A case of aggressive myeloma recognized shortly after the remission following high-dose chemotherapy with autologous peripheral blood stem cell transplantation.
A 45-year-old woman was referred to our hospital with acute renal failure and pyrexia. In August 2005, the patient was diagnosed with IgA-λ type multiple myeloma with chromosome 13 deletion, and received three cycles of vinclistine, adriamycin and dexamethasone followed by high-dose melphalan-based autologous peripheral stem cell transplantation: this resulted in remission 2 months before admission to our hospital. Serum IgA concentration was within the normal limit, but an excess of myeloma cells in bone marrow was confirmed. Immunoelectrophoresis revealed BJP-λ production with no IgA-λ. The patient received several courses of chemotherapy with mechanical ventilation and regular hemodialysis. The progression of the illness was rapid: multiple organ failure promptly developed and the patient died 2 months after admission. Autopsy revealed deposition of light chain λ protein in multiple organs. We report this unusual case of aggressive myeloma recognized shortly after successful autologous transplantation.
Ueda
Kaname
K
Division of Medicine, Department of Hematology and Rheumatology, Nihon University School of Medicine, Itabashi Ward, Tokyo, Japan.
Miura
Katsuhiro
K
Hatta
Yoshihiro
Y
Kobayashi
Sumiko
S
Tanaka
Toshitake
T
Hojo
Atsuko
A
Ishizuka
Hikaru
H
Sawada
Umihiko
U
Kura
Yoshimasa
Y
Takeuchi
Jin
J
D058186:Acute Kidney Injury / Q000150:complications; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D002872:Chromosome Deletion; D025063:Chromosome Disorders / Q000150:complications / Q000175:diagnosis; D002882:Chromosomes, Human, Pair 13; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use; D004317:Doxorubicin / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005334:Fever / Q000150:complications; D006801:Humans; D008558:Melphalan / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D036102:Peripheral Blood Stem Cell Transplantation; D012074:Remission Induction; D014182:Transplantation, Autologous; D014750:Vincristine / Q000008:administration & dosage / Q000627:therapeutic use
D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D008558:Melphalan