Sarcoidosis and multiple myeloma: an association.

An association between sarcoidosis and neoplasia has been suggested. The development of malignant lymphoma has been reported in several patients with sarcoidosis,2 but there have been few reports of patients with sarcoidosis and multiple myeloma.24 We describe five patients with sarcoidosis who developed multiple myeloma. Case histories The table shows details offive patients with sarcoidosis seen by us during 1%9-86. In each case the diagnosis ofsarcoidosis was based on both the clinical findings and histological evidence ofnon-caseating epithelioid cell granulomas. The mean age of the patients at the time of diagnosis was 55 (range 42-65). In four patients myeloma developed several years after the diagnosis of sarcoidosis; in one both diagnoses were made at the same time. The duration ofsarcoidosis was more than two years in three patients (cases 1, 2, and 4), and sarcoidosis was considered to be active at the time of diagnosis of myeloma in two (cases 2 and 5). Two patients (cases 1 and 2) had been treated with steroids. All patients met the diagnostic criteria for multiple myeloma. Four patients (cases 1-4) were treated with cytotoxic drugs and the other (case 5) was followed up without treatment. Four patients survived, but the other (case 3) died in 1985, four years after the diagnosis of myeloma. Comment All our patients showed features consistent with sarcoidosis and were not thought to have had a sarcoidosis like reaction, such as has been described in association with malignant tumours, among them lymphoma and myeloma. In four of the cases the long time interval between the diagnoses (three to 12 years) increases the chance that these patients had two separate disease processes. In the one patient who presented with sarcoidosis and myeloma at the same time it is of course conceivable that both disorders were due to the same disease process. The mean age of our patients at the time of diagnosis of sarcoidosis was appreciably higher than the average age at which sarcoidosis is diagnosed. We thus agree with Brincker that it is the chronic active type of sarcoidosis that develops in middle aged patients that is associated with the subsequent development of neoplastic disease.2 Proof of a causal rather than a merely coincidental association between sarcoidosis and myeloma may be obtained only by prospective epidenlio-logical studies. Both diseases, however, are comparatively rare, the incidence of sarcoidosis in Finland varying from 5 to 21/100 000 and that of myeloma …