Restoration of chemosensitivity by bortezomib: implications for refractory myeloma

Abstract

Resistance to chemotherapy remains one of the major challenges in the treatment of patients with multiple myeloma. Chim et al. report the case of a 59-year-old woman with multiple myeloma, who progressed after treatment with conventional chemotherapeutic agents. Addition of bortezomib to her treatment regimen resulted in complete regression of her disease. The authors suggest that bortezomib can restore chemosensitivity of myeloma cells in heavily pretreated, chemorefractory patients with multiple myeloma. Background. A 59-year-old woman presented to the emergency department with a left rib fracture and was diagnosed with IgA multiple myeloma. The patient underwent autologous bone-marrow transplantation, and 14 months later she developed obstructive jaundice. Investigations. Serum protein electrophoresis, contrast CT of thorax and abdomen, endoscopic retrograde cholangiopancreatography with endoscopic biopsy and pleural biopsy. Diagnosis. Extramedullary plasmacytomas at pancreatic head and pleura. Management. Salvage chemotherapy regimens including bortezomib plus steroid, alkylators plus steroid, bortezomib plus anthracycline and radiotherapy, and combined bortezomib, cyclophosphamide, melphalan and steroid therapy.