348P - Real world practice patterns in multiple myeloma patients presenting with pleural effusion

Date 18 December 2016
Event ESMO Asia 2016 Congress
Session Poster lunch
Topics Plasma Cell Dyscrasias
Presenter Ki Hwan Kim
Citation Annals of Oncology (2016) 27 (suppl_9): ix104-ix111. 10.1093/annonc/mdw586
Authors J.M. Byun1, K.H. Kim2, J.H. Park2, J. Kim2, I. Choi2, D. Shin1, Y. Koh1, I. Kim1, S. Yoon1, H. Lim3
  • 1Internal Medicine, Seoul National University Hospital, 110744 - Seoul/KR
  • 2Internal Medicine, Boramae Medical Center, 156-707 - Seoul/KR
  • 3Department Of Internal Medicine, Veterans Health Service Medical Center, 134-791 - Seoul/KR

Abstract

Background

In many Asians countries battling with the double burden of increasing noncommunicable diseases such as multiple myeloma (MM) on top of unresolved issues of infectious diseases, MM patients presenting with pleural effusion (PE) pose a great diagnostic challenge. Thus, we aimed to devise structured approaches to care by analyzing clinical features and practice patterns of such patients in Korea.

Methods

This is a multicenter retrospective study of newly diagnosed MM patients over 18 years old between January 2011 and December 2015. Among 575 MM patients diagnosed during the study period, 80 (13.9%) were associated with PE. These 80 patients were selected for further analyses.

Results

The median age was 63 (range 35-81), with similar gender distribution (male 55% vs. female 45%). Bilateral PE (61.2%) was more common than unilateral effusion (38.8%). There were 22 patients (27.5%) with effusion as the initial diagnosis of MM and 58 (72.5%) who developed effusion during the course of MM. Fifty-six patients underwent additional examinations to determine the exact cause of effusion; 28 patients received computed tomography (CT) of chest, 5 patients underwent thoracentesis/biopsy, and 23 patients underwent both CT and thoracentesis/biopsy. On the other hand, 24 patients did not undergo additional analyses but treated empirically. The clinical diagnosis given to all patients are shown in the table.rn

Table: 348P

rnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrn
Total (%) No additional exam (%) Additional imaging (%) Invasive procedure (%)
N8024 (30.0)28 (35.0)28 (35.0)
Myelomatous7 (8.8)007 (25.0)
Parapneumonic20 (25.0)3 (12.5)10 (35.7)7 (25.0)
Organism identified9 (45.0)04 (40)5 (71.4)
Clinical diagnosis11 55.0)3 (100)6 (60)2 (28.6)
Tuberculosis2 (2.5)002 (2.5)
Congestive heart failure9 (11.2)4 (16.7)1 (3.6)4 (14.3)
Renal failure, acute and chronic7 (8.8)4 (16.7)3 (10.7)0
Hypoalbuminemia9 (11.2)4 (16.7)4 (14.3)1 (3.6)
Reactive to other general medical conditions15 (18.8)7 (29.2)5 (17.9)3 (10.7)
Combined9 (11.2)1(4.2)4 (14.3)4 (5.0)
Unknown2 (2.5)1 (4.2)1 (3.6)0
rn

Conclusions

Real world analyses of practice pattern in MM patients with PE showed suboptimal use of invasive procedures to determine the exact cause of PE. Since myelomatous effusion and tuberculosis pleurisy are not uncommon in Korea, when in doubt invasive procedures should be actively recommended.

Clinical trial indentification

Legal entity responsible for the study

Seoul Metropolitan Government Seoul National University Boramae Medical Center

Funding

Seoul Metropolitan Government Seoul National University Boramae Medical Center

Disclosure

All authors have declared no conflicts of interest.