Abstract
BackgroundIn general, dexamethasone is a required component drug in various combination chemotherapies for treating multiple myeloma, and its efficacy has been widely recognized. However, administration of dexamethasone is known to cause various adverse effects including hyperglycemia which requires insulin therapy. During the course of treatment, we developed a novel effective dexamethasone-free combination regimen and evaluated it for its effect in multiple myeloma.Case presentationWe report a case of 68-year-old Japanese woman with refractory advanced Bence-Jones-λ type multiple myeloma associated with diabetes mellitus. Various combination regimens were carried out, but the response to some regimens was insufficient or others containing dexamethasone, although effective, were inappropriate to continue due to aggravation of diabetes mellitus. Thus, we developed a dexamethasone-free, short dosing-period regimen consisting of bortezomib, lenalidomide, and clarithromycin. This regimen was found to be highly effective and succeeded in achieving stringent complete response.ConclusionsThe successful dexamethasone-free regimen clearly shows that dexamethasone is not a requisite component in treating multiple myeloma, and it can be substituted with clarithromycin. This regimen is particularly useful for treating patients with multiple myeloma associated with diabetes mellitus.
Highlights
Dexamethasone is a required component drug in various combination chemotherapies for treating multiple myeloma, and its efficacy has been widely recognized
The successful dexamethasone-free regimen clearly shows that dexamethasone is not a requisite component in treating multiple myeloma, and it can be substituted with clarithromycin
This regimen is useful for treating patients with multiple myeloma associated with diabetes mellitus
Summary
We clearly demonstrated that sdpBRMd-CAM800 or sdpBRedRMd-CAM800 regimen is highly effective for treating refractory MM. This regimen has outstanding merits as follows. (2) The regimen is based on a dose-reduction schedule, the adverse effects of Bor and Len are attenuated, and its medical cost is less expensive. (3) The regimen is based on a short-term schedule; it is less risky in developing various adverse effects and gives patients enough time to recover, enabling clinicians to repeat it safely. (4) The regimen contains CAM which might play an important role in enhancing synergistically the effects of Bor and Len. The sdpB(Red)RMd-CAM800 regimen is a promising combination therapy for patients with MM associated with DM
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