Huang Li, Kuang Yuemin, Jiang Zhiyong, Zhu Yan, Luo Xinguo, Shi Fangjing, Hu Shanshan, Gao Xinfang
Department of Hematology, Jinhua People's Hospital, No. 228 Xinhua Street, Jinhua, Zhejiang, 32100, China.
Open Med (Wars). 2020 Jun 11;15(1):540-544. doi: 10.1515/med-2020-0136. eCollection 2020.
Primary secondary tumor increased recently with the use of immunomodulatory drugs in patients with multiple myeloma (MM). However, MM with prior diagnosis of primary secondary tumor is relatively rare. In this study, we reported an MM patient with prior diagnosis of rectal cancer. In brief, an 85-year-old man was first diagnosed with rectal cancer. Given the age, heart failure and small-cell hypochromic anemia (hemoglobin level: 54 g/L), rectal cancer resection was not advised and symptomatic treatments were performed (including sufficient iron supplementation). Eight months later, the patient was diagnosed with MM due to worsening anemia. Anemia and heart failure were corrected after three cycles of treatment with thalidomide, dexamethasone and capecitabine. Radical resection of rectal carcinoma (Hartmann) was finally performed due to acute abdominal distension. Meanwhile, RR interval prolongation (longest interval >5.0 s) and atrial fibrillation occurred in the fifth cycle treatment. One month after discontinuation of thalidomide, RR interval returned to normal range, while atrial fibrillation developed into persistent atrial fibrillation.
随着免疫调节药物在多发性骨髓瘤（MM）患者中的应用，原发性继发性肿瘤近来有所增加。然而，先前诊断为原发性继发性肿瘤的MM相对少见。在本研究中，我们报告了1例先前诊断为直肠癌的MM患者。简而言之，一名85岁男性首先被诊断为直肠癌。鉴于其年龄、心力衰竭和小细胞低色素性贫血（血红蛋白水平：54 g/L），不建议进行直肠癌切除术，而是进行了对症治疗（包括充分补充铁剂）。8个月后，患者因贫血加重被诊断为MM。使用沙利度胺、地塞米松和卡培他滨治疗3个周期后，贫血和心力衰竭得到纠正。最终因急性腹胀进行了直肠癌根治性切除术（哈特曼手术）。同时，在第5周期治疗时出现RR间期延长（最长间期>5.0 s）和心房颤动。停用沙利度胺1个月后，RR间期恢复正常范围，而心房颤动发展为持续性心房颤动。
