Effectiveness of treatment of an elderly patient with good prognosis of multiple myeloma

• Main Authors: Peter Černelč, Veronika Kodre
• Format: Article
• Language: English
• Published: Slovenian Medical Association 2012-12-01
• Series: Zdravniški Vestnik
• Online Access: http://vestnik.szd.si/index.php/ZdravVest/article/view/779

Background: Case report presents the treatment of a multiple myeloma patient with different schemes used in Slovenia in the last 10 years, the inclusion of different medicines in treatment protocols and the evaluation of their effectiveness. Patient and treatment: This 79-year old patient had multiple myeloma IgA lambda with good disease prognosis diagnosed in July 2001 at the age of 69 years. Considering his age > 65 years at the time of diagnosis, patient was not suitable for autologous transplantation and was treated with different treatment schemes: MP (melphalan, prednisone), TM (thalidomide, methylprednisolone), VAD (vincristine, doxorubicine substituted by farmorubicin, dexamethasone), As2O3D (arsenic trioxide, dexamethasone), Vel (bortezomib), VelD (bortezomib, dexamethasone), Ciklo (cyclophosphamide), LenM (lenalidomide, methylprednisolone), Melfiv (melphalan iv), VelDvzdr (bortezomib and dexamethasone, maintenance every 14 days). Results: Treatment effectiveness was evaluated according to modified SWOG criteria. Patient responded to the first Vel treatment with CR that was maintained for 19 months. With the second VelD, VGPR was achieved and maintained for 10 months, and after the third VelD, the response was maintained for 6 months until subsequent therapy. Patient responded to the fourth VelD with MR. Since the patient is not responsive to previously used treatments, in last 5 months he is receiving VelDvzdr and in this period mIgA value increased by less than 5 g/L. Treatment with MP resulted in MR, with Melfiv and As2O3D we achieved SD, while treatments with VAD, Ciklo, TM and LenM were ineffective. Peripheral neuropathy as an important side effect developed after 3 cycles of the first Vel treatment and was resolved in the subsequent cycles. Conclusions: In older patients with good disease prognosis, treated with older treatment schemes, the expected median survival was few years. After 43 months of treatment with older treatment schemes our patient became refractory and was subsequently treated with new medicines. With bortezomib as the only effective medicine, his disease went through different stages, and he survived another 72 months with good quality of life.