[Development of an extramedullary plasmacytoma despite disappearing M protein in multiple myeloma by bortezomib treatment].

Abstract

A 65-year-old male with IgG-kappa multiple myeloma was treated with melphalan-prednisolone (MP) and obtained a minimal response. Five months after the initiation of MP, he developed back pain, renal failure, hypercalcemia and increased plasma cells in the bone marrow. He was treated with bortezomib. After 2 cycles, he developed a peripheral neuropathy, and the dose of bortezomib was decreased to 1.0 mg/m(2). After 5 cycles, serum monoclonal protein was not detected by immunofixation, and the percentage of bone marrow plasma cells decreased to less than 5%. In March 2007, he developed lumbago again, and MRI of the lumbar vertebrae showed a tumor at the para pediculus arcus vertebrae. Immunohistochemistry of the biopsied tumor demonstrated monoclonal plasma cell infiltration. The patient was treated with local radiation therapy. Bortezomib is a new and effective agent for refractory/relapsed multiple myeloma. It has also been reported that bortezomib is effective for solitary extramedullary plasmacytoma (EMP). However, in the patient reported here, although bortezomib induced a complete response with regard to the serum monoclonal protein and the percentage of bone marrow plasma cells, EMP developed in the parapediculus arcus vertebrae. Herein, we document a case of EMP development during successful bortezomib therapy.

• Authors: Hiromi Koiso, Kenichi Tahara, Yohei Osaki, Momoko Mawatari, Tomomi Sekigami, Akihiko Yokohama, Takayuki Saitoh, Hideki Uchiumi, Hiroshi Handa, Norifumi Tsukamoto, Masamitsu Karasawa, Yoshihisa Nojima, Hirokazu Murakami
• Journal: [Rinsho ketsueki] The Japanese journal of clinical hematology (Rinsho Ketsueki) Vol. 50 Issue 2 Pg. 78-82 (Feb 2009) ISSN: 0485-1439 [Print] Japan
• PMID: 19265298 (Publication Type: Case Reports, English Abstract, Journal Article)

Chemical References

• Antineoplastic Agents
• Boronic Acids
• Myeloma Proteins
• Protease Inhibitors
• Pyrazines
• multiple myeloma M-proteins
• Bortezomib

Topics

• Aged
• Antineoplastic Agents (administration & dosage)
• Boronic Acids (administration & dosage)
• Bortezomib
• Humans
• Lumbar Vertebrae
• Male
• Multiple Myeloma (blood, drug therapy)
• Myeloma Proteins (urine)
• Neoplasms, Second Primary (etiology)
• Plasmacytoma (etiology)
• Protease Inhibitors (administration & dosage)
• Pyrazines (administration & dosage)
• Spinal Neoplasms (etiology)