Skeletal clues apparently distinguishing Waldenstrom's macroglobulinemia from multiple myeloma and leukemia

Impact of circulating lymphoma cells at diagnosis on outcomes in patients with Waldenstrom macroglobulinemia

Given the paucity of data surrounding the prognostic relevance of circulating lymphoma (CL) in Waldenström macroglobulinemia (WM), we sought to evaluate the impact of CL at diagnosis on outcomes in patients with WM. Patients were divided into CL+ and CL- based on the results of flow cytometry. The endpoints included assessing progression-free survival (PFS), overall survival (OS), and diagnosis-to-treatment interval (DTI) between the two groups. Among the 308 patients with WM, 69 met the eligibility criteria with 42 and 27 in CL+ and CL- groups, respectively. The two groups were well balanced in regard to all the baseline characteristics. The ORR was numerically higher in the CL+ group compared to the CL-group (81% versus 61%, respectively), however, the CR+VGPR rates were similar between the two groups. The median PFS was not significantly different between the two groups (6.3 years in the CL- group versus not reached [NR] in the CL+ group) regardless of the first-line therapy. There was no significant difference in median OS between the CL- and CL+ groups (13 years versus NR). Although the median DTI was shorter in the CL+ group compared to CL- group, the significance was lost in the multivariable analysis. In this study (largest-to-date) evaluating the impact of CL on outcomes in patients with newly diagnosed WM, we did not find the prognostic utility of CL in WM. Future studies should explore the correlation of CL with other biological factors that impact the outcomes in WM patients.

Multiple myeloma: a review of atypical imaging features and other distinct plasma cell disorders that demonstrate similar imaging features

Multiple osteolytic lesions are a well-recognized and typical imaging feature of multiple myeloma as well as several other plasma cell disorders. Given the high volume of imaging studies obtained of multiple myeloma patients, radiologists will likely encounter a subset of multiple myeloma patients with less common or "atypical" findings during their practice. These atypical findings include osteosclerotic lesions, extramedullary lesions, and amyloid deposition. Similar imaging findings that are considered atypical for multiple myeloma can also be detected in other plasma cell disorders that are distinct from multiple myeloma. For instance, POEMS syndrome is a distinct plasma cell disorder from multiple myeloma, but also can present with osteosclerotic lesions. This article reviews the atypical findings associated with multiple myeloma and also reviews other plasma cell disorders that can have a similar spectrum of imaging findings. Special attention is paid to the musculoskeletal imaging findings.

Management of lytic bone disease in lymphoplasmacytic lymphoma: A case report and review of the literature

Waldenström macroglobulinemia (WM)/lymphoplasmacytic lymphoma (LPL) is often differentiated from myeloma based on the presence of lytic bone lesions (LBL). However, WM/LPL can present with LBL, and management is poorly understood. We describe a case of an 81-year-old woman with LPL who presented with LBL and was successfully treated with chemoimmunotherapy.

Cancers as rare diseases: Terminological, theoretical, and methodological biases

OBJECTIVE

Was cancer a rare disease in the past? Our objective is to consider the various terminological, theoretical, and methodological biases that may affect perceptions of the rarity of cancer in the past.

MATERIALS AND METHODS

We discuss relevant malignant neoplastic biomedical and paleopathological literature and evaluate skeletal data. We selected 108 archaeological sites (n = 151 cancer cases) with published malignant neoplasms and that were amenable to calculating cancer crude prevalence. Furthermore, datasets from four medieval/postmedieval Portuguese and 12 postmedieval UK sites were used to compare age-adjusted rates for metastatic bone disease and tuberculosis.

RESULTS

In the literature review, mean cancer crude prevalence (1.2 %; 95 % CI = 0.96-1.4) exceeded the threshold for a rare disease (RD). Age-standardized rates of MBD and TB were not markedly different in the sites surveyed.

CONCLUSIONS

Methodological, theoretical and historical factors contribute to assumptions that cancers were rare diseases. The assumption that cancers are extremely rare in the paleopathological literature was not fully supported. Cancer is a heterogeneous concept, and it is important to view it as such. If a disease is considered rare, we may fail to recognize it or dismiss it as unimportant in the past.

SIGNIFICANCE

We present a re-evaluation of the idea that cancer is a rare disease. We present a more nuanced way of comparing rates of pathological conditions in archaeological contexts.

LIMITATIONS

Variation in the amount of useable information in published literature on malignant neoplasms.

SUGGESTIONS FOR FURTHER RESEARCH

More large-scale studies of cancer in the past alongside comparative studies of cancer prevalence with other assumed rare diseases.

Radiographic findings in Waldenström's macroglobulinemia resembling fibrogenesis imperfecta ossium (FIO): a case report

A case of Waldenström's macroglobulinemia with radiographic features of fibrogenesis imperfecta ossium is presented. The case raises the possibility that these radiographic findings might be more common in Waldenström's macroglobulinemia than previously appreciated, and illustrates the need for bone biopsy to establish a definitive diagnosis of fibrogenesis imperfecta ossium.

Recognizing hyperviscosity syndrome in patients with Waldenstrom macroglobulinemia

Hyperviscosity syndrome can develop in patients with plasma cell dyscrasias, particularly Waldenstrom macroglobulinemia (WM). Occurring in 10%-30% of patients with hyperviscosity syndrome, WM is an uncommon B-cell proliferative disorder characterized by bone marrow infiltration and production of monoclonal immunoglobulin M. The elevated blood viscosity in WM is the result of increased circulating serum immunoglobulin M. Because hyperviscosity syndrome can be lethal, it must be recognized and managed early. Hyperviscosity syndrome has a triad presentation: vision changes, neurologic abnormalities, and bleeding. Treatment includes hydration with diuresis, plasmapheresis, and control of the underlying disease. The current treatment for WM is chemotherapy (i.e., alkylating agents and nucleoside analogs) and the monoclonal antibody rituximab. Although hyperviscosity syndrome is not one of the most common conditions, when it does occur, oncology nurses play a critical role in patients' assessment and care.

Abnormal bone remodelling and increased levels of macrophage inflammatory protein-1 alpha (MIP-1alpha) in Waldenström macroglobulinaemia

Serum levels of macrophage inflammatory protein-1 alpha (MIP-1alpha) and bone remodelling markers were evaluated in 38 patients with Waldenström macroglobulinaemia (WM) and correlated with clinical and laboratory variables. MIP-1alpha was elevated in WM; untreated patients had higher MIP-1alpha levels than patients in remission or with active disease after treatment. MIP-1alpha correlated with increased bone resorption, beta2-microglobulin and splenomegaly. Receptor activator of nuclear factor-kappaB ligand serum levels were elevated in WM patients; the subsequent increased bone resorption was balanced by a comparable elevation of osteoprotegerin production and bone formation. These findings may explain the absence of lytic lesions in WM patients and suggest a potential role of MIP-1alpha in WM.