Successful treatment of early relapse of ocular myeloma with bortezomib and steroid after autologous stem cell transplantation.

Autologous stem cell transplantation (ASCT) can prolong remission duration, overall and progression free-survival in multiple myeloma (MM). Ocular relapse is rare in MM. Here we present a patient with only ocular relaps and without evidence of bone marrow progression after ASCT. Ig A kappa myeloma, stage IIIA was diagnosed in a 53-year-old man, according to Kyle-Greipp and Durie Salmon. He was treated with three courses of VAD therapy. Then he received high dose melphalan (200 mg/m2), followed by the ASCT. After two months from ASCT, he had bilateral blurry vision, pain, redness in both eyes and diplopia. We detected 5 mm of right-sided proptosis by Hertel exophthalmometry (base 110, 20 mm right eye, 15 mm left eye). Ocular motility of oculus dexter (OD) was restricted in up and lateral gaze. He has diplopia in up gaze. His color vision was 7 of 12 in the right eye and 10 of 12 in the left eye with Ishihara plates. Best corrected visual acuity was 6/10 in the right eye and 7/10 in the left eye. Intraocular pressures were 19 mmHg for OD and 18 mmHg for oculus sinister (OS). Slit lamp biomicroscopy revealed subconjunctival hemorrhages superiorly and temporally in the right eye and bilateral conjunctival hyperemia with chemosis. Fundus examinations of both eyes were unremarkable. Computed tomography and magnetic resonance imaging of orbita revealed a right intraorbital extraconal soft tissue density mass that involved the lacrimal gland and lateral rectus muscle. Prednisolon 1mg/kg/day and bortezomib 1.3 mg/m2 were started (1, 4, 8, 11 days). Eye findings were recovered after one month. Ocular relapse should be considered if there are ocular findings after ASCT for MM. Bortezomib and steroid may be useful for ocular extramedullary relapse of MM (Fig. 2, Ref. 8).