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. 2014 May;3(1):24-29.
doi: 10.1007/s13730-013-0078-x. Epub 2013 Jul 23.

Successful treatment of bortezomib-refractory multiple myeloma derived from monoclonal gammopathy of undetermined significance with dose-adjusted lenalidomide therapy in a patient with concomitant end-stage renal disease due to diabetic nephropathy requiring haemodialysis

Noriaki Kawano  1 , Naoko Yokota-Ikeda  2 , Kunihiro Minoda  3 , Hiroshi Hashiguchi  4 , Shuro Yoshida  2 , Takuro Kuriyama  2 , Kiyoshi Yamashita  2 , Yoshimasa Miyazaki  5 , Sanshiro Inoue  5 , Yoshiya Shimao  6 , Keiko Kodama  2 , Shigehiro Uezono  2 , Akira Ueda  2
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Successful treatment of bortezomib-refractory multiple myeloma derived from monoclonal gammopathy of undetermined significance with dose-adjusted lenalidomide therapy in a patient with concomitant end-stage renal disease due to diabetic nephropathy requiring haemodialysis

Noriaki Kawano et al. CEN Case Rep. 2014 May.

Abstract

Malignancy is a fatal complication of end-stage renal disease (ESRD) requiring haemodialysis. However, the successful treatment of haematological malignancies has been rarely reported. We describe the case of a 63-year-old man who presented with IgA-type multiple myeloma (MM; Durie-Salmon stage IIIB) derived from monoclonal gammopathy of undetermined significance concomitant with ESRD due to diabetic nephropathy. First, haemodialysis was initiated before chemotherapy, and bortezomib and dexamethasone were found to be ineffective. Subsequently, 8 courses of dose-adjusted lenalidomide therapy were administered according to the degree of haematological and renal functions. The patient remained in partial remission without disease progression for 21 months. Thus, lenalidomide therapy is effective for bortezomib-refractory MM concomitant with ESRD.

Keywords: Diabetic nephropathy; Dose-adjusted lenalidomide therapy; Haemodialysis; Monoclonal gammopathy of undetermined significance; Multiple myeloma.

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Figures

Fig. 1
Fig. 1
a Renal biopsy showing diffuse or nodular (Kimmelstiel–Wilson) glomerulosclerosis without amyloid deposition and cast nephropathy that is compatible with advanced diabetic nephropathy. At this point, the exact degree of light chain deposition in glomerular lesions was not clear because there was no examination by immunofluorescence studies for IgG, A, λ and C3. b Bone scintigraphy FDG-PET/CT scan showing multiple bone lesions in the ilia, ribs and thoracic vertebrae. c Histological findings showing diffuse expansion and infiltration of abnormal plasma cells
Fig. 2
Fig. 2
Clinical course of our patient. The case developed IgA-type multiple myeloma (MM; Durie–Salmon stage IIIB) derived from monoclonal gammopathy of undetermined significance concomitant with ESRD due to diabetic nephropathy. First, haemodialysis was initiated before chemotherapy, and bortezomib and dexamethasone were found to be ineffective. Subsequently, 8 courses of dose-adjusted lenalidomide therapy were administered according to the degree of haematological and renal functions. The patient remained in partial remission without disease progression for 21 months
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