Remedy of Relapsed Myeloma in a Affected person With Renal Insufficiency.
J Clin Oncol. 2018 Could 31;:JCO2017776419
Authors: Bladé J, Rosiñol L, Cibeira MT, Fernández de Larrea C
The Oncology Grand Rounds collection is designed to position authentic reviews printed within the Journal into scientific context. A case presentation is adopted by an outline of diagnostic and administration challenges, a assessment of the related literature, and a abstract of the authors’ recommended administration approaches. The purpose of this collection is to assist readers higher perceive tips on how to apply the outcomes of key research, together with these printed in Journal of Medical Oncology, to sufferers seen in their very own scientific follow. A 45-year-old man was recognized in March 2010 with stage III immunoglobulin G kappa a number of myeloma (MM) after presenting with bone ache because of a number of lytic bone lesions and T12 vertebral collapse. Laboratory work-up confirmed a serum M protein of 72 g/L and a 24-hour kappa light-chain urine protein excretion of 730 mg, hemoglobin of 10.2 g/dL, serum albumin of 49 g/L, serum ?2-microglobulin of 6.four mg/L, serum creatinine degree of 1.6 mg/dL with an estimated glomerular filtration fee (eGFR) of 47 mL/min/1.73 m2, and regular serum calcium and lactate dehydrogenase (LDH) ranges. His bone marrow contained 58% plasma cells, which confirmed the 17p deletion abnormality (Fig 1). He was handled with vertebroplasty and alternating chemotherapy with carmustine, vincristine, cyclophosphamide, melphalan, and prednisone and vincristine, carmustine, doxorubicin and dexamethasone. Due to progressive illness, salvage remedy with bortezomib and dexamethasone was administered with no response. The affected person was then switched to lenalidomide and dexamethasone, which yielded minimal response. He underwent autologous stem-cell transplantation (ASCT) with melphalan 200 mg/m2 as high-dose remedy in February 2011, which led to a partial response, however in December 2011, progressive illness was documented, and the affected person was enrolled in a scientific trial of carfilzomib monotherapy, with steady illness for 33 cycles. In October 2014 serum M protein rose to 38.6 g/L, with 24-hour kappa light-chain urine protein excretion of 840 mg, serum creatinine of two.1 mg/dL, and an eGFR of 41 mL/min/1.73 m2. He introduced to debate ongoing therapy choices.
PMID: 29851545 [PubMed – as supplied by publisher]