeloma and to evaluate their impact on survival and outcomes. Methods A retrospective review of consecutive cases of patients with MM undergoing pleural intervention between September 1997 to August 2015 at MD Anderson Cancer Center. Clinical history and laboratory data were extracted and analyzed. Results Preliminary data identified 92 patients with 46 females and 45 males. Median age was 61 years (42 to 84). Some (24%) had amyloid involvement. Most patients (83%) were undergoing active chemotherapy, and many (53%) underwent autologous stem cell transplant. This cohort underwent 94 thoracentesis, 30 indwelling pleural catheters (IPCs), and 19 chest tube placements. Four patients underwent pleural biopsy. Most patients had respiratory symptoms (87%) with cough (45%) and dyspnea (87%), and some (35%) had fever. Procedures were unilateral (69%), and many (74%) had multiple pleural interventions. Pleural fluid etiology included malignancy (42%), volume (38%), infection (12%) and other (8%). In those with MPE and IPC placement, the median duration of catheter was 122 days (range 20-311) which included patients who had an IPC removed due to complication, but excluded patients who expired with IPC in place. Rate of complications for all procedures was 3.5%. Thirty-four patients expired within 100 days of first pleural intervention, and etiologies for those included infection (59%), malignancy (20%), volume overload (18%), and other (3%). Conclusions In our cohort, pleural effusion in multiple myeloma occurred due to malignancy, volume overload and infection. Survival in pleural effusions related to infection was poor. Further study is warranted.
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