内容紹介
Summary
An 85-year-old female was diagnosed with multiple myeloma(MM)(IgG-λ)with t(4 ;14)(p16 ;q32)in 200X. She received bortezomib with dexamethasone(Vd)therapy and lenalidomide with dexamethasone(Ld)therapy, and she subsequently maintained a very good partial response(VGPR). On day 731, she experienced relapse and was treated with 2 courses of elotuzumab with Ld therapy. However, on day 794, she experienced relapse with plasmacytoma, and was treated with 2 courses of pomalidomide and low-dose dexamethasone(Pd), 2 courses of cyclophosphamide with Pd(PCd), and bortezomib with Pd(PVd)therapies. After 3 courses of PVd therapy, she achieved PR. She has continued to receive 11 courses of PVd therapy and has not suffered any adverse events(≥Grade 3). These findings suggest that PVd therapy is a relatively safe and highly efficacious treatment for frail patients with relapsed and refractory MM who have previously received both lenalidomide and bortezomib. Further studies are needed to establish treatment efficacy and safety in frail patients with relapsed and refractory MM with extramedullary disease.
要旨
症例は85歳,女性。200X年にt(4 ;14)(p16 ;q32)の染色体異常を有する多発性骨髄腫(IgG-λ型)と診断した。bortezomib/dexamethasone(Vd)療法,lenalidomide/dexamethasone(Ld)療法を施行し,very good partial response(VGPR)を維持していたが,第731病日再燃に対しelotuzumab併用Ld療法を2コース施行した。しかし郊果は乏しく,腸骨内に形質細胞腫を合併し,第794病日よりpomalidomide,低用量dexamethasone併用(Pd)療法,Pd/cyclophosphamide(PCd)療法施行後,Pd/bortezomib併用(PVd)療法を施行した。PVd療法を3コース施行後PRに到達し,以後もGrade 3以上の有害事象を認めず11コース継続している。PVd療法は髄外病変を合併した再発難治のfrail患者に対して忍容性と高い抗腫瘍効果を見込めると考えられ,今後も髄外病変を合併した再発難治の高齢MM患者の治療に関する症例の蓄積が望まれる。
目次
An 85-year-old female was diagnosed with multiple myeloma(MM)(IgG-λ)with t(4 ;14)(p16 ;q32)in 200X. She received bortezomib with dexamethasone(Vd)therapy and lenalidomide with dexamethasone(Ld)therapy, and she subsequently maintained a very good partial response(VGPR). On day 731, she experienced relapse and was treated with 2 courses of elotuzumab with Ld therapy. However, on day 794, she experienced relapse with plasmacytoma, and was treated with 2 courses of pomalidomide and low-dose dexamethasone(Pd), 2 courses of cyclophosphamide with Pd(PCd), and bortezomib with Pd(PVd)therapies. After 3 courses of PVd therapy, she achieved PR. She has continued to receive 11 courses of PVd therapy and has not suffered any adverse events(≥Grade 3). These findings suggest that PVd therapy is a relatively safe and highly efficacious treatment for frail patients with relapsed and refractory MM who have previously received both lenalidomide and bortezomib. Further studies are needed to establish treatment efficacy and safety in frail patients with relapsed and refractory MM with extramedullary disease.
要旨
症例は85歳,女性。200X年にt(4 ;14)(p16 ;q32)の染色体異常を有する多発性骨髄腫(IgG-λ型)と診断した。bortezomib/dexamethasone(Vd)療法,lenalidomide/dexamethasone(Ld)療法を施行し,very good partial response(VGPR)を維持していたが,第731病日再燃に対しelotuzumab併用Ld療法を2コース施行した。しかし郊果は乏しく,腸骨内に形質細胞腫を合併し,第794病日よりpomalidomide,低用量dexamethasone併用(Pd)療法,Pd/cyclophosphamide(PCd)療法施行後,Pd/bortezomib併用(PVd)療法を施行した。PVd療法を3コース施行後PRに到達し,以後もGrade 3以上の有害事象を認めず11コース継続している。PVd療法は髄外病変を合併した再発難治のfrail患者に対して忍容性と高い抗腫瘍効果を見込めると考えられ,今後も髄外病変を合併した再発難治の高齢MM患者の治療に関する症例の蓄積が望まれる。