Myeloma ascites - A favorable outcome with cyclophosphamide therapy

A 71-year-old woman with multiple myeloma (MM) In remission was admitted fo r evaluation of recent abdominal distension and was diagnosed as having mas sive myeloma ascites. The fluid was characterized by a total nucleated cell count of 6,600/mm(3) (67% plasma cells), with a plasma cell CD38+ phenotyp e. Chemical analysis of the fluid showed lactate dehydrogenase of 122 IU/L, total protein of 2.9 g/dL, albumin of 2.4 g/dL, diastase of 38 IU/dL, chol esterol of 46 mg/dL, and C-reactive protein of 3 g/dL. The serum-ascites al bumin gradient (SAAG) was low (0.9). Electrophoresis of the ascitic fluid s howed a monoclonal spike in the gamma region and immunoelectrophoresis conf irmed the presence of lambda light chains similar to those seen in the urin e. Further analysis of the ascitic fluid showed markedly elevated levels of beta(2) microglobulin (11,161 mu g/L) and interleukin-6 (146 pg/ml compare d to serum level of 4.3 pg/ml). There was evidence of intraabdominal masses that completely resolved with continuous high-dose cyclophosphamide (750 m g/m(2)/day for four days) followed by clinical improvement and disappearanc e of the ascites. We stress the value of complete fluid characterization an d intensive chemotherapy to achieve a favorable outcome. (C) 1999 Wiley-Lis s, Inc.