C78-40 Patient Centered Management in Myelomatous Pleural Effusion

Abstract Introduction Pleural effusions are considered an uncommon finding associated with multiple myeloma (MM) occurring in 6% of patients. Pleural effusions from MM are often due to complications of MM like chronic renal failure or infections. Extramedullary spread of MM may cause myelomatous pleural effusion (MPE). MPE affects less than 1% of patients with MM. They are associated with chest wall, pleural or pulmonary plasmacytomas. Patients with MPE have a poor prognosis with median survival of around 4 months. The poor prognosis of MPE lends itself to palliative management. These options include pleurodesis, frequent thoracentesis, or drainage catheter. Case A 56 year-old woman with history of refractory IgG lambda MM complicated by bowel obstruction requiring stenting presented with acute unremitting nausea, vomiting, poor intake and lack of regular bowel movements. An abdominal CT showed a retroperitoneal mass associated with obstruction and a small right pleural effusion. The patient developed dyspnea 5 days after admission. Imaging showed a large pleural effusion with pleural lesions consistent with neoplasm. Thoracentesis drained 2L of serosanguineous fluid. This Cytologic evaluation of the pleural fluid showed predominately plasma cells. Over the next 5 days the fluid rapidly reaccumulated requiring another thoracentesis. The patient was discharged home for a follow up pleural drainage catheter, however patient expired prior to the follow up appointment. Discussion This patient’s rapidly accumulating MPE necessitated frequent drainage. Management of MPE should focus on patient comfort and quality of life. Due to the advanced refractory MM associated with MPE, careful consideration of prognosis is required. Interventions like pleurodesis and drainage catheter placement in patients with longer anticipated survival may be appropriate. Serial repeat thoracentesis for symptom control should be considered in patients with very short expected survival. This abstract is funded by: none