Ying Shuangwei,Yu Yijian,Zhang Jie, et al. Clinical analysis of patients with multiple myeloma involving the pancreas[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2024, 54(4): 323-327.
Abstract：Objective: To investigate the epidemiology, pathogenesis, clinical manifestations, treatment and prognosis of multiple myeloma (MM) involving the pancreas. Methods: We retrospectively analyzed the clinical manifestations, treatment and prognosis of 4 patients with MM involving the pancreas admitted to Taizhou Hospital, Zhejiang Province, from October 2011 to October 2021, and reviewed the relevant literature. Results: Four patients, 3 male and 2 female aged 53 to 64, of whom 3 were IgG/λ type and 1 was IgG/κ type; 2 were IA and 2 IIIA (DS staging system); 2 were II and 2 were III (ISS staging system). The interval between the diagnosis of MM involving the pancreas and MM was 16.3~92.2 months. None of the four cases had extramedullary disease (EMD) at the time of initial diagnosis of MM, but had EMD at other sites before or at the time of pancreatic involvement. Three cases had fatigue, icteric sclera, and lumbago at the time of pancreatic involvement, and one case had no discomfort; three cases had elevated amylase, and 2 had elevated bilirubin; CA199 was elevated in 2 cases. The head of the pancreas was involved in all four cases; the tail was involved in 2 cases and the pancreatic body in one case; the pancreatic lesions were easy to be missed on ultrasound through the abdomen, and the lesions appeared to be slightly hypointense on CT plain scan, mildly intensified after enhancement, and had an elevated SUV value on PET/CT. In 2 cases, the expression of CD56 was significantly downregulated in both the bone marrow and the EMD (thoracic and abdominal fluid, pancres). Chemotherapy with proteasome inhibitors combined with lenalidomide or anthracycline/platinum agents was given after diagnosis, which achieved shortterm efficacy. Overall survival was only 1.7-7.8 months after diagnosis of pancreatic involvement, and 3 of them died of severe infections. Conclusion: Pancreatic involvement secondary to MM is rare, which occurs at different stages of MM and is often accompanied with or later than other EMD. Its presence often suggests the end-stage ofMM. The decreased expression of CD56 may be related to its development. Without effective treatment currently, the efficacy might be improved by the combination of novel drugs.
