A case of secondary plasma cell leukemia resistant to novel agents, in which stringent complete remission was achieved and maintained for a long period of time after VAD therapy and tandem autologous transplantation.

Abstract	A 61-year-old woman was diagnosed in June 2011 as having immunoglobulin G (IgG) ĸ-type multiple myeloma (MM), stage II, according to the International Staging System (ISS). Chromosome analysis showed a complex karyotype, including t(11;14) and del 13q. Analysis of the cell surface markers revealed that the cells were positive for mature plasma cell-1 (MPC-1), and negative for cluster of differentiation (CD) 45 and CD49e, suggestive of an intermediate level of maturity of the cells. The disease was refractory to bortezomib-dexamethasone (BD) therapy and progressed to plasma cell leukemia despite the treatment. Treatment was therefore switched to lenalidomide-dexamethasone (RD) therapy, however, the condition again proved to be refractory to this therapy. A partial response (PR) was achieved with vincristine-doxorubicin-dexamethasone (VAD) therapy. The residual plasma cells became CD45-positive, suggesting a change of the cells from an intermediate level of maturity to mature cells. In December, autologous peripheral blood stem cell transplantation (Auto-PBSCT) was performed after high-dose melphalan therapy (melphalan 200 mg/m(2)) as pretreatment. PR was observed and a second Auto-PBSCT was performed in July 2012. Stringent complete remission (sCR) has been maintained for 2 years since, without any further treatment. This is the first reported case of secondary plasma cell leukemia (sPCL) resistant to new drugs that was successfully treated by high-dose melphalan in combination with VAD therapy and Auto-PBSCT.
Authors	Yasunobu Sekiguchi, Asami Shimada, Mutsumi Wakabayashi, Keiji Sugimoto, Shigeki Tomita, Hiroshi Izumi, Noriko Nakamura, Tomohiro Sawada, Yasunori Ohta, Norio Komatsu, Masaaki Noguchi
Journal	International journal of clinical and experimental pathology (Int J Clin Exp Pathol) Vol. 7 Issue 9 Pg. 6313-22 ( 2014) ISSN: 1936-2625 [Electronic] United States
PMID	25337285 (Publication Type: Case Reports, Journal Article)
Chemical References	Biomarkers, Tumor Boronic Acids Pyrazines Thalidomide Vincristine Bortezomib Dexamethasone Doxorubicin Leukocyte Common Antigens PTPRC protein, human Lenalidomide
Topics	Antineoplastic Combined Chemotherapy Protocols (therapeutic use) Biomarkers, Tumor (analysis) Bone Marrow Examination Boronic Acids (administration & dosage) Bortezomib Dexamethasone (administration & dosage) Doxorubicin (administration & dosage) Drug Resistance, Neoplasm Drug Substitution Female Humans Immunohistochemistry Lenalidomide Leukemia, Plasma Cell (diagnosis, immunology, therapy) Leukocyte Common Antigens (analysis) Magnetic Resonance Imaging Middle Aged Multiple Myeloma (diagnosis, immunology, therapy) Peripheral Blood Stem Cell Transplantation Plasma Cells (drug effects, immunology, pathology) Pyrazines (administration & dosage) Remission Induction Thalidomide (administration & dosage, analogs & derivatives) Time Factors Tomography, X-Ray Computed Transplantation, Autologous Treatment Outcome Vincristine (administration & dosage)

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