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Biomedical subjects

R A Kyle

Publications and source records attributed to R A Kyle.

At least 217 records · Page 12Linked to original sources
PubMed1995

Prognostic factors in multiple myeloma.

The median duration of survival for patients with multiple myeloma ranges from 2.5 to 3 years. However, there is considerable variability from one patient to another. Renal function as determined from blood urea nitrogen or serum creatinine values, hemoglobin value, calcium level and performance status have been recognized as prognostic factors for more than 20 years. A study of 107 patients with newly diagnosed multiple myeloma at the Mayo Clinic showed that plasma cell labeling index (PCLI); levels of thymidine kinase, beta 2-microglobulin (beta 2-M), serum albumin, and C-reactive protein; and age were all significant univariate prognostic factors. Only PCLI and beta 2-M levels had independent prognostic significance. Among nine patients younger than 65 years with low PCLI and low beta 2-M levels, eight were alive almost six years after starting chemotherapy. Interleukin 6 (IL-6) is a significant univariate predictor of survival in myeloma. An elevated lactate dehydrogenase content is associated with a poor prognosis. An elevated soluble IL-6 receptor (sIL-6R) level is an independent factor associated with shorter survival. In one study, the addition of sIL-6R to PCLI and beta 2-M to the analysis doubled the proportion of patients identified as high-risk. In this study, the two-year survival was 41% at two years if the PCLI was > or = 2%, beta 2-M was > or = 4.0 micrograms/dl, or sIL-6R was > 300 ng/ml. When none of these three factors were increased, the estimated two-year survival was 83%.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1995

A phase II study of high-dose methylprednisolone in refractory or relapsed multiple myeloma.

A single-arm, phase II perspective clinical trial was done in a tertiary care setting to determine the efficacy of high-dose methylprednisolone in the treatment of patients with refractory or relapsed multiple myeloma. Twenty patients who had failed at least one chemotherapeutic regimen received methylprednisolone (2 g) intravenously three times weekly for 8 weeks. After 8 weeks, responders were placed on a maintenance phase of 2 g intravenously weekly with an 8-week reinduction at the time of relapse. Five patients died within the first month of therapy. There were two complete responses, two objective responses and three minor responses. The median survival for all 20 patients was 2.2 months. Median survival for the seven responders was 19 months, with a relapse-free survival of 15 months. Five patients survived at least 16 months. High-dose methylprednisolone is an easily administered, relatively nontoxic, and effective therapy in a subset of patients with multiple myeloma.

Adult↗
PubMed1994

Expression of F4, 8.12, 3I, and 16/6 anti-DNA idiotype-related antigens on cationic human IgG myeloma proteins.

One hundred cationic isolated human IgG myeloma proteins were studied for expression of four anti-DNA idiotypic (Id) markers F4, 3I, 8.12, and 16/6. Forty-three of 100 myelomas showed the presence of at least one anti-DNA idiotype. Twenty-seven were F4 positive, 18 were 16/6 positive, 8 were 3I positive, and 7 were positive for 8.12. Two different anti-DNA idiotypic markers were found together on the same 14 myeloma proteins and 3 myelomas showed three different anti-DNA Ids. Anti-DNA activity was found on only 1 of 100 myelomas but not associated with presence of an anti-DNA Id. Ten myelomas showed anti-F(ab')2 activity and 6 of these also showed the presence of an anti-DNA Id marker. When myeloma proteins expressing anti-DNA Ids were compared in direct competition ELISAs with known Id-positive human IgG anti-DNA antibodies, much less inhibition was recorded in comparison to known human anti-DNA antibodies. Our findings indicate that human IgG myeloma proteins may show positive reactions with anti-DNA idiotypic antibodies but do not express the complete anti-DNA idiotypic antigenic complex.

Antibodies, Antinuclear↗
PubMed1994

Monoclonal gammopathy of undetermined significance.

Monoclonal gammopathy of undetermined significance (MGUS) accounted for 56% of the 1026 patients with a monoclonal plasma cell disorder seen at the Mayo Clinic during 1992. Approximately 3% of persons older than 70 years and 1% of those older than 50 years had MGUS. In a series of 241 Mayo Clinic patients with a serum M-protein but no evidence of multiple myeloma, macroglobulinemia, primary amyloidosis, lymphoma, or related disorders, followed up for 20 to 35 years (median, 22 years), the condition of 19% remained stable. Ten percent had an increase in the serum M-protein to 3.0 g/dL or more but did not require chemotherapy, whereas 47% died of unrelated causes. 59 of the 241 patients (24.5%) developed a serious disease during the median follow-up period of 22 years: multiple myeloma in 39 patients, primary amyloidosis in 8, Waldenström's macroglobulinemia in 7, and other malignant lymphoproliferative disorders in 5. The actuarial rate of malignant transformation was 17% at 10 years and 33% at 20 years. The median interval from diagnosis of MGUS to the diagnosis of serious disease was 8.5 to 10.5 years. No single factor can differentiate a patient with benign monoclonal gammopathy from one in whom a malignant plasma cell disorder will subsequently develop. Therefore, the serum M-protein must be measured and a clinical evaluation conducted periodically.

Actuarial Analysis↗
PubMed1994

Multiple myeloma: how did it begin?

OBJECTIVE: To present a historical overview of multiple myeloma. DESIGN: The pertinent literature, from the early cases of this disorder to subsequent diagnostic advances, was reviewed. RESULTS: The first well-known case of multiple myeloma (described in the 1840s) was that of Mr. McBean, a highly respectable tradesman from London. Although the features of Bence Jones proteinuria were recognized by his physician, Dr. William Macintyre, urine specimens from Mr. McBean were studied in detail by Henry Bence Jones, a well-known chemical pathologist, who confirmed the findings of Macintyre. The disease was rarely recognized until 1889, when the famous case report by Kahler was published. Interestingly, the subject of this case report (Dr. Loos) survived for 8 years despite inadequate chemotherapy. The role of plasma cells was recognized at the turn of the century. In 1922, Bayne-Jones and Wilson identified two distinct groups of Bence Jones protein, but a relationship between Bence Jones protein and the serum proteins of multiple myeloma was not demonstrated until 1956, in a study performed by Korngold and Lipari. (The designation of the two main classes of Bence Jones protein as kappa and lambda is a tribute to these two investigators.) The major breakthrough was the discovery that light chains from a serum IgG myeloma protein and the Bence Jones protein from the same patient's urine were identical. CONCLUSION: Multiple myeloma is a devastating disorder of plasma cell proliferation in the bone marrow that can result in skeletal destruction. Immunoelectrophoresis is useful as the initial diagnostic procedure.

History, 19th Century↗