Necrobiotic Xanthogranuloma (NXG) was first described in 1980 by Kossad and Winkelmann in which they discussed 8 patients with xanthomatous plaques, noted to have monoclonal gammopathy, predominantly IgG kappa type1. Since then, more than 50 patients with this disorder have been described, with approximately 80% of them associated with a monoclonal gammopathy. We describe the first case of NXG with associated monoclonal gammopathy, treated with thalidomide plus dexamethasone, achieving complete resolution of the skin lesions and sustaining response more than three years after treatment.

SummaryOnce-weekly administration of bortezomib has reduced bortezomibinduced peripheral neuropathy without affecting response rates, but this has only been demonstrated prospectively in three-and four-drug combinations. We report a phase II trial of alternate dosing and schedule of bortezomib and dexamethasone in newly diagnosed multiple myeloma patients who are not eligible for or refused autologous stem cell transplantation. Bortezomib 1Á6 mg/m 2 intravenously was given once-weekly for six cycles, together with dexamethasone 40 mg on the day of and day after bortezomib. Fifty patients were enrolled; 58% did not require any dose modification. The majority of patients had multiple co-morbidities, including cardiovascular (76%) and renal insufficiency (54%), and the median number of medications prior to enrollment was 13. Of all evaluable patients, the overall response rate was 79% and at least 45% had at least a very good partial response. The median time to first response was 1Á3 months (range, 0Á25-2Á4 months). The progression-free and overall survivals were 8 months and 46Á5 months, respectively. Twenty-four percent developed worsening neuropathy. We conclude that alternate dosing and scheduling of bortezomib and dexamethasone is both safe and effective for management of newly diagnosed multiple myeloma in frail patients. (ClinicalTrials.gov number, NCT01090921).