Alice Maniatis

Multiple myeloma in elderly patients: prognostic factors and outcome

Abstract:  Objectives: Purpose of this study was to compare prognostic factors and outcome of patients with multiple myeloma (MM) aged >70 yr at diagnosis with those of younger patients. We also applied the recently proposed International Staging System (ISS) for MM in these patients. Patients and methods: Among 1,162 newly diagnosed, symptomatic MM patients included in our database, 357 (31%) were >70 yr of age. Clinical and laboratory variables were evaluated in patients >70 yr and in younger patients and were assessed for possible correlation with survival in patients >70 yr of age. Results: Most clinical and laboratory features were similar in the two groups of patients but older patients presented more frequently with advanced ISS (P = 0.02). Despite similar response rates to primary treatment, younger patients survived longer than patients >70 yr of age (40 vs. 28 months, P = 0.001). There was a longer survival of younger patients than that of older patients diagnosed with ISS stage 1 (median 71 vs. 54 months, P = 0.007) and ISS stage‐2 patients (median: 38 vs. 26 months, P = 0.0008) but for patients with ISS stage 3 median survival was similarly poor in the younger and older age group (21 and 20 months, P = 0.283). Other variables associated with impaired prognosis were severe anemia, extensive bone marrow plasmacytosis and elevated serum LDH. Conclusions: Older patients with MM present more often with advanced ISS and have significantly shorter survival than younger patients. The ISS retained its prognostic significance within the group of elderly patients.

The Effects of Phenylhydrazine-Induced Haemolysis on the Behaviour of Regenerating Marrow Stroma

Summary. Fragments of marrow tissue autotransplanted in a subcutaneous site, regenerate and give rise to a haemopoietic nodule surrounded by a shell of bone. The process originates from supporting stroma of implanted marrow. Phenylhydrazine‐induced acute haemolysis stimulates the growth of these implants and results in almost 100% increase in the weight of implants. This effect is probably the result of an increased demand for erythropoiesis and implies an interaction between blood‐forming cells and the marrow stroma. Phenylhydrazine‐induced chronic haemolysis, on the other hand, suppresses the growth of implants and results in a markedly lower rate of take and decreased weight of implants. This appears to be a direct effect of phenylhydrazine on cell proliferation in the regenerating implant.

Studies on Marrow Histogenesis II. Growth Characteristics of Extramedullary Marrow Autotransplants

Summary and Conclusions Based on these data, we conclude that in the rat: 1. A critical mass of marrow is necessary for extramedullary marrow autotransplants to grow. This mass is roughly 15 mg of tissue. 2. Above this critical mass, a linear correlation exists between the weight of implanted and recovered tissues. 3. During the first 4 days of regeneration, the weight of the implant increases to 400% of initial weight and this may be explained by intense circulation through the implant and, in part, by intense proliferative activity in fibroblasts. After day 4, a decrease in vascularity of the implant and degeneration of many fibroblasts results in decrease in the weight of implant which begins to stabilize around day 8. 4. The final weight of implant is always less than the initial weight (average 25%), indicating a loss of tissue during the regenerative processes.

Studies on Marrow Histogenesis I. The Site of Choice for Extramedullary Marrow Implants

Summary Extramedullary marrow transplantation results in the formation of a nodule of hematopoietically active marrow encapsulated by a shell of bone. The site of choice for such implants is the loose subcutaneous tissue such as that of the abdominal wall; the high rate of success and the easy accessibility makes these implants a useful model for the study of the histophysiology of the marrow.