It is almost axiomatic that once a disease or phase of a disease has been described, the frequency of its observation virtually increases exponentially with its recognition. Indeed, the report by Suchman et al represented one of four recent publications buttressing our initial observations on the aggressive phase of myeloma.1-4
Bergsagel and Pruzanski5 observed that roughly one third of the patients dying with myeloma had characteristics of the terminal phase that consisted of fever, peripheral pancytopenia, and marrow hypercellularity. The data presented by Blade et al suggested that the aggressive phase variant represents, in turn, a subset of one third of such patients or approximately 8% to 10% of all patients dying with myeloma. These data are roughly in keeping with our own preliminary observations.
The description of what constitutes the aggressive phase of myeloma may, in fact, be too restrictive. The presence of a histologic pattern suggestive