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

Journal: [Rinsho Ketsueki] The Japanese Journal Of Clinical Hematology
Published:
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