The late extramedullary relapse of the multiple myeloma with a predominant lesion of the duodenum and pancreas (clinical observation and mini-review)

Abstract

A rare case of the multiple myeloma is written. The patient developed the extramedullary lesions with a primary lesion of the duodenum as a massive plasmacytoma with the bleeding, as well as damage to the pancreas and lymph nodes. The patient received several lines of therapy, including proteasome inhibitors and antitumor immunomodulators before the onset of extramedullary lesions. Extramedullary relapse was detected by positron emission tomography combined with CT (PET/CT) before the appearance of obvious clinical signs, which emphasizes the advisability of including PET/CT in the diagnostic algorithm for such patients. Repeated therapy with the previously used bortezomib or lenalidomide was ineffective, there was a further increase in plasmacytoma in duodenum and its bleeding, which led to severe anemia. The combination of carfilzomib with pomalidomide and dexamethasone allowed to achieve complete remission after three cycles of treatment. In this clinical case, we additionally used clarithromycin and metformin to improve the anti-myeloma activity of combination of main treatment. In a brief review of the literature, the frequency of extramedullary lesions, the causes of the appearance of extramedullary lesions, and approaches to diagnosis and therapy are analyzed. Extramedullary lesions with multiple myeloma are a dangerous manifestation of the clonal evolution of the disease, in which the treatment options are still limited, therefore, the demonstration of successful treatment with carfilzomib shows the value of new methods of treatment, as well as the potential effects on the tumor cell when redesigning drug prescriptions.

Keywords

• multiple myeloma
• stomach fluoroscopy
• duodenum
• computed tomography
• pet/ct
• carfilzomib
• lenalidomide
• pomalidomide
• clarithromycin
• metformin
• re-designation of the drug