Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Hypoalbuminemia in Patients With Multiple Myeloma

Hypoalbuminemia in Patients With Multiple Myeloma Abstract • Clinical data of 65 patients with myeloma were analyzed to identify factors associated with hypoalbuminemia. The serum albumin level was not affected by patient age and gender, type of myeloma, and the occurrence of Bence Jones protein, lytic bone lesions, or hypercalcemia, and it was not related to changes in body weight or in liver and renal function. The albumin level, lower in patients with proteinuria, was unrelated to severity of proteinuria. Albumin level correlated significantly with the monoclonal IgG level, hemoglobin concentration, clinical stage of disease, and estimated body tumor burden. Further analysis indicated the disease stage or the tumor burden as the dominant factor in determining albumin level. An albumin level of 29.0 g/L or less identified unequivocally advanced disease. Practically all patients with stage III myeloma had a serum albumin level of 37.0 g/L or less. Thus, hypoalbuminemia is primarily related to the extent of myeloma proliferation and is therefore of diagnostic and prognostic importance. (Arch Intern Med. 1990;150:605-610) References 1. Hallen J. Discrete gammaglobulin (M – ) components in serum . Acta Med Scand . 1966;462( (suppl) ):1-127. 2. Waldenstrom J. Diagnosis and Treatment of Multiple Myeloma . New York, NY: Grune & Stratton; 1970:142-153. 3. Waldenstrom JG. Benign monoclonal gammopathies . In: Azar HA, Potter M, eds. Multiple Myeloma and Related Disorders . New York, NY: Harper & Row Publishers Inc; 1973;1:247-286. 4. Peto R, Pike MC, Armitage P, et al. Design and analysis of randomized clinical trials requiring prolonged observation of each patient, II: analysis and examples . Br J Cancer . 1977;35:1-39.Crossref 5. Medical Research Council. Prognostic features in the third MRC myelomatosis trial . Br J Cancer . 1980;42:831-840.Crossref 6. Alexanian R, Balcerzak S, Bonnet JD, et al. Prognostic factors in multiple myeloma . Cancer . 1975;36:1192-1201.Crossref 7. Matzner Y, Benbassat J, Polliack A. Prognostic factors in multiple myeloma . Acta Haematol . 1978;60:257-268.Crossref 8. Merlini G, Waldenstrom JG, Jayakar S. A new improved clinical staging system for multiple myeloma based on analysis of 123 treated patients . Blood . 1980;55:1011-1019. 9. Brink S, Bradshaw D, Rosenstrauch WJCJ, van der Merwe AM. Prognostic factors in multiple myeloma . S Afr Med J . 1986;69:35-38. 10. Bataille R, Durie BGM, Grenier J, Sany J. Prognostic factors and staging in multiple myeloma: a reappraisal . J Clin Oncol . 1986;4:80-87. 11. Durie BGM, Salmon S. Multiple myeloma, macroglobulinemia and monoclonal gammopathies . In: Hoffbrand AV, Brain MC, Hirsh J, eds. Recent Advances in Haematology . New York, NY: Churchill Livingstone Inc; 1977:243-261. 12. Durie BGM, Salmon S. A clinical staging system for multiple myeloma . Cancer . 1975;36:842-854.Crossref 13. 1983 Height and Weight Tables . New York, NY: New York Metropolitan Life Insurance Co; 1983. 14. Zar JH. Biostatistical Analysis . 2nd ed. Englewood Cliffs, NJ: Prentice-Hall International Inc; 1984:328-360. 15. Snedecor GW, Cochrane WG. Statistical Methods . 6th ed. Ames, Iowa: Iowa State University; 1967:91-119,258-298. 16. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve . Radiology . 1982;143:29-36.Crossref 17. Metz CE. Basic principles of ROC analysis . Semin Nucl Med . 1978;8:283-298.Crossref 18. Simes RJ. Publication bias: the case for an international registry of clinical trials . J Clin Oncol . 1986;4:1529-1541. 19. Rothschild MA, Oratz M, Schreiber SS. Albumin metabolism . In: Rothschild MA, Waldmann T, eds. Plasma Protein Metabolism . Orlando, Fla: Academic Press Inc; 1970:199-206. 20. Rothschild MA, Oratz M, Schreiber SS. In vivo and in vitro regulation of albumin synthesis . In: Mariani G, ed. Pathophysiology of Plasma Protein Metabolism . New York, NY: Plenum Press; 1984:121-139. 