title: A case of secondary plasma cell leukemia resistant to novel agents, in which stringent complete remission was achieved and maintained for a long period of time after VAD therapy and tandem autologous transplantation.
abstract: A 61-year-old woman was diagnosed in June 2011 as having immunoglobulin G (IgG) ĸ-type multiple myeloma (MM), stage II, according to the International Staging System (ISS). Chromosome analysis showed a complex karyotype, including t(11;14) and del 13q. Analysis of the cell surface markers revealed that the cells were positive for mature plasma cell-1 (MPC-1), and negative for cluster of differentiation (CD) 45 and CD49e, suggestive of an intermediate level of maturity of the cells. The disease was refractory to bortezomib-dexamethasone (BD) therapy and progressed to plasma cell leukemia despite the treatment. Treatment was therefore switched to lenalidomide-dexamethasone (RD) therapy, however, the condition again proved to be refractory to this therapy. A partial response (PR) was achieved with vincristine-doxorubicin-dexamethasone (VAD) therapy. The residual plasma cells became CD45-positive, suggesting a change of the cells from an intermediate level of maturity to mature cells. In December, autologous peripheral blood stem cell transplantation (Auto-PBSCT) was performed after high-dose melphalan therapy (melphalan 200 mg/m(2)) as pretreatment. PR was observed and a second Auto-PBSCT was performed in July 2012. Stringent complete remission (sCR) has been maintained for 2 years since, without any further treatment. This is the first reported case of secondary plasma cell leukemia (sPCL) resistant to new drugs that was successfully treated by high-dose melphalan in combination with VAD therapy and Auto-PBSCT.
authors.affiliation: Department of Hematology, Juntendo University Urayasu Hospital Japan.
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Sekiguchi
authors.affiliation: Department of Hematology, Juntendo University Urayasu Hospital Japan ; Department of Hematology, Juntendo University Hospital Japan.
authors.forename: Asami
authors.initials: A
authors.lastname: Shimada
authors.affiliation: Department of Hematology, Juntendo University Urayasu Hospital Japan.
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Wakabayashi
authors.affiliation: Department of Hematology, Juntendo University Urayasu Hospital Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Sugimoto
authors.affiliation: Department of Pathology, Juntendo University Urayasu Hospital Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Tomita
authors.affiliation: Department of Pathology, Juntendo University Urayasu Hospital Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Izumi
authors.affiliation: Department of Clinical Laboratory, Juntendo University Urayasu Hospital Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Nakamura
authors.affiliation: Department of Clinical Laboratory, Juntendo University Urayasu Hospital Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Sawada
authors.affiliation: Department of Pathology, Research Hospital, The Institute of Medical Science, The University of Tokyo Japan.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Ohta
authors.affiliation: Department of Hematology, Juntendo University Hospital Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Komatsu
authors.affiliation: Department of Hematology, Juntendo University Urayasu Hospital Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Noguchi
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000032:analysis; D001856:Bone Marrow Examination; D001897:Boronic Acids / Q000008:administration & dosage; D000069286:Bortezomib; D003907:Dexamethasone / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D019008:Drug Resistance, Neoplasm; D057915:Drug Substitution; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D000077269:Lenalidomide; D007952:Leukemia, Plasma Cell / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D017493:Leukocyte Common Antigens / Q000032:analysis; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D036102:Peripheral Blood Stem Cell Transplantation; D010950:Plasma Cells / Q000187:drug effects* / Q000276:immunology / Q000473:pathology; D011719:Pyrazines / Q000008:administration & dosage; D012074:Remission Induction; D013792:Thalidomide / Q000008:administration & dosage / Q000031:analogs & derivatives; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014408:Biomarkers, Tumor; D001897:Boronic Acids; D011719:Pyrazines; D013792:Thalidomide; D014750:Vincristine; D000069286:Bortezomib; D003907:Dexamethasone; D004317:Doxorubicin; D017493:Leukocyte Common Antigens; C516769:PTPRC protein, human; D000077269:Lenalidomide
keywords: Bortezomib; VAD therapy; high-dose chemotherapy in combination with autologous peripheral blood stem cell transplantation; lenalidomide