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Published on: May 1, 2015
Three cases of bortezomib-resistant multiple myeloma with extramedullary masses
Makiko Moriuchi1, Ken Ohmachi, Minoru Kojima
1Division of Hematology/Oncology, Department of Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193 Japan. makioku@is.icc.u-tokai.ac.jp
Abstract:
In some patients with multiple myeloma, extramedullary masses may be present at diagnosis or may develop during treatment. Recently, multiple myeloma has been treated using newer therapeutic regimens based on thalidomide and bortezomib. Using these drugs, positive responses to treatment, not found with conventional antineoplastic agents, have been reported along with an improvement in patient outcome. In the present study, we report on three patients with extramedullary masses associated with multiple myeloma. Although all three patients were treated with bortezomib, it was ineffective against the extramedullary masses and the clinical course of the disease differed between the three patients. We propose that the effects of bortezomib on extramedullary masses may differ from case to case and may not be evident in cases of severe disease. Also, the effects of bortezomib may not be evident in the case of myeloma cells that have left the bone marrow microenvironment, similar to thalidomide. In addition, resistance to bortezomib may manifest as extramedullary masses. (160 words in the body of abstract).
Insights
Bortezomib treatment showed limited effectiveness against extramedullary masses in multiple myeloma patients. The drug
Area of Science:
- Hematology
- Oncology
- Pharmacology
Background:
- Multiple myeloma can present with or develop extramedullary masses.
- Novel therapies like thalidomide and bortezomib have improved outcomes.
- Extramedullary disease is a known complication of multiple myeloma.
Observation:
- Three multiple myeloma patients with extramedullary masses were treated with bortezomib.
- Bortezomib was ineffective in treating the extramedullary masses in all three cases.
- Clinical disease progression varied among the patients despite bortezomib treatment.
Findings:
- Bortezomib efficacy against extramedullary masses may be variable and case-dependent.
- Severe disease or myeloma cells outside the bone marrow microenvironment may limit bortezomib's effect.
- Extramedullary masses could indicate resistance to bortezomib therapy.
Implications:
- Current therapeutic strategies may need adjustment for multiple myeloma with extramedullary disease.
- Further research is needed to understand bortezomib resistance mechanisms.
- Identifying biomarkers for bortezomib response in extramedullary myeloma is crucial.