21. Rothschild MA, Oratz M, Schreiber SS. Albumin synthesis . N Engl J Med . 1972;286:748-757,816-821.Crossref 22. Bowie L, Smith S, Gochman N. Characteristics of binding between reagent-strip indicators and urinary protein . Clin Chem . 1977;23:128-130. 23. James GP, Bee DE, Fuller JB. Proteinuria: accuracy and precision of laboratory diagnosis by dip-stick analysis . Clin Chem . 1978;24:1934-1939. 24. Bianchi R, Mariani G, Pilo A, Carmassi F, Toni MG. Increased albumin catabolism in early uremia as a cause of protein depletion . In: Bianchi R, Mariani G, McFarlane AS, eds. Plasma Protein Turnover . Baltimore, Md: University Park Press; 1976:371-378. 25. Kyle RA. Multiple myeloma: review of 869 cases . Mayo Clin Proc . 1975;50:29-40. 26. Thomas FB, Clausen KP, Greenberger NJ. Liver disease in multiple myeloma . Arch Intern Med . 1973;132:195-202.Crossref 27. Lunn PG. Nutritional aspects of plasma protein metabolic studies: protein-energy malnutrition . In: Mariani G, ed. Pathophysiology of Plasma Protein Metabolism . New York, NY: Plenum Press; 1984:299-323. 28. Jeejeebhoy KN, Bruce-Robertson A, Ho J, Sodtke U. The comparative effects of nutritional and hormonal factors on the synthesis of albumin, fibrinogen and transferrin . Ciba Found Symp . 1973;9:215-247. 29. Mullen JL, Gertner MH, Buzby GP, Goodhart GL, Rosato EF. Implications of malnutrition in the surgical patients . Arch Surg . 1979;114:121-125.Crossref 30. Bistrian BR, Blackburn GL, Vitale J, Cochran D, Naylor J. Prevalence of malnutrition in general medical patients . JAMA . 1976;235:1567-1570.Crossref 31. Kulkarni AB, Reinke R, Feigelson P. Acute phase mediators and glucocorticoids elevate α1-acid glycoprotein gene transcription . J Biol Chem . 1985;260:15386-15389. 32. Ramadori G, Sipe JD, Dinarello CA, Mizel SB, Colten HR. Pretranslational modulation of acute phase hepatic protein synthesis by murine recombinant interleukin 1 (IL-1) and purified human IL-1 . J Exp Med . 1985;162:930-942.Crossref 33. Jeejeebhoy KN, Baker JP, Wolman SL, et al. Critical evaluation of the role of clinical assessment and body composition studies in patients with malnutrition and after total parenteral nutrition . Am J Clin Nutr . 1982;35:1117-1127. 34. Shetty PS, Watrasiewicz KE, Jung RT, James WPT. Rapid-turnover transport proteins: an index of subclinical protein-energy malnutrition . Lancet . 1979;2:230-232.Crossref 35. Young GA, Hill GL. Assessment of protein-calorie malnutrition in surgical patients from plasma proteins and anthropometric measurements . Am J Clin Nutr . 1978;31:429-435. 36. Bjorneboe M, Briger Jensen K. Plasma volume, colloidosmotic pressure and gamma globulin in multiple myeloma . Acta Med Scand . 1969;186:475-478.Crossref 37. Rothschild MA, Oratz M, Franklin EC, Schreiber SS. The effect of hypergammaglobulinemia on albumin metabolism in hyperimmunized rabbits studied by albumin-I131 . J Clin Invest . 1962;41:1564-1571.Crossref 38. Rossig N. Albumin metabolism in neoplastic diseases . Scand J Clin Lab Invest . 1968;22:211-216.Crossref 39. Waldmann T, Trier J, Fallon H. Albumin metabolism in patients with lymphoma . J Clin Invest . 1963;42:171-178.Crossref 40. Steinfeld JL. I131-albumin degradation in patients with neoplastic diseases . Cancer. 1960;13:974-984.Crossref 41. Gitlin JD, Colten HR. Molecular biology of acute phase plasma proteins . Lymphokines . 1985;14:123-153. 42. Beutler B, Cerami A. Cachectin: more than a tumor necrosis factor . N Engl J Med . 1987;316:379-385.Crossref 43. Mundy GR, Bertolini DR. Bone destruction and hypercalcemia in plasma cell myeloma . Semin Oncol . 1986;13:291-299. 44. Garrett IR, Durie BGM, Nedwin GE, et al. Production of lymphotoxin, a bone-resorbing cytokine, by cultured human myeloma cells . N Engl J Med . 1987;317:526-532.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Hypoalbuminemia in Patients With Multiple Myeloma

Loading next page...
