Incidence and clinical features of extramedullary multiple myeloma in patients who underwent stem cell transplantation

Extramedullary disease (EMD), defined as an infiltrate of clonal plasma cells at an anatomic site distant from the bone marrow, is an uncommon manifestation of multiple myeloma. Six hundred and sixty-three consecutive patients with multiple myeloma who underwent stem cell transplantation between January 2005 and December 2011 were assessed for the presence of EMD. A cohort of 55 patients with biopsy-proven EMD was identified, comprising 8·3% of the total study population. EMD was present at the time of diagnosis in 14·5% of cases and at the time of relapse in 76% of patients. The most common EMD presentations at relapse were liver involvement and pleural effusions. EMD specimens had high expression of CD44 (92%) and moderate expression of CXCR4. The median overall survival from time of myeloma diagnosis was 4·1 years (95% CI: 3·1, 5·1) and the median overall survival from time of EMD diagnosis was 1·3 years (95% CI: 0·8, 2·3). This report demonstrates that the incidence of EMD has not increased with the introduction of novel agents and stem cell transplantation. The most common EMD presentations in the relapsed setting were liver and pleural fluid. The presence of CD44 and CXCR4 expression may represent new markers of EMD that warrant further investigation.

A compact rotating dilution refrigerator

We describe the design and performance of a new rotating dilution refrigerator that will primarily be used for investigating the dynamics of quantized vortices in superfluid (4)He. All equipment required to operate the refrigerator and perform experimental measurements is mounted on two synchronously driven, but mechanically decoupled, rotating carousels. The design allows for relative simplicity of operation and maintenance and occupies a minimal amount of space in the laboratory. Only two connections between the laboratory and rotating frames are required for the transmission of electrical power and helium gas recovery. Measurements on the stability of rotation show that rotation is smooth to around 10(-3) rad s(-1) up to angular velocities in excess of 2.5 rad s(-1). The behavior of a high-Q mechanical resonator during rapid changes in rotation has also been investigated.