K Zbadi | PubMed Health

PubMed1996

[Prognosis of multiple myeloma treated with conventional chemotherapy has not improved in 20 years].

The treatment of multiple myeloma has changed over the last 20 years. We investigated the effects of theses changes on patient survival in the current practice of a rheumatology ward. Two hundred and seventy-nine patients were hospitalised between 1972 and 1993: 30 from 1972 to 1976, 70 from 1977 to 1981, 86 from 1982 to 1986, 75 from 1987 to 1991 and 18 from 1992 to 1993. Staging according to Durie and Salmon was I in 8%, II in 29% and III in 65%. In principle, the initial therapy was monochemotherapy in 65% of the cases and polychemotherapy in 35%. At the time of the present study, 197 patients have died. The actuarial curves of survival were similar in all historical classes defined by the date of first admission. Curves of median of follow-up and of floating means were level between 1972 and 1990. No correlation was found between the date of first admission and survival in the 174 patients who died between 1972 and 1987. The following parameters were associated with longer survival: achievement of an objective response on chemotherapy, lower patient's age, high haemoglobin, low creatinine, low stage according to Durie and Salmon, low number of plasma cells in bone marrow, low calcemia and low levels of IgA, monoclonal component. The comparison of prognosis factors in historical classes showed a difference only for haemoglobin which was lower in the earlier class. The type of the first chemotherapy regimen varied widely between historical classes. The number of responders was significantly greater after polychemotherapy than after monochemotherapy but no correlation was observed between the type of chemotherapy and survival. The frequencies of early death, and the causes of death in general, were not different in the historical classes. The lack of improvement of survival over the last 20 years shows that the efficacy of current chemotherapies is limited, a conclusion which warrants the exploration of other therapeutic avenues.

Aged↗

PubMed1995

Cervical epidural infection. Four case-reports.

The authors report four cases of cervical epidural infection, in two females (aged 58 and 82 years) and two males (aged 41 and 51 years). Risk factors were noninsulindependent diabetes mellitus in one patient and multiple myeloma treated by chemotherapy in another. Duration of cervical pain at evaluation was five to 15 days. Three patients had a fever and a neurologic deficit: one had brachial diplegia; the myeloma patient developed brachial diplegia after a lumbar puncture and the diabetic patient developed quadriplegia with respiratory disorders also after a lumbar puncture. Cerebrospinal fluid studies showed elevated protein levels with approximately 20 cells per mm3 and no pathogens in smears or cultures. Roentgenograms were normal at admission. The diagnosis was established by myelography (n = 2) and/or computed tomography (n = 2) and/or magnetic resonance imaging (n = 2). The infected area was anterior in three cases and posterolateral in one. Two to seven vertebral levels were affected. A Staphylococcus aureus was recovered from the blood cultures in all four cases and from a local specimen in one of the two patients who had a laminectomy. Of the two patients who did not have surgery, one had a normal neurologic evaluation and the other was an elderly patient with myeloma. In both, antimicrobial and corticosteroid therapy ensured complete resolution of the infection, and the myeloma patient recovered normal neurologic function. Residual neurologic loss was seen in one of the two surgically-treated patients. Two patients developed discitis.

Adult↗