Imaging Features of Extramedullary, Relapsed, and Refractory Multiple Myeloma involving the Liver Across Treatment With Cyclophosphamide, Lenalidomide, Bortezomib, and Dexamethasone

Saboo, Sachin S.; Fennessy, Fiona M.; Benajiba, Lina; Laubach, Jacob P.; Anderson, Kenneth C.; Richardson, Paul G.

doi:10.1200/jco.2011.41.1413

Cited by 10 publications

(7 citation statements)

References 16 publications

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“…In two patients with bortezomib-resistant extramedullary myeloma, Revlimid and dexamethasone (RD) regimen was an effective treatment according to Ito et al [ 36 ]. CRVD (cyclophosphamide, Revlimid, Velcade, dexamethasone) was able to attain radiologic partial response in a patient with hepatic extramedullary disease as reported by Saboo et al [ 37 ]. Bortezomib (Velcade) was originally observed to be efficacious against EM; however, these reports suffered from few sample sizes without adequate controlled trials [ 38 , 39 ].…”

Section: Discussionmentioning

confidence: 71%

Multiple Liver Nodules Mimicking Metastatic Disease as Initial Presentation of Multiple Myeloma

Tiu

Potdar

Arguello-Gerra

et al. 2018

Case Reports in Hematology

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Multiple myeloma is a malignant clonal proliferation of plasma cells in the bone marrow preceded by monoclonal gammopathy of undetermined significance. Initial presentation of multiple myeloma as extramedullary spread in soft tissues particularly in the liver is uncommon. We report a case of a 74-year-old African American female who presented with epigastric pain, hematemesis, elevated alkaline phosphatase, and gamma-glutamyl transferase. Initial impression was peptic ulcer disease; however, ultrasound and CT scan of the abdomen showed multiple liver nodules and perihepatic lymphadenopathy suggestive of metastatic disease. Biopsy of the liver nodules showed CD138 and kappa light chain-restricted positive cells consistent with extramedullary spread of multiple myeloma to the liver. The patient achieved partial response after 6 months of treatment with Velcade, cyclophosphamide, and dexamethasone (VCD). Due to severe neutropenia from cyclophosphamide, regimen was switched to Velcade, Revlimid, and dexamethasone (VRD) which resulted to very good partial response in 1 year which eventually persisted after 4 years. No controlled prospective studies have defined the standard treatment for multiple myeloma with extramedullary spread particularly to the liver. Treatment of multiple myeloma with extramedullary disease follows guidelines for multiple myeloma.

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Section: Discussionmentioning

confidence: 71%

Multiple Liver Nodules Mimicking Metastatic Disease as Initial Presentation of Multiple Myeloma

Tiu

Potdar

Arguello-Gerra

et al. 2018

Case Reports in Hematology

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“…There are very limited data from randomized trials regarding the most appropriate systemic treatment for extramedullary plasmacytoma. Previous case reports suggested that lenalidomide is an effective agent, in combination with dexamethasone, and previous cases of MM relapse following autologous stem cell transplant presenting with diffuse pulmonary nodules exhibited good response to the treatment with bortezomib, dexamethasone and lenalidomide (27)(28)(29)(30)(31).…”

Section: Discussionmentioning

confidence: 97%

“…To the best of our knowledge, extramedullary relapse is an uncommon presentation, and relapses that involve the liver have rarely been described (24). Extramedullary plasmacytoma confers a poor prognosis, since it is resistant to conventional treatments, due to its distinct molecular and histological features (27)(28)(29). There are very limited data from randomized trials regarding the most appropriate systemic treatment for extramedullary plasmacytoma.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment with lenalidomide of secondary multiple myeloma with extramedullary liver plasmacytoma in a renal transplant recipient: A case report and review of the literature

