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March 1991

No Serum Albumin in Myeloma-Reply

Author Affiliations

Chicago, Ill

Arch Intern Med. 1991;151(3):618-619. doi:10.1001/archinte.1991.00400030144036

In Reply.—  Dr Rubinstein proposed several possible pathogenetic mechanisms for hypoalbuminemia associated with multiple myeloma that we have recently described.1 Some of these mechanisms have already been discussed in our article. We would like to elaborate on the following points:

  1. Agreeing with Rubinstein, we also feel that hypoalbuminemia is likely a part of the cachexia syndrome associated with neoplasia. It, however, merits reemphasizing, as we did in our article, that cachexia is not simply the result of inadequate nutritional intake in patients with cancer, but may represent a set of characteristic biochemical and metabolic changes,2 possibly mediated by various tumor- and/or host-derived cytokines. We have mentioned specific suppression of hepatocyte albumin gene expression by interleukin 1. Other cytokines, such as tumor necrosis factor α/cachectin33 and interleukin 6,4 may also act additively or synergistically. Thus, correction of nutritional deficiency or supplementation with excess calorie and protein by hyperalimentation is