Urography in Myelomatosis

To investigate whether urographic contrast media might precipitate Bence Jones protein in the renal tubules and lead to renal failure in patients with myelomatosis, the reaction between the media and myeloma urine was studied in vitro. Appreciable precipitation was found only in urine at or below pH 4·5, and its occurrence did not correlate with the type or concentration of protein present. It is concluded that the risk of urography in myelomatosis is very small.     

Myelomatosis with Xanthomatosis Multiforme

A 45-year-old man developed, apparently simultaneously, two rare conditions, xanthomatosis (with hypercholesterolemia) and myelomatosis. His blood contained very high levels of cholesterol, the major part of which was present in a markedly elevated beta-lipoprotein fraction. Studies carried out over a period of six years, utilizing electrophoresis, ultracentrifugation, determinations of chemical composition and incorporation with C¹⁴-labelled glutamic acid and acetate, indicated a direct association between the two conditions, the myeloma lipoprotein apparently being produced by the abnormal plasma cells in the bone marrow. There were definite indications that the low density S_f 0-12 lipoproteins were primarily involved.     

Combination Therapy for Myelomatosis

Twenty-eight patients with multiple myeloma have been treated with a quadruple chemotherapeutic regimen consisting of 1, 3 bis (2-chloroethyl)-1-nitrosourea (BCNU), cyclophosphamide, melphalan, and prednisolone. Nineteen new patients and nine who had escaped from previous single-agent therapy were included in the study. The results to date, on eight criteria of response, seem to be superior to those obtained from previous chemotherapeutic regimens. The study has been in progress for 18 months and only three patients have died. Only one who had not received previous therapy died, and she had complicating hyperparathyroidism, which almost certainly contributed to her death.     

The Kidney and Intravascular Coagulation in Myelomatosis

In 15 out of 35 patients with myelomatosis histological examination showed intravascular fibrin within the glomeruli, and this was associated with proliferation of the mesangial complex in 12. The presence of intravascular fibrin and mesangial proliferation was not associated with any specific immunoglobulin abnormality or with the presence or absence of Bence Jones proteinuria. In addition to fibrin being present within glomerular capillaries it was also shown in intertubular capillaries in three cases of myelomatosis with acute tubular necrosis. It is suggested that intraglomerular coagulation and fibrin deposition may contribute to the genesis of renal failure in myelomatosis.