Thalidomide treatment for immunoglobulin D multiple myeloma in a patient on chronic hemodialysis

Area of Science:

• Hematology
• Nephrology
• Oncology

Background:

• Multiple myeloma is a plasma cell malignancy.
• Renal failure is a common complication in multiple myeloma.
• Chronic hemodialysis is a life-sustaining treatment for end-stage renal disease.

Observation:

• A 64-year-old Japanese male with IgD lambda myeloma and end-stage renal disease requiring hemodialysis was treated with thalidomide.
• Initial presentation included high serum IgD (4,050 mg/dl) and bone marrow plasma cells (95.6%).

Findings:

• Thalidomide treatment led to a marked reduction in serum IgD to 1,590 mg/dl and myeloma cells to 22.0% within four months.
• Adverse effects, including peripheral neuropathy and constipation, occurred at 100 mg daily but resolved with dose reduction.

Implications:

• Thalidomide demonstrates efficacy in managing IgD lambda myeloma in patients with renal failure on hemodialysis.
• This suggests thalidomide is a potential therapeutic option for select myeloma patients with concurrent kidney disease.