Our prospective data indicate that rituximab is well tolerated and active in patients with WM. Previously untreated and pretreated patients seem to benefit equally. Repeat 4-week courses of rituximab may prolong the duration of response of the disease, but this observation requires confirmation in prospective, randomized trials. Furthermore, studies that will combine rituximab with chemotherapy may be relevant.

Our data indicate that thalidomide has activity in WM but only low doses were tolerated in this elderly patient population. Confirmatory studies as well as studies that will combine thalidomide with chemotherapy or with rituximab may be relevant.

Summary:Adoptive immunotherapy with donor leukocytes has emerged as a promising strategy for the treatment of myeloma recurrence after allogeneic transplantation. 2.9 × 10 8 /kg donor mononuclear cells containing 1.4% CD34 + and 37% CD3 + cells were administered to a 48-year-old patient with non-secretory plasmablastic myeloma relapsing 9 months after a blood stem cell transplant from his HLA-identical sibling. In view of the extensive marrow infiltration and the aggressive behaviour of the disease, the donor cells were preceded by a course of EDAP chemotherapy. There was rapid clinical improvement, and CR was achieved on day 30 post infusion. However, three subcutaneous plasmacytomas showing anaplastic features developed within a few days. These failed to respond to interferon-␣ and continued to grow for 5 weeks in the absence of marrow plasmacytosis or other evidence of systemic disease. Grade 3 acute liver GVHD developed on day 79 which was controlled with immunosuppression. Overt systemic relapse occurred on day 90 as the GVHD came under control. The course of our case suggests highly proliferative malignant cells may escape the graft-versustumour effect of immunocompetent allogeneic cells in extramedullary sites subsequently resulting in overt systemic relapse if left untreated. New approaches are needed to deal with the problem of extramedullary disease recurrence. Keywords: multiple myeloma; extramedullary plasmacytoma; graft-versus-myeloma; immunotherapy; graft-versushost disease Even though high-dose chemotherapy and autologous transplantation induce prolonged remissions in a significant proportion of patients with myeloma and prolong survival, plant-related deaths and disease recurrence.2 While the optimal conditioning regimen is yet to be established, salvage strategies employed aim primarily at palliation or at a temporary disease control.Cell or cytokine-mediated immunotherapy with leukocytes from the original donor, interferon-␣ or interleukin-2 can induce remission in a variety of hematologic malignancies relapsing or persisting after allogeneic transplantation, including multiple myeloma.3-7 Early experience effected some optimism in the problematic management of post-allograft relapse 9-18 despite the fact that immunotherapy itself is associated with significant morbidity and mortality as well as disease recurrence when GVHD is controlled. 8 We describe the unusual clinical course of a patient who received donor leukocytes for rapidly progressive myeloma after an allogeneic blood stem cell transplant, and then developed multiple subcutaneous plasmacytomas while remaining in marrow remission. Case reportA 47-year-old man presented in January 1994 with stage IIA non-secretory plasmablastic myeloma. At diagnosis his renal function and skeletal survey were normal while the C-reactive protein was 7.6 g/dl. The Hb was 9.6 g/dl and the BM biopsy showed 60% immature plasma cells. He was initially treated with four cycles of VAD (vincristineadriamycin-dexamethasone) without response. He then received eig...