 
/lp/american-medical-association/hypoalbuminemia-in-patients-with-multiple-myeloma-gVz2BpeCKF
Publisher
American Medical Association
Copyright
Copyright © 1990 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1990.00390150095018
Publisher site
See Article on Publisher Site

Abstract

Abstract • Clinical data of 65 patients with myeloma were analyzed to identify factors associated with hypoalbuminemia. The serum albumin level was not affected by patient age and gender, type of myeloma, and the occurrence of Bence Jones protein, lytic bone lesions, or hypercalcemia, and it was not related to changes in body weight or in liver and renal function. The albumin level, lower in patients with proteinuria, was unrelated to severity of proteinuria. Albumin level correlated significantly with the monoclonal IgG level, hemoglobin concentration, clinical stage of disease, and estimated body tumor burden. Further analysis indicated the disease stage or the tumor burden as the dominant factor in determining albumin level. An albumin level of 29.0 g/L or less identified unequivocally advanced disease. Practically all patients with stage III myeloma had a serum albumin level of 37.0 g/L or less. Thus, hypoalbuminemia is primarily related to the extent of myeloma proliferation and is therefore of diagnostic and prognostic importance. (Arch Intern Med. 1990;150:605-610) References 1. Hallen J. Discrete gammaglobulin (M – ) components in serum . Acta Med Scand . 1966;462( (suppl) ):1-127. 2. Waldenstrom J. Diagnosis and Treatment of Multiple Myeloma . New York, NY: Grune & Stratton; 1970:142-153. 3. Waldenstrom JG. Benign monoclonal gammopathies . In: Azar HA, Potter M, eds. Multiple Myeloma and Related Disorders . New York, NY: Harper & Row Publishers Inc; 1973;1:247-286. 4. Peto R, Pike MC, Armitage P, et al. Design and analysis of randomized clinical trials requiring prolonged observation of each patient, II: analysis and examples . Br J Cancer . 1977;35:1-39.Crossref 5. Medical Research Council. Prognostic features in the third MRC myelomatosis trial . Br J Cancer . 1980;42:831-840.Crossref 6. Alexanian R, Balcerzak S, Bonnet JD, et al. Prognostic factors in multiple myeloma . Cancer . 1975;36:1192-1201.Crossref 7. Matzner Y, Benbassat J, Polliack A. Prognostic factors in multiple myeloma . Acta Haematol . 1978;60:257-268.Crossref 8. Merlini G, Waldenstrom JG, Jayakar S. A new improved clinical staging system for multiple myeloma based on analysis of 123 treated patients . Blood . 1980;55:1011-1019. 9. Brink S, Bradshaw D, Rosenstrauch WJCJ, van der Merwe AM. Prognostic factors in multiple myeloma . S Afr Med J . 1986;69:35-38. 10. Bataille R, Durie BGM, Grenier J, Sany J. Prognostic factors and staging in multiple myeloma: a reappraisal . J Clin Oncol . 1986;4:80-87. 11. Durie BGM, Salmon S. Multiple myeloma, macroglobulinemia and monoclonal gammopathies . In: Hoffbrand AV, Brain MC, Hirsh J, eds. Recent Advances in Haematology . New York, NY: Churchill Livingstone Inc; 1977:243-261. 12. Durie BGM, Salmon S. A clinical staging system for multiple myeloma . Cancer . 1975;36:842-854.Crossref 13. 1983 Height and Weight Tables . New York, NY: New York Metropolitan Life Insurance Co; 1983. 14. Zar JH. Biostatistical Analysis . 2nd ed. Englewood Cliffs, NJ: Prentice-Hall International Inc; 1984:328-360. 15. Snedecor GW, Cochrane WG. Statistical Methods . 6th ed. Ames, Iowa: Iowa State University; 1967:91-119,258-298. 16. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve . Radiology . 1982;143:29-36.Crossref 17. Metz CE. Basic principles of ROC analysis . Semin Nucl Med . 1978;8:283-298.Crossref 18. Simes RJ. Publication bias: the case for an international registry of clinical trials . J Clin Oncol . 1986;4:1529-1541. 19. Rothschild MA, Oratz M, Schreiber SS. Albumin metabolism . In: Rothschild MA, Waldmann T, eds. Plasma Protein Metabolism . Orlando, Fla: Academic Press Inc; 1970:199-206. 