ATTEINTE RENALE AU COURS DU MYELOME MULTIPLE : EXPERIENCE AU SERVICE D’HEMATOLOGIE DU CAC DE SETIF

Abstract

Introduction : Multiple myeloma (MM) is a malignant hematological disorder characterized by the uncontrolled proliferation of plasma cells, which are responsible for the secretion of complete or incomplete immunoglobulins. Objectives : The aim of this dissertation is to describe the clinical, biological, therapeutic, and evolutionary characteristics of renal involvement in multiple myeloma. Materials and Methods : This was a retrospective, descriptive, and analytical study conducted at the Hematology Department of CAC Sétif over a period of 4 months, from January 1st to April 30th, 2023. Data from new and archived medical records were imported into Excel and analyzed using SPSS software version 22. Our study included: Patients with MM and patients with multiple myeloma complicated by renal involvement. Results and Discussion : According to our study, MM predominantly affects elderly individuals, with a higher incidence in males. Various clinical and biological manifestations were observed in our population, with hematological manifestations being the most common (94% of cases), followed by bone involvement (85% of cases), infectious manifestations (10% of cases), and neurological manifestations (3% of cases). On the biological level, hypercalcemia was found in 15% of cases, a monoclonal peak in serum protein electrophoresis (PBJ) in 69.6% of patients, and a positive urine protein electrophoresis (P24H) in 60.6% of cases. The distribution of monoclonal isotypes in our series highlighted a predominance of IgG (60.6%), followed by light chains (24.2%), IgA (9.1%), and IgD (6.1%). Among light chains, Lambda was predominant in 54.4% of cases, while Kappa was found in 45.5% of cases. Regarding prognosis, 93.5% of patients were classified as stage III (A and B) according to the SD classification, and 97% as stage 3 according to the ISS classification, indicating a poor prognosis. In terms of renal involvement evaluation in MM, complete remission was observed in 18.2% of cases, partial remission in 21.2% of the population, minor remission in 18.2%, and no remission in 42.4% of cases. Conclusion : Renal involvement is a frequent complication of multiple myeloma, and it is often associated with an unfavorable prognosis, as observed in 28% of our study population. Our study revealed a correlation between renal involvement and hematological manifestations in patients with myeloma. Furthermore, evaluation of renal function showed a favorable response in 57.6% of patients receiving appropriate treatment, with complete remission in 18.2% of patients, partial remission in 21.2%, and minor remission in 18.2% of cases. However, further analysis and additional studies are needed to better understand this relationship and improve treatment prospects.