A case of allogeneic hematopoietic stem cell transplantation for primary plasma cell leukemia after treatment with darat
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LETTER TO THE EDITOR
A case of allogeneic hematopoietic stem cell transplantation for primary plasma cell leukemia after treatment with daratumumab Yoshihito Horisawa 1 & Tadakazu Kondo 1 & Masakatsu Hishizawa 1 & Kouhei Yamashita 1 & Akifumi Takaori-Kondo 1 Received: 3 March 2020 / Accepted: 10 April 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Editor, Plasma cell leukemia (PCL) is a variant of multiple myeloma (MM), and it is defined by the presence of more than 20% of plasma cells in peripheral blood and an absolute plasma cell count greater than 2 × 109/l [1]. Because primary PCL (pPCL), a PCL subtype without evidence of previous MM, shows frequent early treatment failure and poor prognosis [2], hematopoietic stem cell transplantation (HCT) should be considered. However, although it is reported that autologous and/ or allogeneic stem cell transplantation improves pPCL outcomes [3], an appropriate strategy of HCT for pPCL remains elusive. Here, we report about a patient who underwent allogeneic HCT (allo-HCT) for pPCL that was treated using salvage chemotherapy with daratumumab. To our knowledge, this is the first report of allo-HCT after treatment with daratumumab. A 47-year-old Japanese man presented with lower back pain and right vision deterioration, which was diagnosed as central retinal vein occlusion by an ophthalmologist, and he was referred to the previous hospital. He was diagnosed with immunoglobulin (Ig) A-kappa-type PCL based on the following laboratory data: white cell blood count, 22,200/μl with 87.0% lymphocytes that were mostly abnormal plasmacytes; serum IgA level, 5904 mg/dl; and serum free kappa/lambda ratio, 166.47. Bone marrow aspiration showed 78.8% plasmacytes, and the karyotype was 46, inv. (Y) (p11.2; q11.2). An interphase fluorescence in situ hybridization study revealed that t (11;14) was positive but t (4;14), t (14;16), del (13), and del (17) were negative. After 4 cycles of bortezomib, lenalidomide, and low-dose dexamethasone (VRd) by the previous doctor, he was referred to our hospital for HCT. * Tadakazu Kondo [email protected] 1
Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho Sakyo-ku, Kyoto 606-8507, Japan
Laboratory test results on admission were as follows: white blood cells, 3940/μl without abnormal plasmacytes; hemoglobin, 13.7 g/dl; platelet count, 21.1 × 104/μl; IgG, 282 ml/dl; IgM, 25 mg/dl; IgA, 475 mg/dl; and serum free kappa/lambda ratio, 10.31. Bone marrow aspiration showed 1.8% plasmacytes, and complex karyotype with t (11;14) was noted (Fig. 1). After the patient’s admission to our hospital, VRd therapy was continued. Because bone marrow aspiration after 5 cycles of VRd revealed an increase in abnormal plasmacytes, we concluded that the disease was refractory to VRd. Therefore, the chemotherapy regimen was changed to daratumumab, lenalidomide, and low-dose dexamethasone (DRd), following which the abnormal plasmacytes in the bone marrow decreased again. After 2 cycle
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