A case report of refractory IgD type multiple myeloma with orbital infiltration and literature review
-
摘要: 报告1例难治性IgD型眼眶浸润髓外多发性骨髓瘤的临床特征及应用达雷妥尤单抗为主的方案联合自体造血干细胞移植治疗，探讨罕见类型的多发性骨髓瘤治疗的效果及预后。回顾性分析2022年8月收治的1例接受达雷妥尤单抗联合自体造血干细胞移植治疗的难治性IgD型多发性骨髓瘤进展伴髓外浸润患者的临床资料，并复习相关文献。患者2021年1月经骨髓细胞学及免疫固定电泳等检查诊断为IgD型多发性骨髓瘤，初诊给予VRd(硼替佐米、地塞米松、来那度胺)方案治疗，2022年8月患者出现视物模糊、头疼伴血细胞减少，评估病情为疾病进展伴多发髓外浸润，给予达雷妥尤单抗联合BPd(苯达莫司汀、泊马度胺、地塞米松)方案治疗，评估达非常好的部分缓解后行自体造血干细胞移植，治疗后患者眼眶肿物明显缩小，血细胞恢复，一般情况较前改善。IgD型多发性骨髓瘤伴髓外浸润发病率低，生存期短，目前尚无统一治疗方案，尽早应用达雷妥尤单抗联合蛋白酶体抑制剂、免疫调节剂、细胞毒性药物及造血干细胞移植可能会延长患者生存期。
-
关键词:
- 复发难治性多发性骨髓瘤 /
- IgD /
- 髓外浸润 /
- 达雷妥尤单抗 /
- 自体造血干细胞移植
Abstract: By reporting the clinical characteristics of a case of refractory IgD type multiple myeloma with orbital infiltration and the treatment regimen employing daratumumab as the primary agent combined with autologous hematopoietic stem cell transplantation, this study investigates the treatment efficacy and prognosis for this rare type of multiple myeloma. The clinical and pathological data of a patient with refractory IgD multiple myeloma progression accompanied by extramedullary multiple myeloma, treated in August 2022 with daratumumab combined with autologous hematopoietic stem cell transplantation was retrospectively analyzed. Additionally, relevant literature was reviewed. The patient was diagnosed with IgD multiple myeloma in January 2021 through bone marrow cytology and immunofixation electrophoresis. Initial treatment was administered using the VRd(bortezomib, dexamethasone, lenalidomide) regimen. In August 2022, the patient presented with visual blurriness and cytopenia. Disease progression with multiple extramedullary infiltrates was assessed, and initially treated with daratumumab combined with BPd(bendamustine, pomalidomide, dexamethasone) regimen. After achieving very good partial remission, the patient received autologous hematopoietic stem cell transplantation. After transplantation, the patient's orbital mass significantly decreased in size, blood cells recovered, and the general condition improved compared to before. IgD multiple myeloma with extramedullary infiltration has a low incidence and a short survival period, with no unified treatment regimen currently established. The early application of daratumumab in combination with proteasome inhibitors, immunomodulatory drugs, cytotoxic drugs, and hematopoietic stem cell transplantation may extend the survival of the patient. -
-
[1] Jagosky MH, Usmani SZ. Extramedullary disease in multiple myeloma[J]. Curr Hematol Malig Rep, 2020, 15(2): 62-71.
[2] Blade J, Beksac M, Caers J, et al. Extramedullary disease in multiple myeloma: a systematic literature review[J]. Blood Cancer J, 2022, 12(3): 45.
[3] Bhutani M, Foureau DM, Atrash S, et al. Extramedullary multiple myeloma[J]. Leukemia, 2020, 34(1): 1-20.
[4] Djidjik R, Lounici Y, Chergeulaïne K, et al. IgD multiple myeloma: clinical, biological features and prognostic value of the serum free light chain assay[J]. Pathol Biol, 2015, 63(4-5): 210-214.
