Successful management of hemodialysis-dependent refractory myeloma with modified daratumumab, bortezomib and dexamethaso
- PDF / 621,471 Bytes
- 4 Pages / 595.276 x 790.866 pts Page_size
- 39 Downloads / 162 Views
CASE REPORT
Successful management of hemodialysis‑dependent refractory myeloma with modified daratumumab, bortezomib and dexamethasone regimen Shinichi Mizuno1 · Chigusa Kitayama1 · Kenta Yamaguchi1 · Satoru Sanada1 · Toshinobu Sato1 Received: 1 July 2020 / Revised: 7 July 2020 / Accepted: 14 July 2020 © Japanese Society of Hematology 2020
Abstract A 71-year-old petite Japanese woman was diagnosed with IgG λ-type multiple myeloma with acute kidney injury, severe anemia, and a pathological rib fracture. Emergent hemodialysis was initiated combined with chemotherapy including bortezomib, lenalidomide, and pomalidomide, but myeloma had become refractory due to the treatments. Therefore, a combination therapy with weekly daratumumab (16 mg/kg), bortezomib (0.7 mg/m2), and dexamethasone was started. Daratumumab was administered on a non-dialysis day with a reduced infusion speed to avoid acute water load. No infusion-related adverse events were observed throughout the treatment. Daratumumab and bortezomib were administrated weekly for three times in the first cycle and a hematological very good partial response was achieved. Then, the treatment schedule was reduced to once every three weeks from the 2nd cycle, the very good partial response had been maintained. Fourteen months after the initiation of maintenance hemodialysis, the patient was able to reduce dialysis frequency due to improvement of renal function. A modified daratumumab, bortezomib and dexamethasone regimen could be a valuable treatment option for dialysis-dependent myeloma patients. Keywords Multiple myeloma · Hemodialysis · Daratumumab · Bortezomib
Introduction Renal impairment (RI) is one of the important organ damages involved in multiple myeloma (MM), which is associated with low quality of life because severe RI requires dialysis. At diagnosis, 20–50% of MM patients present with RI, and 10% require emergency dialysis initiation [1, 2]. Prognosis of patients with RI is worse than those without RI, and severe RI is associated with an increased risk of early death [3]. Daratumumab, an anti-CD38 IgGκ monoclonal antibody, has been one of the most successful therapeutic agents against myeloma in recent years [4]. However, the evidence for the effectiveness and safety on hemodialysis patients have not been established, since patients with severe RI * Shinichi Mizuno s.mizuno@sendai‑kidney.jp 1
Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, 3‑16‑1, Tsutsumimachi, Aoba‑Ku, Sendai, Miyagi 981‑8501, Japan
were excluded from the pivotal studies (CASTRO trial [5], ALCYONE trial [6]). Here, we report a case of refractory MM required dialysis, which was treated safely and effectively with a modified regimen of daratumumab, bortezomib (Bor), and dexamethasone (Dex). In addition, we also discuss the management of dialysis patients from the viewpoint of nephrologists.
Case report A 71-year-old petite Japanese woman was admitted to our hospital in April, 2019 with a left rib fracture, elevated serum creatinine of 14 mg/
Data Loading...
