[DebbieJ54]

Multiple myeloma & autoimmune hemolytic anemia

by DebbieJ54 on Fri Jun 26, 2015 6:54 pm

I am 61 and this all started with anemia and a trip to the ER. A diagnosis of autoimmune hemolytic anemia with blood work up that uncovered monoclonal immunuglobin IgG lambda. Bone marrow biopsy with 25% plasma was originally diagnosed as non-Hodgkins lymphoma, but then sent to Mayo and diagnosis changed to myeloma. Several tiny sclerotic lesions on skeleton came up in the CT scan with contrast (but not certain if these are attributable to myeloma, or possibly benign).

Have done 4 weeks of Rituxan (rituximab, MabThera) while on high dose prednisone to try to rectify the autoimmune hemolytic anemia. Currently trying to taper prednisone (now at 20, was at 60). Can't get a definite diagnosis of active or smoldering myeloma because I am still on prednisone, and doctor wants an MRI of spine to detect activity? Prednisone can skew the results.

So I am in a waiting game trying to taper the prednisone, and my body wants this done S-L-O-W-L-Y. Anytime I get down to 10 mg, I get breathless and my hemoglobin counts start to drop.

From what I have read, this is an extremely RARE situation. Anyone have any info about this kind of thing? I am wondering if I should be looking at a cancer treatment center for more input? I am currently treated in Wisconsin.

[Dr. Luciano Costa]

Re: Multiple myeloma & autoimmune hemolytic anemia

by Dr. Luciano Costa on Sat Jun 27, 2015 8:53 am

This is indeed a very unusual presentation for multiple myeloma, the key question is if the plasma cell disorder is the cause of the autoimmune hemolytic anemia. One may have a smoldering myeloma that otherwise would not require intervention and develop an autoimmune hemolytic anemia that is not related.

I agree that the additional work up with MRI may help to characterize the multiple myeloma. There are several other details that may help to solve the link, such as the nature of the antibody bound to red cells and causing hemolysis, the clonality of the plasma cell in the bone marrow, the presence or absence of specific chromosome abnormalities among the plasma cells, etc.

With all this complexity, I would suggest that you get evaluated by a myeloma expert if that is not yet the case.

[Jer610]

Re: Multiple myeloma & autoimmune hemolytic anemia

by Jer610 on Sat Jun 27, 2015 12:59 pm

Hello Debbie. I posted in February asking somewhat the same thing. I was diagnosed with AIHA and MGUS last April. My Hemo calls me the "mystery guy". The only problems I've had so far are enlarged spleen, galls stones from increased bilirubin, and increasing upper respiratory issues due to immunoparesis (IgA 36 and IgM 39). CT scans year to year show no myeloma/lymphoma culprits. I'm "watch and wait".

[DebbieJ54]

Re: Multiple myeloma & autoimmune hemolytic anemia

by DebbieJ54 on Sat Jan 23, 2016 7:20 am

Thank you for your input! Well, now several months later and I have been diagnosed with osteo­sclerotic myeloma (very rare, I guess). Similar to POEMS syndrome, but I don't have the neuropathy (thank goodness!). Since there is skeletal involvement (sclerotic lesions, not lytic), I am being treated for active myeloma. I have gone 4 cycles cyclophosphamide, Velcade, and dexamethasone (CyBorD) and will be having my autologous stem cell transplant February 1. I have a top notch myeloma specialist, so I am in very good hands!