[5] Soesan M, Paccagnella A, Chiarion-Sileni V, et al. Extramedullary plasmacytoma: clinical behaviour and response to treatment[J]. Ann Oncol, 1992, 3(1): 51-57.
[6] Gozzetti A, Ciofini S, Sicuranza A, et al. Drug resistance and minimal residual disease in multiple myeloma[J]. Cancer Drug Resist, 2022, 5(1): 171-183.
[7] Li Y, Sun Z, Qu X. Advances in the treatment of extramedullary disease in multiple myeloma[J]. Translational Oncology, 2022, 22: 101465.
[8] 陶怡, 糜坚青. 2023年美国国立综合癌症网络(NCCN)《多发性骨髓瘤指南》(第2版)更新解读[J]. 诊断学理论与实践, 2023, 22(2): 121-126. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDLS202302002.htm
[9] Quach H, Ritchie D, Stewart AK, et al. Mechanism of action of immunomodulatory drugs(IMiDS)in multiple myeloma[J]. Leukemia, 2010, 24(1): 22-32.
[10] Grzasko N, Charlinski G, Morawska M, et al. Bendamustine-Based Regimens as Salvage Therapy in Refractory/Relapsed Multiple Myeloma Patients: A Retrospective Real-Life Analysis by the Polish Myeloma Group[J]. J Clin Med, 2021, 10(23): 5504.
[11] Nooka AK, Kaufman JL, Hofmeister CC, et al. Daratumumab in multiple myeloma[J]. Cancer, 2019, 125(14): 2364-2382.
[12] AcarIH, Guvenc B. Efficacy of Bendamustine, Pomalidomide, and Dexamethasone(BPD)Regimen in Relapsed/Refractory Extramedullary Myeloma: A Retrospective Single-Centre Study, Real-Life Experience[J]. Hematol Rep, 2023, 15(3): 465-473.
[13] Nathwani N, Larsen JT, Kapoor P. Consolidation and maintenance therapies for newly diagnosed multiple myeloma in the era of novel agents[J]. Curr Hematol Malig Rep, 2016, 11(2): 127-136.
[14] 刘琼, 王莹, 朱锋, 等. 新型免疫治疗时代IgD型多发性骨髓瘤疗效及预后影响因素分析[J]. 白血病·淋巴瘤, 2022, 31(7): 407-411.
[15] Ntanasis-Stathopoulos I, Gavriatopoulou M, Kastritis E, et al. Multiple myeloma: Role of autologous transplantation[J]. Cancer Treat Rev, 2020, 82: 101929.
[16] Pozotrigo M, Adel N, Landau H, et al. Factors impacting stem cell mobilization failure rate and efficiency in multiple myeloma in the era of novel therapies: experience at Memorial Sloan Kettering Cancer Center[J]. Bone Marrow Transplant, 2013, 48(8): 1033-1039.
[17] Zhu Z, Li X, Liu Y, et al. High efficacy of stem cell mobilization with etoposide+ cytarabine plus G-CSF in patients with multiple myeloma[J]. Front Oncol, 2022, 12: 825550.
[18] Gul AN, Kelkitli E. Autologous Hematopoietic Stem Cell Transplantation in Multiple Myeloma[J]. J Exp Clin Med, 40(3): 659-663.
[19] Chari A, Suvannasankha A, Fay JW, et al. Daratumumab plus pomalidomide and dexamethasone in relapsed and/or refractory multiple myeloma[J]. Blood, 2017, 130(8): 974-981.
[20] Rajkumar SV, Dimopoulos MA, Palumbo A, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma[J]. Lancet Oncol, 2014, 15(12): e538-e548.
[21] 庄俊玲. 多发性骨髓瘤髓外病变诊治进展[J]. 临床血液学杂志, 2019, 32(7): 499-503. doi: 10.13201/j.issn.1004-2806.2019.07.003
-
下载:
计量
- 文章访问数: 205
- 施引文献: 0