Multiple Myeloma and Monoclonal Gammopathy of Unknown Significance
HIV-infected individuals have a higher risk to develop both a monoclonal gammopathy (MG) and a multiple myeloma (MM) as compared to the general population. If a MG appears with a low M spike without other symptoms and signs, it is called MG of undetermined significance (MGUS). The prevalence of MG among HIV infected patients in the HAART era is 3–5 %.
The pathophysiology of the development of a monoclonal gammopathy in the context of HIV is complex, it is associated with an abnormal function and unspecific polyclonal activation of B-cells. The correlation of MG in HIV infected patients with morbidity and mortality and the association with the development of myeloma and lymphoma is unclear. MM is a rare disease in HIV-infected individuals and patients with AIDS. The clinical presentation of MM is more aggressive, it occurs at younger age, often as solitary bone or extramedullary plasmocytoma, and sometimes as plasma cell leukemia. The M-protein is often low. The aggressiveness is reflected by the rapid progression, short overall survival and histopathology with atypical or anaplastic features.
MG in the HIV-infected patients should be followed up closely, without specific treatment. HIV-related myeloma should be treated according to the guidelines of MM in the general population. In our experience, all currently used treatment protocols for patients with MM, including bortezomib, thalidomide, lenalidomide and dexamethasone, are feasible and adequately tolerated in HIV-infected patients. Even high-dose chemotherapy with autologous stem cell transplantation should be considered.
KeywordsMultiple Myeloma Autologous Stem Cell Transplantation Monoclonal Gammopathy Mixed Cryoglobulinemia Plasma Cell Leukemia
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