Kashima Emiko, Fujieda Atsushi, Nato Yuma, Ino Kazuko, Tawara Isao, Masuya Masahiro, Katayama Naoyuki
Department of Hematology and Oncology, Mie University Graduate School of Medicine.
Department of Hematology, Suzuka Kaisei Hospital.
Rinsho Ketsueki. 2020;61(3):223-227. doi: 10.11406/rinketsu.61.223.
A 56-year-old man diagnosed with multiple myeloma was treated with CBD (cyclophosphamide, bortezomib, and dexamethasone; DEX), which was discontinued because of bortezomib-associated adverse events. Thereafter, he was treated with Ld (lenalidomide; LEN+DEX) followed by high-dose chemotherapy with autologous stem cell rescue, resulting in a complete response. Ld as maintenance therapy was discontinued because of immune thrombocytopenia, resulting in disease progression. Although treatment was switched to Pd (pomalidomide+DEX), DLd (daratumumab+LEN+DEX), and IRd (ixazomib+LEN+DEX); the patient's M protein level continued to increase and the extramedullary disease expanded despite radiotherapy. He was treated with E-Ld (elotuzumab+LEN+DEX) after 3 cycles of short VAD (vincristine, doxorubicin, and DEX). The extramedullary disease disappeared after 8 cycles of E-Ld. To the best of our knowledge, this is the first report showing the effectiveness of E-Ld treatment for extramedullary disease of a heavily treated patient for multiple myeloma. We believe that the clinical course of this patient provides useful insights about the antimyeloma mechanism of elotuzumab.
一名56岁的男性被诊断为多发性骨髓瘤,接受了环磷酰胺、硼替佐米和地塞米松(CBD)治疗,但因硼替佐米相关不良事件而停药。此后,他接受了来那度胺联合地塞米松(Ld)治疗,随后进行了自体干细胞救援的大剂量化疗,实现了完全缓解。Ld作为维持治疗因免疫性血小板减少而停药,导致疾病进展。尽管治疗方案改为泊马度胺联合地塞米松(Pd)、达雷妥尤单抗联合来那度胺和地塞米松(DLd)以及伊沙佐米联合来那度胺和地塞米松(IRd),但患者的M蛋白水平持续升高,尽管进行了放疗,髓外疾病仍在扩大。在进行了3个周期的短程VAD(长春新碱、阿霉素和地塞米松)治疗后,他接受了埃罗妥珠单抗联合来那度胺和地塞米松(E-Ld)治疗。经过8个周期的E-Ld治疗后,髓外疾病消失。据我们所知,这是第一份显示E-Ld治疗对多发性骨髓瘤经过大量治疗患者的髓外疾病有效的报告。我们认为该患者的临床病程为埃罗妥珠单抗的抗骨髓瘤机制提供了有用的见解。