Successful outcome of anaplastic multiple myeloma with lenalidomide, cyclophosphamide, and dexamethasone therapy
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LETTER TO THE EDITOR
Successful outcome of anaplastic multiple myeloma with lenalidomide, cyclophosphamide, and dexamethasone therapy Wenjiao Tang 1 & Yangfan Xu 1 & Bing Xiang 1 Received: 22 July 2020 / Accepted: 10 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Editor, Anaplastic multiple myeloma (AMM) is a rare morphological variant of multiple myeloma with an aggressive course [1], which is inadequately understood since only limited case reports have been published. Moreover, there is no consensus on the treatment, and it responses poorly to several novel therapies [2, 3]. Here, we report an AMM patient with extramedullary involvement who was successfully treated with a lenalidomide-based regimen. A 70-year-old female presented with a rapidly expanding painful mass in the right mandible for 1 month (Fig. 1a), resulting in her inability to intake orally. She had to obtain nutritional support through a nasogastric tube. She was initially suspected of infection and received antibacterial therapy, but the symptoms deteriorated. Finally, the biopsy pathology revealed that many uniformly large atypical cells infiltrated the fibrous and muscular tissues, accompanied by necrosis. Based on the immunohistochemistry identifying CD138, CD38, CD10, and mum-1 positive, with high expression of P53 and Ki-67, the pathological diagnosis of anaplastic plasmacytoma was made. The PET-CT scan revealed a 56 × 38 × 69 mm mass in the right mandible with a maximum SUV 5.5 (Fig. 1c), as well as the ninth left rib fracture, lytic bone lesions of the left ilium, and abnormal 18F-FDG intake of the axial and proximal limb bones. The laboratory examination showed hemoglobin 87 g/L, albumin 39.8 g/L, globulin 15.2 g/L, and elevated lactic dehydrogenase 1352 U/L. Serum and urine immunofixation electrophoresis confirmed the monoclonal lambda light chain. Bone marrow examinations identified 22% of lambda-restricted atypical immature plasma cells, with 1q21 gains and IGH gains detected by fluorescence in
situ hybridization. TP53 gene exon2-11 sequencing showed a homozygous missense mutation of c.215C > G. She was diagnosed with AMM. Considering the aggressiveness of anaplastic and extramedullary myeloma, we gave the patient a three-drug combined therapy (RCD) of a 28-day cycle, including lenalidomide 25 mg once daily for 21 days, cyclophosphamide 400 mg once weekly, and dexamethasone 40 mg per week. After one cycle induction therapy, the mass entirely resolved (Fig. 1b) and she achieved complete remission with normal serum and urine immunofixation electrophoresis. With a follow-up duration of 4 months, the patient has completed four cycles of RCD and sustains complete remission. AMM was reported to be common in young patients with a predisposition to extramedullary lesions [4, 5]. Anaplastic plasmacytoid cells can hardly be differentiated from lowdifferentiated cancers, malignant melanoma, and sarcoma, so immunohistochemistry is critical in the diagnosis. The cytogenetic study showed that AMM harbors higher preva
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