Unusual discordant responses in two multiple myeloma patients during bortezomib treatment

• Published in: Onkologie Vol. 31; no. 1-2; p. 45
• Main Authors: Pirrotta, Maria Teresa, Gozzetti, Alessandro, Cerase, Alfonso, Bucalossi, Alessandro, Bocchia, Monica, Defina, Marzia, Lauria, Francesco
• Format: Journal Article
• Language: English
• Published: Switzerland 01.01.2008
• Subjects: Aged; Antineoplastic Agents - therapeutic use; Boronic Acids - therapeutic use; Bortezomib; Cerebellum - pathology; Dexamethasone - therapeutic use; Disease Progression; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Resistance, Neoplasm; Fatal Outcome; Female; Humans; Immunoglobulin kappa-Chains - blood; Immunoglobulin lambda-Chains - biosynthesis; Male; Meninges - pathology; Multiple Myeloma - drug therapy; Multiple Myeloma - pathology; Neoplasm Invasiveness; Neoplasm Staging; Plasma Cells - pathology; Pyrazines - therapeutic use; Skin - pathology
• ISSN: 1423-0240
• DOI: 10.1159/000112217

Cases of discordant responses in multiple myeloma (MM) patients after thalidomide therapy have been sometimes reported, in which extramedullary masses progress or present de novo with a simultaneous serum monoclonal protein reduction. We hereby report, for the first time, on two cases of MM patients with extramedullary myeloma localizations that developed during Velcade (bortezomib, PS341) treatment with a concomitant serum monoclonal protein reduction. We observed in both patients a very good response in the serum monoclonal protein level, while extramedullary lesions appeared in the central nervous system and subcutaneously. We discuss pharmacokinetics of bortezomib and physiopathology of this unusual event and review the literature.