[Plasma cell leukemia induced to complete remission with negative minimal residual disease by qualitative PCR analysis after hyper-CVAD and high-dose melphalan followed by autologous peripheral blood stem cell transplantation].
A 69-year-old Japanese man was diagnosed as having primary plasma cell leukemia. His malignant plasma cells had a chromosomal translocation t(11;14)(q13;q32) that created overexpression of cyclin D1. Two courses of VAD (vincristine, doxorubicin, dexamethasone) therapy failed to achieve complete remission. Three subsequent courses of hyper-CVAD (cyclophosphamide, vincristine, doxorubicin, dexamethasone) therapy successfully induced remission with negative FISH test for t(11;14)(q13;q32). Thereafter, the patient received high-dose melphalan (125 mg/m(2)) followed by autologous peripheral blood stem cell transplantation. Cyclin D1 that was present prior to the high-dose chemotherapy, was no longer detected by qualitative PCR analysis. Despite complete cytogenetic remission, the disease relapsed 6 months later, and the patient eventually died 16 months following the diagnosis. Plasma cell leukemia is a rare hematological malignancy with a poor prognosis. The treatment has not been standardized yet. The present case suggested the effectiveness of the combination of hyper-CVAD and high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation. Nevertheless, because of the short remission duration, intensification using tandem high-dose chemotherapy or maintenance using new agents such as bortezomib and thalidomide should be considered for improving the prognosis.
Hosono
Naoko
N
Dept. of Hematology and Oncology, University of Fukui, Japan.
Yamauchi
Takahiro
T
Nakamura
Toru
T
Yamashita
Tarou
T
Ueda
Takanori
T
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D006801:Humans; D007952:Leukemia, Plasma Cell / Q000188:drug therapy* / Q000235:genetics / Q000601:surgery*; D008297:Male; D008558:Melphalan / Q000627:therapeutic use*; D036102:Peripheral Blood Stem Cell Transplantation; D016133:Polymerase Chain Reaction; D012074:Remission Induction; D014182:Transplantation, Autologous; D017211:Treatment Failure; D014750:Vincristine / Q000627:therapeutic use
D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide; D008558:Melphalan