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Multiple Myeloma in Young Patients-Reply

Joan Bladé, MD; Robert A. Kyle, MD; Philip R. Greipp, MD
Arch Intern Med. 1997;157(3):361. doi:10.1001/archinte.1997.00440240127023.
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The letter from Kaplon and Karnad concerning our article1 raises the issue of the occurrence of monoclonal gammopathies and multiple myeloma in patients with HIV infection. In their letter, they state that very young HIV-infected patients with multiple myeloma have unusual clinical presentations with extensive extramedullary involvement. In fact, Karnad et al2 described a 26-year-old patient with acquired immunodeficiency syndrome and nonsecretory multiple myeloma presenting with extramedullary plasmacytomas and lytic bone lesions who was not included in our review. Taking into account that the development of high-grade, malignant B-cell lymphoma is a frequent and well-established complication of HIV infection, we emphasize that the differential diagnosis between anaplastic multiple myeloma and immunoblastic lymphoma must be considered in cases with extensive extramedullary involvement and an aggressive clinical course.3,4 On the other hand, M-proteins have been found in association with the acquired immunodeficiency syndrome. In a small series, more than


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