内容紹介
A Newly Diagnosed Case of Multiple Myeloma in Which Lenalidomide Was Continued after Surgery for a Pancreatic Neuroendocrine Tumor That Developed during Lenalidomide Maintenance Therapy
Summary
A 75-year-old woman was diagnosed with symptomatic IgG-λ multiple myeloma(good-prognosis group)in December 2010. A stringent complete response(sCR)was achieved by using induction therapy with bortezomib(BOR, Velcade®)+dexamethasone(DEX)(VD)and consolidation therapy with BOR+lenalidomide(LEN, Revlimid®)+DEX(VRD). Although maintenance therapy with Revlimid®+DEX(Rd)was initiated, a pancreatic neuroendocrine tumor was detected in April 2013. Therefore, LEN was discontinued and distal pancreatectomy was performed in September 2013. Because discontinuation of LEN was followed by exacerbation of myeloma, LEN was resumed with the consent of the patient; however, she became resistant to the treatment. The course of this case suggests that some patients must continue to receive LEN even if a sCR is achieved.
要旨
症例は75歳,女性。2010年12月に症候性IgG-λ型多発性骨髄腫(予後良好群)の診断となり,bortezomib(BOR,Velcade®)+dexamethasone(DEX)(VD)による寛解導入とBOR+lenalidomide(LEN,Revlimid®)+DEX(VRD)による地固め療法を行い,厳格な完全奏効(stringent complete response: sCR)が得られた。その後,Revlimid®+DEX(Rd)によるLEN維持療法を行った。2013年4月に膵神経内分泌腫瘍を認めLENを休薬し,9月に膵尾部切除を行った。LEN休薬後に骨髄腫が増悪したため同意の下,LENを再開したが治療抵抗性となった。本症例の経過から,sCRが獲得されてもLENを継続する必要のある患者群が存在することが示唆された。
目次
Summary
A 75-year-old woman was diagnosed with symptomatic IgG-λ multiple myeloma(good-prognosis group)in December 2010. A stringent complete response(sCR)was achieved by using induction therapy with bortezomib(BOR, Velcade®)+dexamethasone(DEX)(VD)and consolidation therapy with BOR+lenalidomide(LEN, Revlimid®)+DEX(VRD). Although maintenance therapy with Revlimid®+DEX(Rd)was initiated, a pancreatic neuroendocrine tumor was detected in April 2013. Therefore, LEN was discontinued and distal pancreatectomy was performed in September 2013. Because discontinuation of LEN was followed by exacerbation of myeloma, LEN was resumed with the consent of the patient; however, she became resistant to the treatment. The course of this case suggests that some patients must continue to receive LEN even if a sCR is achieved.
要旨
症例は75歳,女性。2010年12月に症候性IgG-λ型多発性骨髄腫(予後良好群)の診断となり,bortezomib(BOR,Velcade®)+dexamethasone(DEX)(VD)による寛解導入とBOR+lenalidomide(LEN,Revlimid®)+DEX(VRD)による地固め療法を行い,厳格な完全奏効(stringent complete response: sCR)が得られた。その後,Revlimid®+DEX(Rd)によるLEN維持療法を行った。2013年4月に膵神経内分泌腫瘍を認めLENを休薬し,9月に膵尾部切除を行った。LEN休薬後に骨髄腫が増悪したため同意の下,LENを再開したが治療抵抗性となった。本症例の経過から,sCRが獲得されてもLENを継続する必要のある患者群が存在することが示唆された。