A 60-year-old female patient with a
therapy-resistant Bence-Jones (BJ) lambda-type
multiple myeloma was treated with
bortezomib. She had been treated with tandem autologous
stem cell transplantations and achieved complete remission before
her disease relapsed. Sixteen hours after the first administration of
bortezomib, an episode of
fever, slight consciousness disturbance and
vomiting occurred, which was accompanied by a remarkable elevation of LDH (3608 IU/l). Serum levels of
creatinine,
uric acid, and AST were also transiently elevated. Serum
interleukin-6 level was also increased after the administration of
bortezomib. The symptoms disappeared rapidly within 48 hours.
Bortezomib at a 25%-reduced dose was administered again along with
dexamethasone 26 days later, which caused a moderate increase in LDH levels, but no other symptoms. Further treatment caused no increase in LDH. The treatment was very effective and eradicated both urinary BJ
protein and bone marrow myeloma cells after 8 sessions of
bortezomib administration. These findings suggest that a
bortezomib-induced rapid reduction in
tumor burden led to
tumor lysis syndrome, for which caution is needed when treating myeloma patients with this very effective agent.