Mizuno Shinichi, Kitayama Chigusa, Mashiko Shigeto, Sanada Satoru
Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, 3-16-1, Tsutsumimachi, Aoba-Ku, Sendai, Miyagi, 981-8501, Japan.
CEN Case Rep. 2022 May;11(2):265-268. doi: 10.1007/s13730-021-00668-w. Epub 2021 Nov 24.
An 81-year-old Japanese woman was diagnosed with Bence Jones protein κ-type multiple myeloma with acute kidney injury and severe anemia, complicated by congestive heart failure with triple vessel coronary artery disease. Her serum κ-free light-chain (FLC) level was 49,400 mg/L and κ/λ ratio was extremely high at 2373. Her kidney function deteriorated rapidly and required hemodialysis before initiating chemotherapy. A combination therapy of daratumumab (16 mg/kg), lenalidomide, and dexamethasone was initiated as a first-line treatment; the infusion rate of daratumumab was adjusted to reduce the heart load. The level of κ-FLC was rapidly reduced by 75% in only one week and by 99% after three weeks. Furthermore, she was dialysis-independent after the fourth dose of daratumumab. We report the first case of untreated patient with myeloma who had been successfully treated with daratumumab, lenalidomide, and dexamethasone therapy even in dialysis requiring state. Daratumumab may benefit patients with acute kidney injury caused by multiple myeloma, owing to the immediate need of FLC level reduction. Daratumumab and lenalidomide combination therapy could be a valuable treatment option for patients requiring dialysis when bortezomib may be hesitate to use due to severe heart disease.
一名81岁的日本女性被诊断为κ型本-周蛋白多发性骨髓瘤，伴有急性肾损伤和严重贫血，并伴有充血性心力衰竭和三支冠状动脉疾病。她的血清κ游离轻链（FLC）水平为49400mg/L，κ/λ比值极高，为2373。她的肾功能迅速恶化，在开始化疗前需要进行血液透析。开始使用达雷妥尤单抗（16mg/kg）、来那度胺和地塞米松联合治疗作为一线治疗；调整达雷妥尤单抗的输注速率以减轻心脏负担。κ-FLC水平仅在一周内迅速降低了75%，三周后降低了99%。此外，在第四次注射达雷妥尤单抗后，她不再需要透析。我们报告了首例未治疗的骨髓瘤患者，即使在需要透析的情况下，也通过达雷妥尤单抗、来那度胺和地塞米松治疗成功治愈。由于需要立即降低FLC水平，达雷妥尤单抗可能对多发性骨髓瘤引起的急性肾损伤患者有益。当因严重心脏病而犹豫使用硼替佐米时，达雷妥尤单抗和来那度胺联合治疗可能是需要透析的患者的一种有价值的治疗选择。
