Vnitr Lek 2019, 65(1):37-44 | DOI: 10.36290/vnl.2019.009

Systemic inflammatory response with high CRP values as the dominant symptom of multiple myeloma

Zdeněk Král¹, Zdeněk Adam^1,*, František Folber¹, Mojmír Moulis², Miroslav Tomíška¹, Lucie Říhová⁶, Martin Štork¹, Alena Buliková^1,6, Luděk Pour¹, Marta Krejčí¹, Viera Sandecká¹, Renata Koukalová³, Zdeněk Řehák³, Zdenka Čermáková^4,5

¹ Interní hematologická a onkologická klinika LF MU a FN Brno, pracoviště Bohunice

² Patologický ústav LF MU a FN Brno, pracoviště Bohunice

³ Oddělení nukleární medicíny, centrum PET, RECAMO, MOÚ, Brno

⁴ Oddělení klinické biochemie FN Brno, pracoviště Bohunice

⁵ Katedra laboratorních metod LF MU, Brno

⁶ Oddělení klinické hematologie FN Brno, pracoviště Bohunice

A man aged 60 years was examined for intense inflammatory response, night sweats, subfebrile and later febrile temperatures and a weight loss of 18 kg in 7 months. CRP was 270 mg/l, i.e. more than 20 times the upper limit of the physiological range. Reactive leukocytosis (10 × 10⁹/l), thrombocytosis (530 × 10⁹/l), increased fibrinogen (greater than 7 g/l), and anemia with hemoglobin of 80 g/l were present. No infection or systemic autoimmune disease has been proven. The patient had normal renal function and had no osteolytic deposits detectable by FDG-PET/CT. The procalcitonin level was not elevated. The bone marrow examination revealed a 30-40% infiltration of proplasmacyte type with admixture of plasmablasts, expressing light chains λ. Monoclonal immunoglobulin IgA λ was at a low concentration of about 8 g/l and the ratio of free light chains κ/λ was 0.13. The extent of bone marrow infiltration and anemia met the criteria for the diagnosis of symptomatic multiple myeloma. Following initiation of the combination therapy using thalidomide, bortezomib and dexamethasone, the maximum decrease in the concentrations of monoclonal immunoglobulin, free light chains and CRP was observed already after the first 2 cycles of treatment. Later, during the following two 2 cycles, the disease began to progress again. The patient underwent successful stem cell collection after the application of cyclophosphamide 2.5 g/m² and leukocyte growth factor (G-CSF), and high-dose chemotherapy (melphalan 200 mg/m²) with the support of stem cell transplantation. At 2 months following high-dose chemotherapy, CRP levels of the physiological range decreased, the blood count was normalized, and monoclonal immunoglobulin was not detectable.

Conclusion: The chronic inflammatory response may be due to plasmocytary bone marrow infiltration even if there are no other symptoms of multiple myeloma present, except for anemia which, however, also involves the inflammatory reaction. In this case, the systemic inflammatory reaction with high CRP levels signalled aggressive behaviour of the disease.

Keywords: CRP; multiple myeloma; procalcitonin; systemic inflammatory response

Received: March 26, 2018; Accepted: June 29, 2018; Published: January 1, 2019  Show citation