Aggressive plasmablastic multiple myeloma in a 42-year-old: is inflammatory bowel disease or infliximab treatment to be blamed?

Abstract

A man in his early 40s with a history of ulcerative colitis, treated with infliximab, was diagnosed with plasmablastic multiple myeloma. He was treated with chemotherapy and stem cell transplant but developed recurrence and ultimately died from metastatic disease. Could inflammatory bowel disease or infliximab therapy have any role in development of myeloma in this young patient? The role of inflammatory bowel disease and infliximab therapy in the development of multiple myeloma is controversial but interesting and worth considering.

Association between Multiple Myeloma and Ulcerative Colitis: A Cross-Sectional Analysis

“…The patient was found to have thrombocytopenia, anemia, and fatigue, and was eventually diagnosed with MM; however, given the delay of diagnosis, the patient passed away shortly after diagnosis [ 38 ]. Similar findings were reported by Yadav et al, where Infliximab use in a UC patient was associated with aggressive metastatic disease [ 5 ]. TNF-α inhibitors in IBD can lead to decreased apoptosis of plasma cells, thus setting the stage for the development of MM [ 7 ].…”

“…Recurring symptoms are observed during treatment, with long periods of compete subsidence of symptoms. It is estimated that up to 67% of patients will have a relapse in the 10 years following diagnosis, with age at diagnosis being a key indicator of relapse [ 4 , 5 ]. Owing to its chronic inflammatory nature, IBD has long been associated with numerous malignant conditions, most notably colorectal cancer [ 4 , 5 ].…”

“…Although ulcerative colitis (UC) and multiple myeloma (MM) are reported to coexist, albeit in the form of small case-series, the association between MM and UC is yet to be established, nor has it been systematically evaluated [ 4 , 5 ]. While MM in general has been shown to be most prevalent among elderly, African American males, the corresponding demographic profile among patients with comorbid UC remains illusory.…”

A Rare Presentation of HIV-Negative Plasmablastic Lymphoma: A Diagnostic Dilemma

“…While plasmablastic plasma cell myeloma is initially treated with VRd (bortezomib, lenalidomide, and dexamethasone), there is no standard of care for PBL [2, 11]. Given the poor outcomes and lack of response to commonly used chemotherapy such as CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) and CHOP-like regimens, the National Comprehensive Cancer Network (NCCN) guidelines state that standard CHOP is not adequate treatment [12].…”

Diffuse Kidney and Retroperitoneal Infiltration by Plasmablastic Myeloma

“…Extramedullary localization of plasmablastic myeloma may be observed in more than two-thirds of patients [6] mainly in lymph nodes, the upper digestive tract, a common site of primary extramedullary plasmacytoma, and the central nervous system [6,8]. Kidney involvement has been rarely reported [9].…”