Relapsed Myeloma with Hepatic Involvement and Tumour Lysis with Bortezomib

Excerpt

A 82 year old gentleman was diagnosed with IgG multiple myeloma and had treatment with attenuated cyclophosphamide, thalidomide and dexamethasone (CTDa) chemotherapy. Patient achieved a very good partial response. Fourteen months from the initial diagnosis, he presented with anaemia, renal impairment (creatinine 142 µmol/L) and hypercalcemia (2.65 mmol/L). The monoclonal M band and SFLC ratio rose from 2.0 to 22.0 g/L and 11 to 2016 respectively. Trephine biopsy confirmed 95% bone marrow infiltration by CD 138 positive cells (Fig. 1). β2microglobulin was 22 mg/L (range 1.2–2.4 mg/L). In addition, patient had deranged liver function tests; bilirubin 39 µmol/L, alkaline phosphatase 207 U/L and alanine transaminase 111 U/L. Clinical examination revealed non-tender hepatomegaly 5 cm below right sub-costal margin. A subsequent CT scan demonstrated hepatosplenomegaly (Fig. 2). The liver biopsy showed extensive infiltration by diffuse sheets of discohesive, highly atypical cells with plasmacytoid and blastic morphology (Fig. 3). Immunohistochemistry demonstrated strong reactivity for CD 138 (Fig. 4) and MUM1 with kappa light chain restriction.

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