20. Rothschild MA, Oratz M, Schreiber SS. In vivo and in vitro regulation of albumin synthesis . In: Mariani G, ed. Pathophysiology of Plasma Protein Metabolism . New York, NY: Plenum Press; 1984:121-139. 21. Rothschild MA, Oratz M, Schreiber SS. Albumin synthesis . N Engl J Med . 1972;286:748-757,816-821.Crossref 22. Bowie L, Smith S, Gochman N. Characteristics of binding between reagent-strip indicators and urinary protein . Clin Chem . 1977;23:128-130. 23. James GP, Bee DE, Fuller JB. Proteinuria: accuracy and precision of laboratory diagnosis by dip-stick analysis . Clin Chem . 1978;24:1934-1939. 24. Bianchi R, Mariani G, Pilo A, Carmassi F, Toni MG. Increased albumin catabolism in early uremia as a cause of protein depletion . In: Bianchi R, Mariani G, McFarlane AS, eds. Plasma Protein Turnover . Baltimore, Md: University Park Press; 1976:371-378. 25. Kyle RA. Multiple myeloma: review of 869 cases . Mayo Clin Proc . 1975;50:29-40. 26. Thomas FB, Clausen KP, Greenberger NJ. Liver disease in multiple myeloma . Arch Intern Med . 1973;132:195-202.Crossref 27. Lunn PG. Nutritional aspects of plasma protein metabolic studies: protein-energy malnutrition . In: Mariani G, ed. Pathophysiology of Plasma Protein Metabolism . New York, NY: Plenum Press; 1984:299-323. 28. Jeejeebhoy KN, Bruce-Robertson A, Ho J, Sodtke U. The comparative effects of nutritional and hormonal factors on the synthesis of albumin, fibrinogen and transferrin . Ciba Found Symp . 1973;9:215-247. 29. Mullen JL, Gertner MH, Buzby GP, Goodhart GL, Rosato EF. Implications of malnutrition in the surgical patients . Arch Surg . 1979;114:121-125.Crossref 30. Bistrian BR, Blackburn GL, Vitale J, Cochran D, Naylor J. Prevalence of malnutrition in general medical patients . JAMA . 1976;235:1567-1570.Crossref 31. Kulkarni AB, Reinke R, Feigelson P. Acute phase mediators and glucocorticoids elevate α1-acid glycoprotein gene transcription . J Biol Chem . 1985;260:15386-15389. 32. Ramadori G, Sipe JD, Dinarello CA, Mizel SB, Colten HR. Pretranslational modulation of acute phase hepatic protein synthesis by murine recombinant interleukin 1 (IL-1) and purified human IL-1 . J Exp Med . 1985;162:930-942.Crossref 33. Jeejeebhoy KN, Baker JP, Wolman SL, et al. Critical evaluation of the role of clinical assessment and body composition studies in patients with malnutrition and after total parenteral nutrition . Am J Clin Nutr . 1982;35:1117-1127. 34. Shetty PS, Watrasiewicz KE, Jung RT, James WPT. Rapid-turnover transport proteins: an index of subclinical protein-energy malnutrition . Lancet . 1979;2:230-232.Crossref 35. Young GA, Hill GL. Assessment of protein-calorie malnutrition in surgical patients from plasma proteins and anthropometric measurements . Am J Clin Nutr . 1978;31:429-435. 36. Bjorneboe M, Briger Jensen K. Plasma volume, colloidosmotic pressure and gamma globulin in multiple myeloma . Acta Med Scand . 1969;186:475-478.Crossref 37. Rothschild MA, Oratz M, Franklin EC, Schreiber SS. The effect of hypergammaglobulinemia on albumin metabolism in hyperimmunized rabbits studied by albumin-I131 . J Clin Invest . 1962;41:1564-1571.Crossref 38. Rossig N. Albumin metabolism in neoplastic diseases . Scand J Clin Lab Invest . 1968;22:211-216.Crossref 39. Waldmann T, Trier J, Fallon H. Albumin metabolism in patients with lymphoma . J Clin Invest . 1963;42:171-178.Crossref 40. Steinfeld JL. I131-albumin degradation in patients with neoplastic diseases . Cancer. 1960;13:974-984.Crossref 41. Gitlin JD, Colten HR. Molecular biology of acute phase plasma proteins . Lymphokines . 1985;14:123-153. 42. Beutler B, Cerami A. Cachectin: more than a tumor necrosis factor . N Engl J Med . 1987;316:379-385.Crossref 43. Mundy GR, Bertolini DR. Bone destruction and hypercalcemia in plasma cell myeloma . Semin Oncol . 1986;13:291-299. 44. Garrett IR, Durie BGM, Nedwin GE, et al. Production of lymphotoxin, a bone-resorbing cytokine, by cultured human myeloma cells . N Engl J Med . 1987;317:526-532.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Mar 1, 1990

References