Takemori Nobuo, Imai Goro, Hoshino Kazuo, Ooi Akishi, Kojima Masaru
Division of Hematology, Department of Internal Medicine, Imai Hospital, Tanaka-cho 100, Ashikaga, Tochigi, 326-0822, Japan.
Department of Internal Medicine, Imai Hospital, Tanaka-cho 100, Ashikaga, Tochigi, 326-0822, Japan.
J Med Case Rep. 2018 Feb 18;12(1):40. doi: 10.1186/s13256-017-1550-6.
In general, dexamethasone is a required component drug in various combination chemotherapies for treating multiple myeloma, and its efficacy has been widely recognized. However, administration of dexamethasone is known to cause various adverse effects including hyperglycemia which requires insulin therapy. During the course of treatment, we developed a novel effective dexamethasone-free combination regimen and evaluated it for its effect in multiple myeloma.
We report a case of 68-year-old Japanese woman with refractory advanced Bence-Jones-λ type multiple myeloma associated with diabetes mellitus. Various combination regimens were carried out, but the response to some regimens was insufficient or others containing dexamethasone, although effective, were inappropriate to continue due to aggravation of diabetes mellitus. Thus, we developed a dexamethasone-free, short dosing-period regimen consisting of bortezomib, lenalidomide, and clarithromycin. This regimen was found to be highly effective and succeeded in achieving stringent complete response.
The successful dexamethasone-free regimen clearly shows that dexamethasone is not a requisite component in treating multiple myeloma, and it can be substituted with clarithromycin. This regimen is particularly useful for treating patients with multiple myeloma associated with diabetes mellitus.
一般来说，地塞米松是治疗多发性骨髓瘤的各种联合化疗中必需的组成药物，其疗效已得到广泛认可。然而，已知使用地塞米松会引起包括高血糖在内的各种不良反应，而高血糖需要胰岛素治疗。在治疗过程中，我们开发了一种新型有效的无地塞米松联合方案，并评估了其对多发性骨髓瘤的疗效。
我们报告了一例68岁的日本女性患者，患有难治性晚期本斯-琼斯λ型多发性骨髓瘤并伴有糖尿病。我们实施了各种联合方案，但对某些方案的反应不足，而其他含地塞米松的方案虽然有效，但由于糖尿病加重而不宜继续使用。因此，我们开发了一种由硼替佐米、来那度胺和克拉霉素组成的无地塞米松、短疗程方案。该方案被发现具有高效性，并成功实现了严格完全缓解。
成功的无地塞米松方案清楚地表明，地塞米松不是治疗多发性骨髓瘤的必需成分，可用克拉霉素替代。该方案对治疗伴有糖尿病的多发性骨髓瘤患者特别有用。
