Multiple myeloma represents a challenge for hematologists because it has become more frequent at a young age in recent years. This is why autologous stem cell transplantation is included in the standard treatment of myeloma patients. We present the case of a 39-year-old patient who was diagnosed with non-secretory myeloma with double autologous transplantation and underwent neurosurgery for spinal cord compression caused by a plasmocytoma at D5 level. We present the evolution and complexity of this very difficult case.
Multiple myeloma accounts for 10% of the hematologic malignancies and is characterized by a single clone of plasma cells producing a monoclonal protein. The aim of this review is to summarize the current treatment methods of multiple myeloma. In the last 15 years, the incidence of myeloma has increased in patients younger than 65 years, thus treatment became even more important in order to obtain a long lasting remission or plateau phase. The treatment of this disease is complex and focuses not only on increasing the patients’ survival, but also improving their quality of life.
Hematological conditions can lead to serious disturbances in blood rheology, being frequently associated with increased systemic inflammation and increased risk of bleeding. The imbalance between coagulation and thrombolytic factors in patients with acute coronary syndromes may lead to undesirable outcomes, and the success of emergency coronary angioplasty or by-pass grafting may be altered by increased bleeding in coagulopathies such as hemophilia. This paper intends to review the present knowledge in the field of acute coronary syndromes in subjects with hematological and onco-hematological disorders such as thrombotic thrombocytopenic purpura, immune thrombocytopenic purpura, von Willebrand disease, hemophilia, polycythemia vera, erythrocyte disorders, myelodysplastic syndrome, leukemia, lymphoma or myeloma.
We present the method of immunomagnetic stem cell separation with the ISOLEX 300i device (Isolex® 300i Magnetic Cell Selection System, Nextell Therapeutics Inc. Irvine California 21618 USA) and the results obtained using this method in patients admitted to the Hematology and Bone Marrow Transplantation Clinic of Tîrgu Mureş, Romania. Cell selection has a great importance in separating stem cells from tumor cells, therefore contributing to the success of autologous stem cell transplantation.
Chronic myeloid leukemia (CML) is a clonal myeloproliferative disorder, which can involve the hematopoietic stem cell or early progenitor cells, without the loss of their capacity to differentiate. Typically, CML has three clinical phases: a chronic phase, an accelerated phase, and an aggressive transformation in blast crisis, analogous to acute leukemia. The following article presents the case of a 49-year-old patient diagnosed with Philadelphia-negative CML in blastic transformation, where after multiple conventional acute leukemia induction chemotherapy regimens an unrelated allogeneic hematopoietic stem cell transplant was performed.
Plasma cell leukemia (PCL) is one of the most aggressive monoclonal gammopathies, being characterized by the presence of more than 20% of plasma cells in the peripheral blood and an absolute number of these cells of more than 2×109, with different morphology, from young elements to mature cells. The incidence of PCL varies between 2–4% among multiple myeloma (MM) patients. In comparison with MM, PCL appears more often in younger patients. The following article describes the case of a 49-year-old female patient diagnosed with PCL which needed urgent control of the clinical manifestations due to its irreversible complications. Urgent autologous stem cell transplantation is recommended in this group of patients.
This study presents a new method of combined growth factor mobilization with increased dose (15 μg/kg) of filgrastim and standard mono dose of plerixafor in subjects with multiple myeloma, Hodgkin or non-Hodgkin lymphoma. Efficient mobilization is a key factor in the treatment of this group of patients, because autologous transplantation can be performed in cases in which we succeed to obtain a minimally sufficient number of stem cells. Autologous stem cell transplantation is included in the current standard treatment of multiple myeloma and in the relapsed cases of lymphomas.
Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL), representing up to 30 percent of all lymphomas. DLBCL is a fast-growing, aggressive form of NHL, which can appear as a transformation from a less aggressive form of lymphoma or can be de novo pathology. The following article describes the case of a 55-year-old female patient who developed a DLBCL as a second malignancy after an R-CHOP-treated marginal zone splenic lymphoma. This was followed by the transformation of the DLBCL into an aggressive acute lymphoblastic leukemia, for which the patient needed aggressive treatment according to the international acute lymphoblastic leukemia protocol.
We present a case of a 51 year old multiple myeloma patient due to the complexity of his disease. After prior high dose therapy with cardiotoxic cytostatic drugs patient developed cardiac arrest due to a ventricular fibrillation. Cardiopulmonary resuscitation was successfully but the hematologist stopped the cytostatic treatment due to the high cardiac risk.
The only way to control his myeloma was an autologous transplantation but this also had a very high cardiotoxic potential due to the high dose of Melphalan administered as conditioning treatment.
We present the difficulties and the results of this complex case. It also arises the potential beneficial effects of the megadose of stem cells on the myocardium but this needs further studies.