Hussain Azhar, Almenfi Hana Farag, Almehdewi Abdelfattah M, Hamza Mohammed S, Bhat Malpe Surekha, Vijayashankar Narasimha Prasad
Medicine, Xavier University School of Medicine, Oranjestad, ABW.
Internal Medicine, Khaled Ben Al-Walid Clinic, Tripoli, LBY.
Cureus. 2019 May 22;11(5):e4716. doi: 10.7759/cureus.4716.
Multiple myeloma (MM) is a malignant disorder characterized by proliferation of a single clone of plasma cells derived from β-cells in the bone marrow. It is the second most common adult hematological malignancy, and it is the most common cancer with skeletal components as its primary site. The purpose of the retrospective study was to assess the hematological profile, different biochemical parameters, and the serum electrophoresis patterns of patients consistent with clinical symptoms of multiple myeloma.
A retrospective study of 99 patients diagnosed with multiple myeloma (MM) was carried out at the Hematology Department of Benghazi Medical Center (BMC) in Benghazi, Libya from January 2010 to March 2017. Information on the laboratory features was obtained at presentation (before treatment) and analyzed.
Of the 99 study detected cases of multiple myeloma at diagnosis, 14% were younger than 45 years and 35% were 70 years or older. The mean age was 61 years, of which 42 (42.4%) were males and 57 (57.6%) were females. Anemia was seen in roughly half of the diagnosed cases, most of which was normocytic normochromic anemia. High erythrocyte sedimentation rate (ESR) was seen in 65.3% of cases and increased neutrophil-to-lymphocyte ratio (NLR) was seen in 29.7%. Other abnormal serum levels with regard to the cases are as follows: hyperproteinemia in 30%, low albumin/globulin (A/G) ratio in 54.2%, hypercalcemia in 11.3%, serum creatinine level of >2.0 mg/dL in 27.2% cases, and increased β2-microglobulin in 67%. Serum protein electrophoresis revealed a localized band in 70.8% of patients. Monoclonal bands were seen in 44 cases (95.7%) and a bi-clonal pattern in two cases (4.3%), 78% of M-band showed migration to γ-region of electrophoretogram and 18% to β-region. Hypogammaglobulinemia was detected in 32.8% and hypergammaglobulinemia was detected in 49.2%. Of the hypergammaglobulinemia, 18.1% showed polyclonal gammaglobulinemia. Bence Jones protein was positive in 50% cases. IgG was the commonest type, followed by IgA then light chain. In 26.5% of cases, the only diagnosis was multiple myeloma. Light chain multiple myeloma patients had high α2 globulin concentration and normal A/G ratio. Apart from the diagnosis of multiple myeloma, a number of cases had varying diagnoses including the following: 4% non-secretory myeloma, 2% amyloidosis with nephrotic syndrome, 2% liver cirrhosis, and 18.2% renal failure. Most patients presented in stage III.
The presence of anemia, high ESR, and low A/G ratio in elderly patients should alert the clinician to investigate along the lines of multiple myeloma. In this study, unfortunately, the laboratory investigations were insufficient for diagnosing this disease in most patients. Most patients were diagnosed at stage III. Absence of paraprotein in the blood does not exclude multiple myeloma. It was further observed that most of the patients presented with significant renal damage, which attributed to hyperuricemia, hypercalcemia, or high NLR. Multiple causes of renal failure occur in myeloma and are often present at the time of diagnosis.
多发性骨髓瘤（MM）是一种恶性疾病，其特征是骨髓中源自β细胞的单个浆细胞克隆增殖。它是第二常见的成人血液系统恶性肿瘤，也是以骨骼为主要部位的最常见癌症。这项回顾性研究的目的是评估符合多发性骨髓瘤临床症状患者的血液学特征、不同生化参数及血清电泳图谱。
2010年1月至2017年3月，在利比亚班加西的班加西医疗中心（BMC）血液科对99例诊断为多发性骨髓瘤（MM）的患者进行了回顾性研究。收集了患者初诊时（治疗前）的实验室检查结果并进行分析。
在99例确诊为多发性骨髓瘤的研究病例中，14%的患者年龄小于45岁，35%的患者年龄在70岁及以上。平均年龄为61岁，其中男性42例（42.4%），女性57例（57.6%）。约一半的确诊病例存在贫血，大多数为正细胞正色素性贫血。65.3%的病例红细胞沉降率（ESR）升高，29.7%的病例中性粒细胞与淋巴细胞比值（NLR）升高。其他与病例相关的异常血清水平如下：30%的患者出现高蛋白血症，54.2%的患者白蛋白/球蛋白（A/G）比值降低，11.3%的患者高钙血症，27.2%的病例血清肌酐水平>2.0mg/dL，67%的患者β2-微球蛋白升高。血清蛋白电泳显示70.8%的患者出现局限性条带。44例（95.7%）出现单克隆条带，2例（4.3%）出现双克隆模式，78%的M带在电泳图谱中迁移至γ区，18%迁移至β区。32.8%的患者检测到低丙种球蛋白血症，49.2%的患者检测到高丙种球蛋白血症。在高丙种球蛋白血症患者中，18.1%表现为多克隆丙种球蛋白血症。50%的病例本周氏蛋白呈阳性。IgG是最常见的类型，其次是IgA，然后是轻链。26.5%的病例唯一诊断为多发性骨髓瘤。轻链型多发性骨髓瘤患者α2球蛋白浓度高，A/G比值正常。除了多发性骨髓瘤的诊断外，一些病例还有不同的诊断，包括：4%为非分泌型骨髓瘤，2%为伴有肾病综合征的淀粉样变性，2%为肝硬化，18.2%为肾衰竭。大多数患者处于Ⅲ期。
老年患者出现贫血、ESR升高和A/G比值降低应提醒临床医生考虑多发性骨髓瘤的排查。在本研究中，遗憾的是，大多数患者的实验室检查不足以诊断该病。大多数患者诊断时处于Ⅲ期。血液中无副蛋白并不能排除多发性骨髓瘤。进一步观察发现，大多数患者存在明显的肾损害，这归因于高尿酸血症、高钙血症或高NLR。骨髓瘤患者肾衰竭有多种原因，且常在诊断时就已存在。