Xie

Zhu

et al. 2015

Oncology Letters

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Abstract. Multiple myeloma (MM) represents a rare form of post-transplantation lymphoproliferative disorder, and the presence of plasma cells in the liver is generally associated with aggressive forms of MM. In the present study, an unusual case of extramedullary plasmacytoma, affecting the liver and vertebrae of a recipient of a renal transplant, is reported. The patient had been previously treated with bortezomib for an MM following renal transplantation, as diagnosed by percutaneous needle biopsy of the hepatic lesion. He was then treated with 5 cycles of RCD regimen (lenalidomide, 25 mg, days 1-21; cyclophosphamide. 50-100 mg, days 1-21; and dexamethasone, 20 mg, days 1, 8, 15 and 22). The patient achieved partial clinical remission without any severe therapy-associated toxicity effects, indicating that lenalidomide is an effective and safe treatment for extramedullary liver plasmacytoma in renal recipients. In conclusion, the present case study indicated that the RCD regimen was effective and safe in the treatment of relapsed and refractory MM. IntroductionCompared with the general population, recipients of a kidney transplant have an increased risk of developing various types of cancer (associated and non-associated with infections), due to the immunosuppressant treatment that must be maintained in order to prevent and treat acute rejection of the organ (1). The incidence of secondary cancer increases with the time from the transplant (2). Post-transplant lymphoproliferative disorders (PTLDs) are frequent in patients who receive immunosuppressants, including anti-thymocyte and -lymphocyte globulins or muromonab-CD3, or those who are infected de novo by Epstein-Barr virus (EBV) through the transplanted kidney (3). PTLDs may present early or late; be nodal, extranodal, polymorphic or monomorphic; and follow an indolent or aggressive clinical course (3). In contrast to classical PTLDs, there are limited studies on plasma cell malignancies that occur following solid organ transplantation. Multiple myeloma (MM) represents ≤4% of all PTLDs, and is associated with a poor response to discontinuation of immunosuppression and conventional therapy, and a short median survival rate (4,5). Generally, the presence of plasma cells in the liver is associated with aggressive forms of MM (6,7). In the present study, the case of a patient who developed post-transplant MM with extramedullary liver plasmacytoma 11 years following renal transplantation, and was successfully treated with lenalidomide, is reported. Case reportIn February 2012, a 45-year-old female was admitted to The First People's Hospital of Changzhou (Changzhou, China) with complaints of pain in the left shoulder. Due to chronic renal failure, the patient had received a cadaveric kidney transplantation at the same hospital on November 2 nd 2001, and was subsequently administered immunosuppression composed of 250 mg/day cyclosporine, 50 mg/day azathioprine and 25 mg/day prednisone, in a dose-tapering manner. From June 2002, the patient received 200 mg/day cyclo...

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“…For patients with eligible multiple myeloma, the treatment of choice includes induction therapy (usually involving novel biological agents) followed by ASCT (34). The CyB or D regimen is effective in multiple myeloma and produces rapid and complete hematological responses in the majority of patients (35)(36)(37)(38). Previous case reports suggest that lenalidomide is an effective agent in combination with dexamethasone (38,39).…”

Section: Discussionmentioning

confidence: 99%

“…The CyB or D regimen is effective in multiple myeloma and produces rapid and complete hematological responses in the majority of patients (35)(36)(37)(38). Previous case reports suggest that lenalidomide is an effective agent in combination with dexamethasone (38,39). However, this treatment is generally not considered to be curative and relapses occur.…”

Section: Discussionmentioning

confidence: 99%

Autologous stem cell transplantation in EBV-positive post-renal transplant refractory multiple myeloma: A case report and literature review

et al. 2018

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Renal transplant recipients exhibit an increased risk of developing plasma cell neoplasms (PCNs; comprising multiple myeloma and plasmacytoma); however, multiple myeloma manifesting with refractory extramedullary plasmacytomas associated with Epstein-Barr virus are markedly rare in these patients. In the present case report, an unusual case of refractory multiple myeloma with multiple extramedullary plasmacytoma (including liver, vertebrae, breast, muscle, skin and soft tissues) was presented. The patient exhibited mild bone marrow infiltration which was successfully treated with novel agents, including bortezomib and lenalidomide, followed by autologous stem cell transplantation (ASCT). In addition, the patient was a renal transplant recipient who achieved a partial clinical remission with controllable therapy-related toxicity effects. Therefore, the present case indicated that ASCT is an effective and safe salvage therapy for renal transplant recipients with secondary extramedullary plasmacytomas and who are resistant to traditional chemotherapy (bortezomib and lenalidomide). ASCT was well-tolerated in the renal transplant recipient.

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Imaging Features of Extramedullary, Relapsed, and Refractory Multiple Myeloma involving the Liver Across Treatment With Cyclophosphamide, Lenalidomide, Bortezomib, and Dexamethasone

Cited by 10 publications

References 16 publications

Multiple Liver Nodules Mimicking Metastatic Disease as Initial Presentation of Multiple Myeloma

Multiple Liver Nodules Mimicking Metastatic Disease as Initial Presentation of Multiple Myeloma

Successful treatment with lenalidomide of secondary multiple myeloma with extramedullary liver plasmacytoma in a renal transplant recipient: A case report and review of the literature

Autologous stem cell transplantation in EBV-positive post-renal transplant refractory multiple myeloma: A case report and literature review

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