Feldman J, Yaretzky A
Geriatric Dept., Meir Hospital, Kfar Saba.
Harefuah. 1995 Feb 15;128(4):210-2, 264, 263.
Asymptomatic multiple myeloma was diagnosed in an 80-year-old woman with ischemic heart and cerebrovascular disease. The diagnosis was based on the finding of a rapid sedimentation rate (120 mm in the first hour), paraproteinemia with high levels of monoclonal IgA (4,582 mg%) and the characteristic findings on bone marrow aspiration. There was neither Bence-Jones protein nor hypercalcemia, nor clinical signs of multiple myeloma, such as bone pain, pathological fractures, or recurrent infections. We faced a dilemma in deciding whether or not to treat this elderly, asymptomatic woman. Chemotherapy in an elderly patient can be hazardous, and even life-threatening, due to adverse effects. On the other hand, untreated myeloma may be followed by rapid deterioration. It was decided not to start chemotherapy unless the clinical picture were to change for the worse. Although the hyperviscosity syndrome in this condition is usually due to elevated IgM paraprotein, it has been caused by IgG, or as in this case, by IgA hyperparaproteinemia.
一名患有缺血性心脏病和脑血管疾病的80岁女性被诊断为无症状多发性骨髓瘤。诊断依据为血沉加快（第1小时120毫米）、单克隆IgA水平升高的副蛋白血症（4582毫克%）以及骨髓穿刺的特征性表现。既没有本-周蛋白，也没有高钙血症，也没有多发性骨髓瘤的临床症状，如骨痛、病理性骨折或反复感染。在决定是否治疗这位老年无症状女性时，我们面临两难境地。由于不良反应，老年患者进行化疗可能有风险，甚至危及生命。另一方面，未经治疗的骨髓瘤可能会迅速恶化。决定除非临床情况恶化，否则不开始化疗。虽然这种情况下的高黏滞综合征通常是由于IgM副蛋白升高引起的，但也可能由IgG引起，或者在这种情况下，由IgA副蛋白血症引起。
