Renal recovery with lenalidomide in a patient with bortezomib-resistant multiple myeloma

A 51-year-old man presented with an 8 month history of migratory pain and weakness.

Conventional X-ray, MRI, laboratory investigations including serum electropheresis and immunofixation, measurement of the glomerular filtration rate and levels of serum creatinine and lactate dehydrogenase, and 24 h urine analysis for proteinuria.

Durie-Salmon stage IIIB multiple myeloma with IgG lambda gammopathy and renal impairment associated with urinary excretion of free lambda light chains.

Initially, the patient received supportive analgesia with metamizol and opioids, erythropoiesis-stimulating agents and monthly administration of bisphosphonates. A standard regimen of bortezomib, doxorubicin and dexamethasone was started, but the patient did not respond and developed severe renal failure. Treatment was switched to low-dose lenalidomide and high-dose dexamethasone. The lenalidomide dose was gradually increased up to 15 mg daily and the dexamethasone dose reduced to 40 mg once a week. Therapy was well tolerated, and the patient underwent autologous stem-cell transplantation around 16 months after start of induction treatment and 12 months after the start of lenalidomide-based therapy. At 2 years after initiation of lenalidomide-based therapy, the patient remains in partial remission with stable renal function and excellent performance status.