Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2013 Winter;13(4):553-7.

Multiple myeloma relapse following autologous stem cell transplant presenting with diffuse pulmonary nodules

Bradley Sumrall  1 , Lisa Diethelm  2 , Archie Brown Jr  1
Affiliations
Case Reports

Multiple myeloma relapse following autologous stem cell transplant presenting with diffuse pulmonary nodules

Bradley Sumrall et al. Ochsner J. 2013 Winter.

Abstract

Background: Multiple myeloma is a common disease, accounting for about 10% of hematologic malignancies in the United States. For eligible patients, the treatment of choice includes induction therapy (usually involving newer biologic agents) followed by autologous stem cell transplant; however, this treatment is generally not considered curative, and relapses usually occur. However, extramedullary relapse is an uncommon presentation, and relapses that involve the lungs have only rarely been described.

Case report: We report the case of a patient who underwent an autologous stem cell transplant for multiple myeloma and subsequently relapsed with diffuse pulmonary nodules. She then had a rapid clinical and serologic response following initiation of salvage therapy.

Conclusion: This case is remarkable for both the radiographic appearance of the pulmonary involvement, as well as the rapid resolution of these findings after 2 cycles of treatment with bortezomib, dexamethasone, and lenalidomide.

Keywords: Multiple myeloma; multiple pulmonary nodules; plasmacytoma; recurrence; stem cell transplantation.

PubMed Disclaimer

Conflict of interest statement

The authors have no financial or proprietary interest in the subject matter of this article.

Figures

Figure 1.
Figure 1.
Posteroanterior chest radiograph reveals innumerable nodules in perihilar distribution with basilar predominance. Perihilar stripe and hilar contours appear normal, arguing against lymph node enlargement. No pleural fluid is evident.
Figure 2.
Figure 2.
Computed tomographic multiplanar image reconstructed in the coronal plane at the level of the carina reveals multiple pulmonary nodules in perihilar distribution, corresponding to the abnormality seen on frontal chest radiograph.
Figure 3.
Figure 3.
High-resolution computed tomography image with 0.625 mm craniocaudal thickness and high spatial frequency reconstruction algorithm reveals subpleural location of some nodules. Pulmonary vascular margins are smooth, excluding perivascular nodules. The presence of subpleural nodules and the absence of beaded vascular margins argue for random nodular distribution due to hematogenous dissemination.
Figure 4.
Figure 4.
Right middle lobe transbronchial biopsy demonstrating plasma cells (hematoxylin and eosin stain magnified 400×). The neoplastic cells were positive for CD138 and CD56.
See this image and copyright information in PMC

References

    1. Kyle RA, Rajkumar SV. Multiple myeloma. Blood. 2008 Mar 15;111(6):2962–2972. - PMC - PubMed
    1. Howlader N, Noone AM, Krapcho M SEER Cancer Statistics Review, 1975-2009 (Vintage 2009 Populations), (eds). National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2009_pops09/, based on November 2011 SEER data submission, posted to the SEER website, April 2012. Accessed August 28, 2013.
    1. Kyle RA, Gertz MA, Witzig TE, et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc. 2003 Jan;78(1):21–33. - PubMed
    1. Varettoni M, Corso A, Pica G, Mangiacavalli S, Pascutto C, Lazzarino M. Incidence, presenting features and outcome of extramedullary disease in multiple myeloma: a longitudinal study on 1003 consecutive patients. Ann Oncol. 2010 Feb;21(2):325–330. Epub 2009 Jul 24. - PubMed
    1. Bladé J, Lust JA, Kyle RA. Immunoglobulin D multiple myeloma: presenting features, response to therapy, and survival in a series of 53 cases. J Clin Oncol. 1994 Nov;12(11):2398–2404. - PubMed

Publication types

LinkOut - more resources