Successful Bortezomib/dexamethasone Induction Therapy with Lenalidomide in an Elderly Patient with Primary Plasma Cell Leukemia Complicated by Renal Failure and Pulmonary Hypertension

Tamura, Shinobu; Koyama, Asumi; Shiotani, Chieko; Kurihara, Toshio; Nishikawa, Akinori; Okamoto, Yukiharu; Fujimoto, Tokuzo

doi:10.2169/internalmedicine.53.1672

Cited by 7 publications

(5 citation statements)

References 24 publications

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“…These findings further support our speculation that PH is secondary to MM rather than an independent pathological process in MM patients. According to several published case reports, besides MM, reversible PH could be also seen in other plasma disorders including smoldering MM, plasma cell leukemia, and POEMS syndrome (characterized by polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes) 34–37 . The common feature of these cases indicates that PH is usually associated with active disease status.…”

Section: Discussionmentioning

confidence: 99%

“…According to several published case reports, besides MM, reversible PH could be also seen in other plasma disorders including smoldering MM, plasma cell leukemia, and POEMS syndrome (characterized by polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes). 34 , 35 , 36 , 37 The common feature of these cases indicates that PH is usually associated with active disease status. The dysregulation of specific cytokines, such as vascular endothelial growth factor, interleukin‐6, interleukin‐1β, tumor necrosis factor‐α, or transforming growth factor‐α, has been presumed as a possible mechanism of PH development in these settings.…”

Section: Discussionmentioning

confidence: 99%

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Echocardiography‐defined pulmonary hypertension is an adverse prognostic factor for newly diagnosed multiple myeloma patients

et al. 2022

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Background: Pulmonary hypertension (PH) is a common but rarely recognized comorbidity of multiple myeloma (MM) patients, while its prognostic significance for MM has been rarely reported. Methods:We retrospectively analyzed the clinical characteristics and prognostic value of baseline echocardiography-defined PH in 426 newly diagnosed MM (NDMM) patients.Results: Echocardiograph-defined PH was found in 12.7% (54/426) of NDMM patients, associated with older age, anemia, and renal insufficiency, as well as severe diastolic dysfunction and higher BNP and NT-pro-BNP levels. Patients with PH presented with a higher prevalence of atrial fibrillation, while with a similar incidence of thrombosis compared with those without PH. Based on similar treatment regimens and autologous stem cell transplantation (ASCT) rates, patients without PH have deeper and better responses than those with PH (p = 0.002). With the remission of MM, 81.5% of PH was reversible, accompanied by improvement of right ventricular dysfunction and normalization of BNP/NTpro-BNP levels, while could reoccur at MM relapse. Survival analysis revealed that PH was an adverse prognostic factor, associated with reduced progressionfree survival (PFS) (21 vs. 50 months, p < 0.001) and overall survival (OS) (45 vs. 90 months, p = 0.014). Multivariate analysis further verified that baseline PH was an independent predictor for shorter PFS and OS. Conclusion:In conclusion, echocardiography-defined PH is an adverse prognostic indicator for MM patients and should be routinely evaluated in MM patients at diagnosis to make a precise prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Echocardiography‐defined pulmonary hypertension is an adverse prognostic factor for newly diagnosed multiple myeloma patients

et al. 2022

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“…In 2014, Tamura [30] and colleagues, described a case of a 76-year-old man with primary plasma cell leukemia (PPCL) complicated by renal failure and pulmonary hypertension. Bortezomib/dexamethasone (BD) induction therapy with lenalidomide was administered in association with continuous hemodiafiltration (CHDF).…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Hypertension Induced by Thalidomide (and Derivatives) in Patients with Multiple Myeloma: A Systematic Review

Nashwan¹,

Al‐Dewik²,

Sabah³

et al. 2016

JCT

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Thalidomide is widely used in the treatment of multiple myeloma (MM). In recent years, several cases of pulmonary hypertension have been reported following treatment with thalidomide. The aim of this review was to evaluate the published literature on multiple myeloma patients with pulmonary hypertension following thalidomide treatment. A literature search was performed between 2000 and 2016. A total of 7 eligible studies were identified and deemed eligible, including 11 cases-approximately 37% (4 cases) with IgA (k), 27% (3 cases) with IgG (λ) MM, 27% (3 cases) with IgG (k) MM, and one case (9%) with primary plasma cell leukemia (PPCL). The vast majority of cases-82% (9 cases)-are associated with thalidomide, while only 18% (2 cases) are related to thalidomide derivatives (lenalidomide and pomalidomide). In conclusion, pulmonary hypertension induced by thalidomide or derivatives in multiple myeloma (MM) patients is related to a multifactorial etiology including the pathophysiology of the disease, thromboembolic events, preexisted cardiovascular conditions, comorbidities, and combination with other chemo-or bio-therapeutic agents. MM patients should be evaluated for signs and symptoms underlying cardiopulmonary disease before initiating, and during treatment with thalidomide.

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“…On the same day, we started induction therapy with lenalidomide (15 mg/day orally on days 1-14), bortezomib (1.3 mg/m 2 subcutaneously on days 1, 4, 8, and 11), and low-dose dexamethasone (20 mg/day orally on days 1, 2, 4, 5, 8, 9, 11, and 12), also known as RVD induction therapy, each for a 21-day cycle. 10 Eight days after starting the induction therapy, the circulating plasma cells in the peripheral blood disappeared, and he was transferred from the ICU after withdrawal of CHDF. After a total of 3 cycles of chemotherapy, the laboratory abnormalities markedly subsided, consistent with a very good partial response (VGPR), because serum immunofixation was positive.…”

Section: Case Reportmentioning

confidence: 99%

Successful Intrathecal Chemotherapy Combined with Radiotherapy Followed by Pomalidomide and Low-Dose Dexamethasone Maintenance Therapy for a Primary Plasma Cell Leukemia Patient

et al. 2017

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Primary plasma cell leukemia (PPCL) is a rare aggressive variant of plasma cell disorder and frequently presents with extramedullary disease. Central nervous system (CNS) involvement with PPCL has an extremely poor prognosis. We describe a 46-year-old man with PPCL treated with a combination of lenalidomide, bortezomib, and dexamethasone as induction therapy following upfront allogeneic stem cell transplantation (allo-SCT). Despite achieving a very good partial response, the patient suffered from an isolated CNS relapse 12 months after allo-SCT. He was immediately started on concurrent intrathecal chemotherapy (IT) and cranial irradiation (RT). Subsequently, pomalidomide and low-dose dexamethasone (Pd) were given as maintenance therapy. He has been without CNS recurrence for more than 18 months. Our case suggests that concurrent IT and RT followed by Pd maintenance therapy may be an effective option to control CNS relapse of PPCL after allo-SCT.

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Successful Bortezomib/dexamethasone Induction Therapy with Lenalidomide in an Elderly Patient with Primary Plasma Cell Leukemia Complicated by Renal Failure and Pulmonary Hypertension

Cited by 7 publications

References 24 publications

Echocardiography‐defined pulmonary hypertension is an adverse prognostic factor for newly diagnosed multiple myeloma patients

Echocardiography‐defined pulmonary hypertension is an adverse prognostic factor for newly diagnosed multiple myeloma patients

Pulmonary Hypertension Induced by Thalidomide (and Derivatives) in Patients with Multiple Myeloma: A Systematic Review

Successful Intrathecal Chemotherapy Combined with Radiotherapy Followed by Pomalidomide and Low-Dose Dexamethasone Maintenance Therapy for a Primary Plasma Cell Leukemia Patient

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