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

Abstract

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...

Orthotopic heart transplant rejection in association with immunomodulatory therapy for AL amyloidosis: A case series and review of the literature

“…Other immunologic phenomena have been seen with IMiDs such as acute graft‐versus‐host disease in two patients after allogeneic bone marrow transplant . Nonetheless, there have been a number of reports of IMiD tolerability, all in the setting of kidney allografts (Table ) . At the Boston University Amyloidosis Center, four renal transplant patients with AL amyloidosis have successfully undergone treatment with IMiD therapies (including thalidomide, lenalidomide, and pomalidomide) for a median duration of 10.5 months without any signs of organ rejection (personal communication and experience).…”

“…Reported cases of IMiD-associated solid allograft rejection Reported cases of IMiD tolerability in patients with solid organ transplant immunologic phenomena have been seen with IMiDs such as acute graft-versus-host disease in two patients after allogeneic bone marrow transplant 11,12. Nonetheless, there have been a number of reports of IMiD tolerability, all in the setting of kidney allografts (Table2) [13][14][15][16][17]. At the Boston University Amyloidosis…”

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

“…The addition of lenalidomide (Revlimid) may have been responsible for the improvement in response as documented by a few case reports. Xie et al successfully treated secondary multiple myeloma with extramedullary liver plasmacytoma in a renal transplant patient with RCD regimen (Revlimid, cyclophosphamide, dexamethasone) [ 34 ]. Similarly, Felici et al utilized the RCD regimen on a patient with bilateral retro-orbital localization [ 35 ].…”

An extramedullary plasmacytoma in the kidney of a 14-year-old girl

“…Treatment with chemotherapy does not appear to be indicated because it had no effect on the course of EMP and is not recommended. [ 16 ] Any risk factors for the development of MM are not described. After treatment, all patients with EMP should have close observation to detect local recurrences or progression to MM.…”