Marked improvement of platelet transfusion refractoriness after bortezomib therapy in multiple myeloma.
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.
Miki
Hirokazu
H
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.
Ozaki
Shuji
S
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.
Tanaka
Osamu
O
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.
Lee
Etsuko
E
Division of Transfusion Medicine, Tokushima University Hospital, Tokushima, Japan.
Takimoto
Tomomi
T
Division of Transfusion Medicine, Tokushima University Hospital, Tokushima, Japan.
Watanabe
Hirofumi
H
Division of Transfusion Medicine, Tokushima University Hospital, Tokushima, Japan.
Fujii
Shiro
S
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.
Nakamura
Shingen
S
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.
Kagawa
Kumiko
K
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.
Takeuchi
Kyoko
K
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.
Yata
Ken-Ichiro
KI
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.
Abe
Masahiro
M
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.
Kagami
Shoji
S
Division of Transfusion Medicine, Tokushima University Hospital, Tokushima, Japan.
Matsumoto
Toshio
T
Department of Medicine and Bioregulatory Sciences, The University of Tokushima Graduate School of Health Biosciences, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan.
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
D000906:Antibodies; D001897:Boronic Acids; D006680:HLA Antigens; D011719:Pyrazines; D000069286:Bortezomib; D003907:Dexamethasone