Various drugs
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Lack of efficacy: case report A 47-year-old man exhibited lack of efficacy while receiving treatment with bortezomib, lenalidomide and dexamethasone for plasma cell leukaemia (PCL). The man presented with right vision deterioration and lower back pain. Based on further investigations, he was diagnosed with central retinal vein occlusion. Furthermore, based on laboratory findings he was diagnosed with immunoglobulin (Ig) A-kappa-type PCL, and started receiving treatment with bortezomib, lenalidomide and dexamethasone (VRd) chemotherapy [dosages and routes not stated]. After 4 cycles of this therapy, he was referred for haematopoietic stem cell transplantation (HCT). He was hospitalised, and was continued on bortezomib, lenalidomide and dexamethasone therapy. After 5 cycles of chemotherapy, bone marrow aspiration showed rise in abnormal plasmacytes; thus, it was concluded that this PCL was refractory to VRd chemotherapy. Thus, the man’s chemotherapy regimen was changed to lenalidomide, dexamethasone and off-label daratumumab. Following chemotherapy change, abnormal cells in the bone marrow reduced. After 2 cycles of new chemotherapy regimen, autologous stem cell transplantation was performed with high dose melphalan, and a stringent complete remission was achieved. Subsequently, the chemotherapy was continued for 2 cycles in total after ASCT. He had bone marrow transplantation with a conditioning regimen of melphalan, fludarabine and 8-Gy total body irradiation. He was discharged from hospital on day 50. Primary PCL remained in stringent complete remission 18 months after allogenic HCT (allo-HCT). Horisawa Y, et al. A case of allogeneic hematopoietic stem cell transplantation for primary plasma cell leukemia after treatment with daratumumab. Annals of Hematology 99: 803518607 2699-2701, No. 11, Nov 2020. Available from: URL: http://doi.org/10.1007/s00277-020-04029-y
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Reactions 5 Dec 2020 No. 1833
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