Multiple myeloma-associated amyloidosis is an independent high-risk prognostic factor

Ann Hematol. 2009 Jan;88(1):59-66. doi: 10.1007/s00277-008-0554-0. Epub 2008 Jul 22.


Several prognostic factors have been recognized in patients with multiple myeloma (MM). Among the most important are: the serum levels of beta2-microglobulin, albumin, and LDH; the labeling index; and an abnormal karyotype. Patients with amyloidosis (AL) have poor prognosis; however, little is known concerning the prognostic significance of AL associated to MM. In 201 consecutive patients with de novo MM, we performed a fat-pad biopsy needle aspiration (FPBNA) that was stained with Congo red. Sixty eight (34%) patients had AL and a poorer prognosis disease: lower performance status, presence of B symptoms, higher LDH and calcium values, and worse response to chemotherapy. Cox regression model for overall survival detected three variables having independent prognostic significance: the presence of AL (RR = 3.4, P < 0.004), serum albumin levels <3.5 g/dl (RR 3.2, p < 0.005), and patients not achieving complete remission or very good partial remission (RR 2.9, p < 0.02). In 28% of patients with de novo MM, FPBNA was useful to detect incidental amyloidosis. During follow-up, 69% of these patients had symptoms of AL. Excluding 16 patients with obvious symptoms of AL at diagnosis, overall survival was worse in patients who developed later symptoms of AL. MM-associated AL represents a poorer prognosis disease even in the absence of symptoms at diagnosis, and this specific association may be considered as an independent high-risk prognostic factor. The routine study of periumbilical fat-pad tissue should be mandatory in all patients with MM.

MeSH terms

  • Adipose Tissue / pathology
  • Adult
  • Aged
  • Amyloidosis / blood
  • Amyloidosis / diagnosis*
  • Amyloidosis / drug therapy
  • Amyloidosis / pathology*
  • Antineoplastic Agents / therapeutic use
  • Biopsy
  • Disease-Free Survival
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multiple Myeloma / blood
  • Multiple Myeloma / diagnosis*
  • Multiple Myeloma / drug therapy
  • Multiple Myeloma / pathology*
  • Prognosis
  • Proportional Hazards Models
  • Regression Analysis
  • Remission Induction
  • Risk Factors


  • Antineoplastic Agents