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Successful intrathecal chemotherapy combined with radiotherapy followed by pomalidomide and low-dose dexamethasone maintenance therapy for a primary plasma cell leukemia patient

Yusuke Yamashita, Shinobu Tamura, Takehiro Oiwa, Hiroshi Kobata, Kodai Kuriyama, Toshiki Mushino, Shogo Murata, Hiroki Hosoi, Akinori Nishikawa, Nobuyoshi Hanaoka, Takashi Sonoki
  • Yusuke Yamashita
    Department of Hematology/Oncology, Wakayama Medical University, Japan
  • Takehiro Oiwa
    Department of Hematology/Oncology, Wakayama Medical University, Japan
  • Hiroshi Kobata
    Department of Hematology/Oncology, Wakayama Medical University, Japan
  • Kodai Kuriyama
    Department of Hematology/Oncology, Wakayama Medical University, Japan
  • Toshiki Mushino
    Department of Hematology/Oncology, Wakayama Medical University, Japan
  • Shogo Murata
    Department of Hematology/Oncology, Wakayama Medical University, Japan
  • Hiroki Hosoi
    Department of Hematology/Oncology, Wakayama Medical University, Japan
  • Akinori Nishikawa
    Department of Hematology/Oncology, Wakayama Medical University, Japan
  • Nobuyoshi Hanaoka
    Department of Hematology/Oncology, Wakayama Medical University, Japan
  • Takashi Sonoki
    Department of Hematology/Oncology, Wakayama Medical University, Japan

Abstract

Primary plasma cell leukemia (PPCL) is a rare aggressive variant of plasma cell disorder and frequently presents with extramedullary disease. Central nervous system (CNS) involvement with PPCL has an extremely poor prognosis. We describe a 46-year-old man with PPCL treated with a combination of lenalidomide, bortezomib, and dexamethasone as induction therapy following upfront allogeneic stem cell transplantation (allo-SCT). Despite achieving a very good partial response, the patient suffered from an isolated CNS relapse 12 months after allo-SCT. He was immediately started on concurrent intrathecal chemotherapy (IT) and cranial irradiation (RT). Subsequently, pomalidomide and low-dose dexamethasone (Pd) were given as maintenance therapy. He has been without CNS recurrence for more than 18 months. Our case suggests that concurrent IT and RT followed by Pd maintenance therapy may be an effective option to control CNS relapse of PPCL after allo-SCT.

Keywords

Primary Plasma Cell Leukemia; Allogeneic Stem Cell Transplantation, Central Nervous System Relapse, Pomalidomide

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Submitted: 2016-11-21 18:45:31
Published: 2017-02-23 12:00:32
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Copyright (c) 2017 Yusuke Yamashita, Shinobu Tamura, Takehiro Oiwa, Hiroshi Kobata, Kodai Kuriyama, Toshiki Mushino, Shogo Murata, Hiroki Hosoi, Akinori Nishikawa, Nobuyoshi Hanaoka, Takashi Sonoki

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