Clinical Medicine Research
Volume 2, Issue 4, July 2013, Pages: 73-76
Received: Jun. 8, 2013;
Published: Jul. 20, 2013
Views 2830 Downloads 224
Carlo Rostagno, Department of Sperimental and Clinical Medicine, Critic Area Section, University of Florence, Italy
Rostagno Perfetto, Department of Sperimental and Clinical Medicine, Critic Area Section, University of Florence, Italy
The relationships between pulmonary hypertension multiple myeloma, monoclonal protein and finally drug treatment of plasma cell diseases are complex and not fully elucidated. Pulmonary hypertension has been reported as a rare complication of multiple myeloma (MM), more frequently in patients with POEMS syndrome. More recently pulmonary hypertension has been described during thalidomide treatment for refractory MM. We report a case of severe pulmonary hypertension associated with MM, pleural and cardiac amyloidosis. A revision of literature follows.
Pulmonary Hypertension and Multiple Myeloma, Clinical Medicine Research.
Vol. 2, No. 4,
2013, pp. 73-76.
GShiue ST, McNally DP. Pulmonary hypertension from prominent vascular involvement in diffuse amyloidosis. Arch Intern Med. 1988 ;148(3):687-9
Lehtonen J, Kettunen P. Pulmonary hypertension as a dominant clinical picture in a case of amyloidosis and smoldering multiple myeloma. Int J Cardiol. 2007 Jan 31;115(1):e29-30. Epub 2006 Oct 17.
Chinen K , Fujioka Y. Severe pulmonary hypertension caused by smoldering plasma cell myeloma : an autopsy case of POEMS syndrome . Case reports in medicine 2012; doi .10.1155/2012/836893
Dispenzieri A, Kyle RA, Lacy MQ et al . POEMS syndrome : definitions and long-term outcome . Blood 2003; 101: 2496 -2506
Ribadeau-Dumas S, Tillie-Leblond I, Rose C, et al. Pulmonary hypertension associated with POEMS syndrome. Eur Respir J. 1996;9:1760-1762
Rose C, Zandecki M, Copin MC, et al. POEMS syndrome: report on six patients with unusual clinical signs, elevated levels of cytokines, macrophage involvement and chromosomal aberrations of bone marrow plasma cells. Leukemia. 1997;11:1318-1323
Younis TH. Reversible pulmonary hypertension and thalidomide therapy for multiple myeloma. British Journal of Haematology 121, 191–192, 2003
Antonioli E , Nozzoli C, Gianfaldoni G et al. Pulmonary hypertension related to thalidomide therapy in refractory multiple myeloma Ann Oncol (November 2005) 16(11): 1849-1850.
Rostagno C, Ciolli S. Transient severe symptomatic pulmonary hypertension as onset symptom in multiple myeloma. Ann Haematol 2006;85:627-8
Dingli D; Utz JP Gertz MA. Pulmonary hypertension in patients with amyloidosis . Chest 2001; 120: 1736-8
Elice F, Fink L, Tricot G, BarlogieB, Zangari M. Acquired resistance to activated protein C (aAPCR) in multiple myeloma is a transitor abnormality associated with an increased risk of venous thromboembolism. Br J Haematol 2006; 134: 399–405
Kristinsson SY, Fears TR, Gridley G, Turesson I, Mellqvist UH, Bjorkholm M, et al. Deep vein thrombosis after monoclonal gammopathy of undetermined significance and multiple myeloma. Blood. 2008; 112(9):3582-6.
Zangari M, Saghafifar F, Anaissie E, et al Activated protein C resistance in the absence of factor V Leiden mutation is a common finding in multiple myeloma and is associated with an increased risk of thrombotic complications. Blood Coagul Fibrinolysis 2002; 13: 187-192.
Corso A, Lorenzi A, Terulla V, et al Modification of thrombomodulin plasma levels in refractory myeloma patients during treatment with thalidomide and dexamethasone. Ann Hematol 2004; 83: 588-591.
Bardwick PA, Zvaifler NJ, Gill GN, Newman D, Greenway GD, Resnick DL. Plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes: the POEMS syndrome: report on two cases and a review of the literature. Medicine. 1980;59:311-322
Soubrier MJ, Dubost JJ, Sauvezie BJ. POEMS syndrome: a study of 25 cases and a review of the literature. French Study Group on POEMS syndrome. Am J Med. 1994;97:543-553
Yaqub S, Moder KG, Lacy MQ . Severe , reveversible pulmonary hypertension in a patient with monoclonal gammopathy and features of dermatomyosistis. Mayo Clin Proc 2004; 79: 687-9
Lesprit P, Godeau B, Authier FJ, et al. Pulmonary hypertension in POEMS syndrome: a new feature mediated by cytokines. Am J Respir Crit Care Med. 1998;157:907-911
Feinberg L, Temple D, de Marchena E, Patarca R, Mitrani A. Soluble immune mediators in POEMS syndrome with pulmonary hypertension: case report and review of the literature. Crit Rev Oncog. 1999;10:293-302
Paciocco G, Bossone E, Erba H, Rubenfire M. Reversible pulmonary hypertension in POEMS syndrome: another etiology of triggered pulmonary vasculopathy? Can J Cardiol. 2000;16:1007-101
Lesprit P, Authier FJ, Gherardi R, et al. Acute arterial obliteration: a new feature of the POEMS syndrome? Medicine. 1996;75:226-232
Watanabe O, Maruyama I, Arimura K, et al. Overproduction of vascular endothelial growth factor/vascular permeability factor is causative in Crow-Fukase (POEMS) syndrome. Muscle Nerve. 1998;21:1390-1397
Soubrier M, Dubost JJ, Serre AF, et al. Growth factors in POEMS syndrome: evidence for a marked increase in circulating vascular endothelial growth factor. Arthritis Rheum. 1997;40:786-78
Villa A, Mazzola AA, Ghio S, Martinoli E, Marino P. Reversible pulmonary hypertension related to thalidomide treatment for multiple myeloma. Case Rep Oncol. 2011 Sep;4(3):487-9. doi: 10.1159/000333016. Epub 2011 Sep 28
Cavo M, Zamagni E, Tosi P et al. First-line therapy with thalidomide and dexamethasone in preparation for autologous stem cell transplantation for multiple myeloma. Haematology2004; 89: 826–831.
C. Lafaras, E. Mandala, E. Verrou, D. Platogiannis, N. Barbetakis, T. Bischiniotis K. Zervas Non-thromboembolic pulmonary hypertension in multiple myeloma, after thalidomide treatment: A pilot study. Annals of Oncology 19: 1765–1769, 200
Pepke-Zaba J, Morrell NW. The endothelin system and its role in pulmonary arterial hypertension (PAH). Thorax 2005; 60(6): 443–444.
Steiner MK, Preston IR, Klinger JR, Hill NS. Pulmonary hypertension: invale nitric oxide, sildenafil and natriuretic peptides. Curr Opin Pharmacol 2005; 5(3):245–250.
Hattori Y, Shimoda M, Okamoto S et al. Pulmonary hypertension and thalidomide therapy in multiple myeloma. Br J Haematol 2005; 128: 885–888.