A rare case of bifocal, extramedullary and hyposecretory relapse of multiple myeloma

Kód výsledku v IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F61989592%3A15110%2F21%3A73608336" target="_blank" >RIV/61989592:15110/21:73608336 - isvavai.cz</a>

Nalezeny alternativní kódy

RIV/00098892:_____/21:N0000077

Výsledek na webu

<a href="https://onlinelibrary.wiley.com/doi/epdf/10.1002/ccr3.4570" target="_blank" >https://onlinelibrary.wiley.com/doi/epdf/10.1002/ccr3.4570</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1002/ccr3.4570" target="_blank" >10.1002/ccr3.4570</a>

Jazyk výsledku

angličtina

Název v původním jazyce

A rare case of bifocal, extramedullary and hyposecretory relapse of multiple myeloma

Popis výsledku v původním jazyce

We present a rare extramedullary, bifocal, and hyposecretory manifestation of relapsed MM that could be mistaken for an infection. We stress the importance of complex evaluation including serum, urine, and bone marrow assessment and whole-body imaging. What is the new aspect of your work? A very rare manifestation of multiple myeloma relapse, being all extramedullary, bifocal, and hyposecretory. Moreover, the activity of the disease did not behave as myeloma but rather as a different (infectious) condition. What is the central finding of your work? We stress the importance of comprehensive examination including modern diagnostic tools to elucidate the diagnosis that goes behind routine criteria. What is (or could be) the specific clinical relevance of your work? The key clinical points are following: Multiple myeloma manifestation can be really atypical and can be mistaken for a different condition. The approach to suspected relapse of multiple myeloma should not rely solely on routine monitoring but it should include complex assessment including serum and urine tests, bone marrow assessment, and whole-body imaging. Extramedullary myeloma needs to be looked for using appropriate imaging techniques. 1 INTRODUCTION With prolonged survival of multiple myeloma (MM) patients due to the introduction of novel drugs, we encounter uncommon manifestations of the relapses. As the disease evolves, it becomes more aggressive, including secondary plasma cell leukemia, extramedullary plasmocytoma (EM), or central nervous system involvement. The latter relapses are often with lower M-protein, some patients might have “light-chain escape” or even become non-secretory. We present an unusual manifestation of a bifocal, hyposecretory, and extramedullary relapse of MM that was revealed due to thorough examination including the use of modern imaging techniques. 2 CASE REPORT A 69-year-old man was diagnosed with MM based on usual complaints (lower back pain with lytic bone involvement of the spine). The initial diagnosis was IgA kappa MM, stage IIIA (Durie-Salmon), ISS 2 (International Staging System), with hyperdiploidy (trisomy of chromosome 15) and t(4;14). The patient characteristics and therapy outcomes are in Table 1. Due to co-morbidities, he was transplant ineligible and started induction treatment with VMP regimen (bortezomib, melphalan, and prednisone). After 9 cycles, he reached partial remission (PR) with stable levels of M-protein (12 g/L) and was followed without therapy. 16 months after the diagnosis, he relapsed and started therapy with IRD regimen (ixazomib, lenalidomide, and dexamethasone). The therapy induced complete response.

Název v anglickém jazyce

A rare case of bifocal, extramedullary and hyposecretory relapse of multiple myeloma

Popis výsledku anglicky

We present a rare extramedullary, bifocal, and hyposecretory manifestation of relapsed MM that could be mistaken for an infection. We stress the importance of complex evaluation including serum, urine, and bone marrow assessment and whole-body imaging. What is the new aspect of your work? A very rare manifestation of multiple myeloma relapse, being all extramedullary, bifocal, and hyposecretory. Moreover, the activity of the disease did not behave as myeloma but rather as a different (infectious) condition. What is the central finding of your work? We stress the importance of comprehensive examination including modern diagnostic tools to elucidate the diagnosis that goes behind routine criteria. What is (or could be) the specific clinical relevance of your work? The key clinical points are following: Multiple myeloma manifestation can be really atypical and can be mistaken for a different condition. The approach to suspected relapse of multiple myeloma should not rely solely on routine monitoring but it should include complex assessment including serum and urine tests, bone marrow assessment, and whole-body imaging. Extramedullary myeloma needs to be looked for using appropriate imaging techniques. 1 INTRODUCTION With prolonged survival of multiple myeloma (MM) patients due to the introduction of novel drugs, we encounter uncommon manifestations of the relapses. As the disease evolves, it becomes more aggressive, including secondary plasma cell leukemia, extramedullary plasmocytoma (EM), or central nervous system involvement. The latter relapses are often with lower M-protein, some patients might have “light-chain escape” or even become non-secretory. We present an unusual manifestation of a bifocal, hyposecretory, and extramedullary relapse of MM that was revealed due to thorough examination including the use of modern imaging techniques. 2 CASE REPORT A 69-year-old man was diagnosed with MM based on usual complaints (lower back pain with lytic bone involvement of the spine). The initial diagnosis was IgA kappa MM, stage IIIA (Durie-Salmon), ISS 2 (International Staging System), with hyperdiploidy (trisomy of chromosome 15) and t(4;14). The patient characteristics and therapy outcomes are in Table 1. Due to co-morbidities, he was transplant ineligible and started induction treatment with VMP regimen (bortezomib, melphalan, and prednisone). After 9 cycles, he reached partial remission (PR) with stable levels of M-protein (12 g/L) and was followed without therapy. 16 months after the diagnosis, he relapsed and started therapy with IRD regimen (ixazomib, lenalidomide, and dexamethasone). The therapy induced complete response.

Druh

J_SC - Článek v periodiku v databázi SCOPUS

CEP obor

—

OECD FORD obor

30205 - Hematology

Projekt

Výsledek vznikl pri realizaci vícero projektů. Více informací v záložce Projekty.

Návaznosti

P - Projekt vyzkumu a vyvoje financovany z verejnych zdroju (s odkazem do CEP)

Rok uplatnění

2021

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Název periodika

Clinical Case Reports

ISSN

2050-0904

e-ISSN

—

Svazek periodika

9

Číslo periodika v rámci svazku

8

Stát vydavatele periodika

GB - Spojené království Velké Británie a Severního Irska

Počet stran výsledku

6

Strana od-do

"nestránkováno"

Kód UT WoS článku

000757370700083

EID výsledku v databázi Scopus

999