Neurofibromatosis type I and smoldering multiple myeloma: a case report

We present a case of a 64-year-old woman with neurofibromatosis (NF1) and smoldering multiple myeloma (SMM). SMM was diagnosed 9 years ago when the asymptomatic patient was found to have mild anemia, IgA paraproteinemia, hypogammaglobulinemia, osteopenia without any lytic bone lesions and bone marrow plasmacytosis. During follow-up period she remained stable in an excellent clinical condition without requiring any therapy for almost 4 years. Forty-two months after diagnosis she had a femoral fracture and since then biphosphonates have been administered intravenously, once monthly. Subsequent evaluations of the disease showed a dramatic reduction of IgA paraprotein to below half the initial value. We will discuss the probable pathogenesis of plasma cell dyscrasia in NF1 patients, as well as the likely antimyeloma activity of biphoshonates.