[Achievement of a stringent complete response with low-dose pomalidomide monotherapy in a multiple myeloma patient]

An 80-year-old man presented to our hospital with a thoracic vertebrae compression fracture. He was diagnosed with IgG-λ myeloma (International Staging System stage II, Durie-Salmon stage IIIA). Since melphalan-prednisolone (MP) was not effective, we treated him with lenalidomide and low-dose dexamethasone (DEX) (Ld), achieving a partial response. As DEX provoked edema and psychiatric symptoms, the patient disagreed with its use, and pomalidomide (POM) monotherapy was initiated. Although the POM dosage was reduced to 1-2 mg/day due to somnolence, which was reported as an adverse event, stringent complete response (sCR) was achieved and sustained for 10 months following 11 cycles of low-dose POM monotherapy. It is assumed that sCR was achieved with low-dose POM monotherapy due to its early introduction as well as there being no high-risk chromosomal abnormalities. Even though adverse events develop with a standard dose, a continuation of low-dose POM is considered more important than discontinuation.