title: Relapse of IgA lambda multiple myeloma presenting as obstructive jaundice and abdominal pain.
abstract: BACKGROUND
  Only few cases of pancreatic involvement of multiple myeloma (MM) have been reported in the medical literature.
  
  
  METHODS
  We here report a case of devastating extramedullary relapse of IgA/lambdaMM (stage IA) treated at diagnosis with a dexamethasone, adriamycin, vincristine (DAV) regimen followed by high-dose therapy and autologous stem cell transplantation (ASCT), achieving a partial remission. After 6 years of stable disease, the patient presented symptoms of obstructive jaundice determined by a large mass of the head of the pancreas. An ultrasound-guided fine-needle aspiration cytology of the pancreatic mass revealed the presence of myeloma plasma cells. A chest X-ray demonstrated a massive right pleural effusion, and the cytomorphologic evaluation of the pleural effusion showed the presence of abnormal plasma cells.
  
  
  RESULTS
  We observed a progression of disease despite an aggressive treatment with high-dose cyclophosphamide.
  
  
  CONCLUSIONS
  Our case shows that extramedullary relapses of MM after ASCT are very resistant to conventional chemotherapy. The role of new drugs and the optimal treatment strategy in these cases remain to be defined.
authors.affiliation: Hematology, University Campus Bio-Medico, Rome, Italy. o.annibali@unicampus.it
authors.forename: Ombretta
authors.initials: O
authors.lastname: Annibali
authors.forename: Francesco
authors.initials: F
authors.lastname: Marchesi
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Petrucci
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Tirindelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Avvisati
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007146:Immunoglobulin lambda-Chains / Q000032:analysis*; D041781:Jaundice, Obstructive / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D009101:Multiple Myeloma / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000517:prevention & control*; D010190:Pancreatic Neoplasms / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D055502:Secondary Prevention
chemical_list: D007146:Immunoglobulin lambda-Chains