Erath Alexandra, Patel Dilan A, Hosack Eric A, Patanella James E, Ibach Daniel M, Kassim Adetola A
Vanderbilt University School of Medicine, Nashville, TN, USA.
Department of Hematology and Bone Marrow Transplant, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA.
World J Oncol. 2020 Feb;11(1):33-36. doi: 10.14740/wjon1241. Epub 2020 Feb 2.
Multiple myeloma is a common plasma cell malignancy with a median overall survival of fewer than 10 years. Proteasome inhibitors comprise an important part of the treatment regimen for this disease. The present study reports the case of a 57-year-old man who experienced a second relapse of multiple myeloma 6 years after initial treatment with bortezomib, lenalidomide, dexamethasone (VRD) followed by autologous hematopoietic cell transplant. The first relapse had been successfully treated with VRD, but this approach failed to control his second relapse. Given the lack of response to VRD therapy and relapse while on bortezomib maintenance, the patient was deemed proteasome inhibitor-refractory and received a new treatment of elotuzumab, lenalidomide, and dexamethasone. Four and a half cycles were completed before the treatment was stopped due to grade 4 cytopenias. The patient received a novel combination of elotuzumab, bortezomib, nelfinavir, and dexamethasone. After six cycles, the serum M-protein level was improved to 0.6 g/dL and the kappa light chains dropped from 3.49 to 1.04 mg/dL. A bone marrow biopsy conducted after five treatment cycles demonstrated < 1% plasma cells by immunohistochemistry and achievement of minimal residual disease status. Overall, this case study suggests that proteasome inhibitor-refractory multiple myeloma may be successfully re-treated with proteasome inhibitors when co-administered with nelfinavir.
多发性骨髓瘤是一种常见的浆细胞恶性肿瘤，中位总生存期不足10年。蛋白酶体抑制剂是该疾病治疗方案的重要组成部分。本研究报告了一例57岁男性患者的病例，该患者在接受硼替佐米、来那度胺、地塞米松（VRD）初始治疗并进行自体造血细胞移植6年后，多发性骨髓瘤出现第二次复发。第一次复发已通过VRD成功治疗，但该方法未能控制其第二次复发。鉴于对VRD治疗缺乏反应且在硼替佐米维持治疗期间复发，该患者被认为对蛋白酶体抑制剂难治，并接受了埃罗妥珠单抗、来那度胺和地塞米松的新治疗。在因4级血细胞减少症停止治疗前完成了4.5个周期。该患者接受了埃罗妥珠单抗、硼替佐米、奈非那韦和地塞米松的新联合治疗。六个周期后，血清M蛋白水平提高到0.6 g/dL，κ轻链从3.49降至1.04 mg/dL。五个治疗周期后进行的骨髓活检通过免疫组织化学显示浆细胞<1%，达到微小残留病状态。总体而言，本病例研究表明，蛋白酶体抑制剂难治的多发性骨髓瘤在与奈非那韦联合使用时，可能成功地用蛋白酶体抑制剂重新治疗。
