Oral low-dose etoposide therapy for refractory multiple myeloma with extramedullary involvement

Area of Science:

• Hematology
• Oncology
• Pharmacology

Background:

• Multiple myeloma (MM) is a hematologic malignancy characterized by uncontrolled proliferation of plasma cells.
• Extramedullary plasmacytomas can occur in patients with MM, posing significant therapeutic challenges.
• Standard chemotherapy regimens and alpha-interferon were ineffective in this patient.

Observation:

• A 65-year-old male patient presented with IgG kappa-type multiple myeloma and extensive subcutaneous plasmacytomas.
• Previous treatments including MMCP, AVPP, and alpha-interferon failed to control the disease.
• The patient received oral etoposide at 50 mg/day.

Findings:

• Complete resolution of subcutaneous plasmacytomas was observed after 5 months of daily oral etoposide.
• Monoclonal protein levels became undetectable after 8 months of continuous treatment.
• The primary side effect noted was alopecia (hair loss).

Implications:

• Long-term, daily low-dose oral etoposide may represent a viable treatment option for refractory multiple myeloma with extramedullary involvement.
• This approach warrants further investigation in clinical trials for patients with similar refractory disease.
• The findings suggest a potential new therapeutic strategy for managing advanced multiple myeloma and plasmacytomas.