title: Marked improvement of platelet transfusion refractoriness after bortezomib therapy in multiple myeloma.
abstract: We report a patient with refractory multiple myeloma (MM) who developed platelet transfusion refractoriness (PTR). A 61-year-old woman was diagnosed with MM in July 2003. She underwent high-dose chemotherapy followed by autologous stem cell transplantation, and achieved a very good partial response. However, she relapsed in June 2006, and was referred to our hospital in October of the same year. Laboratory examinations showed pancytopenia and increased plasma cells in the peripheral blood. Platelet transfusions from random donors became ineffective, and anti-HLA class I antibody (83.8% positive) was detected in the serum by flow cytometry assay (Flow PRA). Therefore, she was considered to have developed PTR due to anti-HLA class I antibody caused by the previous blood transfusions. She was transfused with HLA-matched platelets, and then treated with bortezomib plus dexamethasone (BD) for refractory MM. The serum IgG level decreased from 7,451 to 1,735 mg/dL, and HLA class I antibody was markedly decreased to 1.9%. In addition, platelet transfusion from random donors showed clinical effects after BD therapy. This case suggests that bortezomib might be effective in different types of immune disease by inhibiting allo-reactive antibody.
authors.affiliation: Department of Medicine and Bioregulatory Sciences, The University of Tokushima Graduate School of Health Biosciences, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan.|Department of Hematology, Tokushima University Hospital, Tokushima, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Miki
authors.affiliation: Department of Medicine and Bioregulatory Sciences, The University of Tokushima Graduate School of Health Biosciences, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan. ozakishu@clin.med.tokushima-u.ac.jp.|Department of Hematology, Tokushima University Hospital, Tokushima, Japan. ozakishu@clin.med.tokushima-u.ac.jp.|Division of Transfusion Medicine, Tokushima University Hospital, Tokushima, Japan. ozakishu@clin.med.tokushima-u.ac.jp.
authors.forename: Shuji
authors.initials: S
authors.lastname: Ozaki
authors.affiliation: Department of Medicine and Bioregulatory Sciences, The University of Tokushima Graduate School of Health Biosciences, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan.|Department of Hematology, Tokushima University Hospital, Tokushima, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Tanaka
authors.affiliation: Division of Transfusion Medicine, Tokushima University Hospital, Tokushima, Japan.
authors.forename: Etsuko
authors.initials: E
authors.lastname: Lee
authors.affiliation: Division of Transfusion Medicine, Tokushima University Hospital, Tokushima, Japan.
authors.forename: Tomomi
authors.initials: T
authors.lastname: Takimoto
authors.affiliation: Division of Transfusion Medicine, Tokushima University Hospital, Tokushima, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Watanabe
authors.affiliation: Department of Medicine and Bioregulatory Sciences, The University of Tokushima Graduate School of Health Biosciences, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan.|Department of Hematology, Tokushima University Hospital, Tokushima, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Fujii
authors.affiliation: Department of Medicine and Bioregulatory Sciences, The University of Tokushima Graduate School of Health Biosciences, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan.|Department of Hematology, Tokushima University Hospital, Tokushima, Japan.
authors.forename: Shingen
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Department of Medicine and Bioregulatory Sciences, The University of Tokushima Graduate School of Health Biosciences, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan.|Department of Hematology, Tokushima University Hospital, Tokushima, Japan.
authors.forename: Kumiko
authors.initials: K
authors.lastname: Kagawa
authors.affiliation: Department of Medicine and Bioregulatory Sciences, The University of Tokushima Graduate School of Health Biosciences, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan.|Department of Hematology, Tokushima University Hospital, Tokushima, Japan.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Takeuchi
authors.affiliation: Department of Medicine and Bioregulatory Sciences, The University of Tokushima Graduate School of Health Biosciences, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan.|Department of Hematology, Tokushima University Hospital, Tokushima, Japan.
authors.forename: Ken-Ichiro
authors.initials: KI
authors.lastname: Yata
authors.affiliation: Department of Medicine and Bioregulatory Sciences, The University of Tokushima Graduate School of Health Biosciences, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan.|Department of Hematology, Tokushima University Hospital, Tokushima, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Abe
authors.affiliation: Division of Transfusion Medicine, Tokushima University Hospital, Tokushima, Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Kagami
authors.affiliation: Department of Medicine and Bioregulatory Sciences, The University of Tokushima Graduate School of Health Biosciences, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Matsumoto
mesh_terms: D000906:Antibodies; D001897:Boronic Acids / Q000627:therapeutic use*; D000069286:Bortezomib; D003907:Dexamethasone / Q000627:therapeutic use; D005260:Female; D006680:HLA Antigens / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000601:surgery; D017713:Platelet Transfusion; D011719:Pyrazines / Q000627:therapeutic use*; D016879:Salvage Therapy; D014184:Transplantation, Homologous
chemical_list: D000906:Antibodies; D001897:Boronic Acids; D006680:HLA Antigens; D011719:Pyrazines; D000069286:Bortezomib; D003907:Dexamethasone