[Multiple myeloma: a geriatric dilemma]

Asymptomatic multiple myeloma was diagnosed in an 80-year-old woman with ischemic heart and cerebrovascular disease. The diagnosis was based on the finding of a rapid sedimentation rate (120 mm in the first hour), paraproteinemia with high levels of monoclonal IgA (4,582 mg%) and the characteristic findings on bone marrow aspiration. There was neither Bence-Jones protein nor hypercalcemia, nor clinical signs of multiple myeloma, such as bone pain, pathological fractures, or recurrent infections. We faced a dilemma in deciding whether or not to treat this elderly, asymptomatic woman. Chemotherapy in an elderly patient can be hazardous, and even life-threatening, due to adverse effects. On the other hand, untreated myeloma may be followed by rapid deterioration. It was decided not to start chemotherapy unless the clinical picture were to change for the worse. Although the hyperviscosity syndrome in this condition is usually due to elevated IgM paraprotein, it has been caused by IgG, or as in this case, by IgA hyperparaproteinemia.