Background: Myelomatous pleural effusion (MPE), as a presentation of extramedullary infiltration of multiple myeloma (MM), is rare and currently associated with poor outcomes without effective therapy. The potential value of cytokine detection in pleural effusion to MPE has not been reported to date.
Case Presentation: We herein report a case of refractory and relapsed multiple myeloma that developed bilateral MPE due to disease progression caused by intolerance to various chemotherapy regimens. Cytomorphology and flow cytometry were adopted for diagnosis confirmation. Chemotherapy containing immunomodulators combined with thoracic catheterization drainage was applied to the patient, showing a certain therapeutic effect. During the course of disease, the change of cytokine profile in pleural effusion was monitored by cytometric bead array (CBA) technology, revealing that cytokines related to tumor load such as interleukin 6 (IL-6) and interleukin 10 (IL-10) in pleural effusion decreased with the improvement of disease, while other cytokines such as interleukin 2 (IL-2), interleukin 4 (IL-4), interleukin 17A (IL-17A), tumor necrosis factor α (TNF-α), interferon γ (IFN-γ), granzyme A, granzyme B, perforin and granulysin increased with the improvement of disease.
Conclusion: There is a prospect that cytokine level in pleural effusion may indicate treatment response of MPE, and in light of this case, immunomodulators may be utilized in treating patients suffering MPE. Due to limitations of our single case, we urge more groups to evaluate the potential role of cytokine profile in MPE.



中文翻译：

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胸水细胞因子谱在骨髓瘤性胸腔积液中的潜在作用

背景：骨髓瘤性胸腔积液 (MPE) 是多发性骨髓瘤 (MM) 髓外浸润的一种表现，非常罕见，目前在没有有效治疗的情况下与不良预后相关。迄今为止，尚未报道在 MPE 胸腔积液中检测细胞因子的潜在价值。
案例介绍：我们在此报告了一例难治性和复发性多发性骨髓瘤，由于对各种化疗方案不耐受而导致疾病进展，导致双侧 MPE。采用细胞形态学和流式细胞仪进行诊断确认。对患者应用含免疫调节剂的化疗联合胸导管引流，显示出一定的治疗效果。在病程中，通过细胞计数珠阵列（CBA）技术监测胸腔积液中细胞因子谱的变化，揭示了与肿瘤负荷相关的细胞因子如白细胞介素6（IL-6）和白细胞介素10（IL-10）胸腔积液随病情好转而减少，而其他细胞因子如白细胞介素2（IL-2）、白细胞介素4（IL-4）、白细胞介素17A（IL-17A）、肿瘤坏死因子α（TNF-α）、
结论：胸腔积液中细胞因子水平有可能表明MPE的治疗反应，鉴于此，免疫调节剂可用于治疗MPE患者。由于我们单个案例的局限性，我们敦促更多的团体评估细胞因子谱在 MPE 中的潜在作用。