Wada Akinori, Yasumura Satoshi, Kajikawa Sayaka, Murakami Jun, Sato Tsutomu
Department of Hematology, Toyama University Hospital.
Division of Clinical Laboratory and Blood Center, Toyama University Hospital.
Rinsho Ketsueki. 2020;61(8):879-884. doi: 10.11406/rinketsu.61.879.
A 50-year-old woman diagnosed with surgically resected plasmacytoma of the ovaries and uterus presented with another plasmacytoma in the pancreas with positive uptake on positron emission tomography (PET) and massive right pleural effusion with plasma cell infiltration (myelomatous pleural effusion). After four courses of the bortezomib, lenalidomide, and dexamethasone regimen as induction therapy, partial response was achieved with reduced myelomatous pleural effusion and negative uptake on PET in the pancreatic plasmacytoma. However, soon after she received bortezomib and high-dose cyclophosphamide for peripheral blood stem cell harvesting, right myelomatous pleural effusion increased without signs of heart failure or infection. Because of the progressive nature of the disease, daratumumab was introduced as 2 courses of daratumumab, lenalidomide, and dexamethasone (DLd) regimen, after which she achieved complete response with disappearance of the pleural effusion. After autologous peripheral blood stem cell transplantation, she received an additional four courses of the DLd regimen as consolidation therapy. She maintained relapse-free survival for two years with maintenance therapy containing daratumumab and dose-reduced lenalidomide. Our case may suggest the usefulness of daratumumab before autologous peripheral stem cell transplantation for relapsed/refractory myelomatous pleural effusion.
一名50岁女性，被诊断为卵巢和子宫浆细胞瘤，经手术切除后，胰腺又出现了一个浆细胞瘤，正电子发射断层扫描（PET）显示摄取阳性，并有大量右侧胸腔积液伴浆细胞浸润（骨髓瘤性胸腔积液）。在接受了四个疗程的硼替佐米、来那度胺和地塞米松方案作为诱导治疗后，胸腔积液减少，胰腺浆细胞瘤PET摄取转阴，病情取得部分缓解。然而，在她接受硼替佐米和大剂量环磷酰胺用于采集外周血干细胞后不久，右侧骨髓瘤性胸腔积液增多，且无心力衰竭或感染迹象。由于疾病呈进展性，遂采用2个疗程的达雷妥尤单抗、来那度胺和地塞米松（DLd）方案，之后胸腔积液消失，病情完全缓解。自体外周血干细胞移植后，她又接受了四个疗程的DLd方案作为巩固治疗。通过含达雷妥尤单抗和减量来那度胺的维持治疗，她维持了两年无复发生存。我们的病例可能提示，对于复发/难治性骨髓瘤性胸腔积液，在自体外周干细胞移植前使用达雷妥尤单抗可能有效。
