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Plasma Cell Disorders

Endocrine, metabolic, nutritional and body composition abnormalities are common in advanced intensively-treated (transplanted) multiple myeloma

Bone Marrow Transplantation volume 49, pages 907–912 (2014)Cite this article

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A Corrigendum to this article was published on 19 May 2014

This article has been updated

Abstract

Modern treatment strategies have increased life expectancy in multiple myeloma, but little is known about the endocrine, metabolic and nutritional status of long-term survivors. We performed endocrine, metabolic, bone, body composition and nutritional evaluations in 32 patients with intensively-treated, advanced but stable, myeloma a median duration of 6 years from diagnosis and three lines of intensive treatment, including at least one haematopoietic SCT procedure. All patients were off active treatment. There was a high prevalence of endocrine dysfunction: hypothyroidism (9%), hypogonadism (65% males) and elevated prolactin (19%). Adrenocortical function was preserved despite large cumulative corticosteroid pretreatment. Biochemical markers were consistent with postmenopausal status in all females and infertility in males. Nutritionally, 59% were vitamin D insufficient/deficient, reduced serum folate in 25% and vitamin B12 in 6%. Total body DEXA scanning confirmed ‘sarcopenic-obesity’ in 65%, but reduced bone density was seen in a minority. We conclude that potentially correctable endocrine, metabolic and nutritional abnormalities are prevalent in heavily-treated patients with stable multiple myeloma. Preservation of bone supports the efficacy of bisphosphonate treatment from diagnosis, but sarcopenic-obesity may contribute to frailty. Ultimately, multi-system screening and appropriate interventions may optimise quality of long-term survival and further studies are warranted.

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  • 02 July 2014

    This article has been corrected since Online Publication and a corrigendum has also been published.

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Acknowledgements

The investigators thank Myeloma UK for supporting this research with the Richard Townley Research Grant. We also thank the patients for participating; Charlotte Morgan and the staff of the Clinical Research Facility at the Royal Hallamshire Hospital, Sheffield, UK for coordinating this research; Professor Richard Eastell, Consultant in Metabolic Bone Medicine for advice on bone marker measurement; Fatma Gossiel, Bone Metabolism Unit, University of Sheffield for measuring the bone markers; Sandra Gutcher and James Swinscoe for DEXA scans; the laboratory scientists and technicians at Sheffield Teaching Hospitals NHS Foundation Trust clinical laboratory. We also acknowledge the other members of the Late Effects Group, Sheffield.

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Author notes

  1. Robert Coleman, Christine Eiser, William Ledger and Shehnaaz Jivraj: Members of the Late Effects Group are listed before References.

Authors and Affiliations

  1. Department of Clinical Oncology, Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

    D M Greenfield

  2. Academic Unit of Supportive Care, University of Sheffield, Sheffield, UK

    E Boland & S H Ahmedzai

  3. Department of Clinical Haematology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

    Y Ezaydi & J A Snowden

  4. Academic Unit of Diabetes, Endocrinology and Reproduction, University of Sheffield, Sheffield, UK

    R J M Ross

Authors
  1. D M Greenfield
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  2. E Boland
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  3. Y Ezaydi
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  4. R J M Ross
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  5. S H Ahmedzai
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  6. J A Snowden
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Consortia

Late Effects Group

  • Robert Coleman
  • ,  Christine Eiser
  • ,  William Ledger
  •  &  Shehnaaz Jivraj

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Correspondence to D M Greenfield.

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The authors declare no conflict of interest.

Additional information

LATE EFFECTS GROUP, SHEFFIELD, UK Professor Robert Coleman, YCR Professor of Medical Oncology, Academic Unit of Clinical Oncology, University of Sheffield; Professor Christine Eiser, Professor of Child Health Psychology at the University of Sheffield, UK; Professor William Ledger, Professor of Obstetrics and Gynaecology at the University of New South Wales ; Dr Shehnaaz Jivraj, Gynaecologist at the Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS FT.

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Greenfield, D., Boland, E., Ezaydi, Y. et al. Endocrine, metabolic, nutritional and body composition abnormalities are common in advanced intensively-treated (transplanted) multiple myeloma. Bone Marrow Transplant 49, 907–912 (2014). https://doi.org/10.1038/bmt.2014.63

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