Myelomatous pleural effusion (MPE) is a rare and often grave condition that poses significant challenges in the management of multiple myeloma (MM). Recent research highlights the complexities and treatment options associated with MPE, particularly in cases of early recurrence following autologous transplantation. This blog delves into a notable case presentation, shedding light on the clinical implications and the importance of timely intervention in managing this challenging condition.
In a recent study, a 35-year-old female patient diagnosed with lambda light chain multiple myeloma presented with alarming symptoms just two months post-autologous transplantation. She complained of dyspnea and pain radiating to her left shoulder. A thorough physical examination revealed decreased respiratory sounds in the lower lobe of the left lung, accompanied by dullness upon percussion. Imaging studies, including chest X-ray and thorax computed tomography (CT), confirmed the presence of pleural effusion and a plasmacytoma, particularly prominent on the left side.
To further investigate the nature of the pleural effusion, therapeutic thoracentesis was performed, and the collected fluid underwent rigorous examination through flow cytometry, cytology, and peripheral smear. The findings indicated that the patient was experiencing an early recurrence of her multiple myeloma after transplantation. This diagnosis necessitated immediate action; thus, the patient was started on DRd chemotherapy (dexamethasone, lenalidomide, and bortezomib). Fortunately, both clinical and radiological improvement were observed shortly thereafter.
The case underscores the critical need for healthcare professionals to evaluate pleural effusions in the context of multiple myeloma, particularly considering the potential for MPE. The prognosis for patients with MPE is generally poor, and the duration of response to treatment tends to be short-lived. Therefore, employing effective and dynamic treatment strategies is paramount. These strategies are crucial for bridging patients to clinical trials or hematopoietic stem cell transplantation, which may offer a better long-term outcome.
In conclusion, the management of myelomatous pleural effusion in multiple myeloma patients requires a nuanced understanding and prompt intervention. This case illustrates the importance of early recognition and treatment of complications arising from multiple myeloma, ultimately aiming to improve patient outcomes.
This research was conducted by Ak Müzeyyen Aslaner and Figen Barut, affiliated with the Department of Hematology and Pathology at the Faculty of Medicine, Zonguldak Bulent Ecevit University in Turkey. Their work contributes significantly to the existing body of knowledge on MPE and emphasizes the necessity for ongoing research and clinical vigilance in this area.
