Complete remission in IgG kappa multiple myeloma with initially unfavorable prognosis after bortezomib-thalidomide-dexamethasone induction and autologous hematopoietic stem cell transplantation
DOI:
https://doi.org/10.5281/zenodo.21896222Keywords:
multiple myeloma, immunoglobulin G, autologous hematopoietic stem cell transplantation, residual neoplasm, remission induction, case reportAbstract
Introduction: Multiple myeloma is a hematologic neoplasm characterized by clonal proliferation of plasma cells in the bone marrow and production of a monoclonal immunoglobulin, with a usually aggressive clinical course when extensive bone disease is present.
Objective: To describe a case of IgG kappa multiple myeloma with multiple vertebral osteolytic lesions at diagnosis that achieved complete remission without minimal residual disease after induction and autologous hematopoietic stem cell transplantation.
Case presentation: We present the case of a 59-year-old man, former smoker, with no known baseline medical conditions, who had a six-month history of stabbing lumbar pain partially relieved by common analgesics, accompanied by 5 kg weight loss over the same period. Because symptoms persisted, laboratory studies and computed tomography of the chest, abdomen and pelvis were performed. Laboratory findings showed anemia, a monoclonal gamma peak on protein electrophoresis, elevated beta-2-microglobulin, positive immunofixation for IgG kappa monoclonal protein, and flow cytometry with a population of atypical monoclonal kappa plasma cells. Imaging showed disseminated vertebral osteolytic lesions with wedging. Multiple myeloma was confirmed and induction with bortezomib-thalidomide-dexamethasone was started, followed by autologous hematopoietic stem cell transplantation after mobilization and collection. The post-transplant course included transient neutropenia and thrombocytopenia resolving within the first ten days, self-limited diarrhea without mucositis, and associated hypocalcemia and hypokalemia. The patient was discharged in good general condition. Follow-up flow cytometry showed complete remission without evidence of minimal residual disease.
Conclusions: This case illustrates that an integrated diagnostic approach and timely induction and intensification therapy can achieve complete remission in multiple myeloma even when the initial presentation —with extensive bone disease— suggests an unfavorable prognosis, and it underscores the value of minimal residual disease as a marker of deep treatment response.
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Copyright (c) 2024 Fabiana Giménez Chamorro, Vivian Gayoso Álvarez, Nelly Gómez Larrosa, Isamar Fabiola Ferreira, Zara Escobar Benítez (Autor/a)
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