Retrospective review of multiple myeloma and immunosecretory disorder cases diagnosed in a tertiary setting

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dc.contributor.author Visser, Hilgaard Frans
dc.contributor.author Visser, Adele
dc.contributor.author Snyckers, Christian Hugo
dc.contributor.author Goller, Ruan
dc.contributor.author Pool, Roger
dc.contributor.author Myburgh, Jan G.
dc.date.accessioned 2010-04-15T09:13:18Z
dc.date.available 2010-04-15T09:13:18Z
dc.date.issued 2009
dc.description.abstract PURPOSE OF THE STUDY: Despite the relatively high incidence of multiple myeloma reported worldwide, South African statistics seem to be significantly lower. Our purpose in doing this study was to determine whether patients with suspected immunosecretory disorders are being appropriately evaluated and followed up. Secondary purposes include an impression of the most common clinical features prompting investigation as well as the stage of disease at time of diagnosis. DESCRIPTION OF METHODS: All patients investigated for immunosecretory disorders by serum or urine electrophoresis over a 4-year period were included in this study. Each patient's laboratory and radiological data were evaluated to determine the true diagnosis, and assess the comprehensiveness of the investigation. SUMMARY OF RESULTS: In total, 582 patients were included - 30 patients had multiple myeloma (6.7%). A single case of plasmacytoma and plasma cell leukaemia was identified. Waldenstrom's macroglobulinaemia was identified in seven patients (1.2%) and monoclonal gammopathy of undetermined significance (MGUS) in 83 patients (14.3%). Due to the risk of progression from MGUS to multiple myeloma, patients need to be re-evaluated biannually, shown to be the case in only 11% of cases. Of all the malignant disorders (48 cases) the majority of patients were diagnosed in an orthopaedic setting (45%), followed by internal medicine (39%). Radiological abnormalities were the most common clinical finding prompting investigation, with lytic lesions or osteoporosis seen in 50%, pathological fractures in 17% and neurological manifestations noted in 18% of cases. The majority of patients who could be staged were diagnosed at a relatively late stage of disease, rendering the prognosis worse than in early disease. This suggests a relatively low index of suspicion in our clinical setting. CONCLUSION: Multiple myeloma and related disorders are commonly encountered in the orthopaedic setting. Although the sample size is small, this data suggests that patients are diagnosed late in disease progression and often not evaluated appropriately. A clear protocol should be established to actively exclude this diagnosis if it is suspected. en
dc.identifier.citation Visser, HF, Visser, A, Snyckers, CH, Goller, R, Pool, R & Myburgh JG 2009, 'Retrospective review of multiple myeloma and immunosecretory disorder cases diagnosed in a tertiary setting', SA Orthopaedic Journal, vol. 8, no. 4, pp. 38-43. [http://www.charpublications.co.za/C_JournalsORTH.asp] en
dc.identifier.issn 1681-150X
dc.identifier.other 35321482200
dc.identifier.uri http://hdl.handle.net/2263/13967
dc.language.iso en en
dc.publisher South African Orthopaedic Association / Char Publications en
dc.rights South African Orthopaedic Association / Char Publications en
dc.subject Immunosecretory disorders en
dc.subject Radiology en
dc.subject.lcsh Multiple myeloma -- Diagnosis -- South Africa en
dc.title Retrospective review of multiple myeloma and immunosecretory disorder cases diagnosed in a tertiary setting en
dc.type Article en


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