February 10, 1997

Multiple Myeloma in Young Patients

Author Affiliations

Johnson City, Tenn

Arch Intern Med. 1997;157(3):361. doi:10.1001/archinte.1997.00440240127022

The article by Bladé et al1 that appeared in the July 8, 1996, issue of the Archives is an excellent review of the rare presentation of multiple myeloma in young patients. Blade and colleagues' discussion, however, does not mention the equally uncommon occurrence of the disease in very young patients who are infected with human immunodeficiency virus (HIV). Monoclonal gammopathy,2,3 plasmacytoma,4 and multiple myeloma5,6 have been reported in HIV-infected patients younger than 30 years. Multiple myeloma in very young HIV-infected patients is also associated with multiple extramedullary plasmacytomas at unusual sites (eg, gastrointestinal tract, kidney, testicle, and lung).6-8 The presence of Epstein-Barr virus genomes in the tumor tissue of 2 young patients with HIV infection and multiple myeloma8,9 suggests a role for Epstein-Barr virus in the pathogenesis of myeloma in some patients with acquired immunodeficiency syndrome. A myelomaassociated paraprotein directed against the HIV-1 p24 antigen

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