Imaging findings in relapsing multiple myeloma

Abstract

We present the case of a 59-year-old woman with Bence Jones (kappa type) multiple myeloma, first diagnosed in October 2005. After initial induction treatment followed by single highdose chemotherapy with melphalan, a very good partial remission was reached and lasted for more than 2 years. At this stage (October 2007), residual medullary involvement of the right humeral diaphysis was documented on a computed tomography (CT) scan (left). Three months later in January 2008, serum levels of free kappa light chains had increased, from 286 to 1770 mg/l. At this time the CT scan identified relapsing myeloma with infiltration of the medulla of the humeral diaphysis (centre). As disease progression was not clinically relevant at this point, the patient remained under close follow-up. Six months later, further disease progression was documented with progressive proteinuria, impaired renal function and a free kappa light chain level of 17 240 mg/l. CT scan revealed an increase in extent and attenuation of the medullary myelomatous infiltrate, which correlated with the clinical course (right). Consequently, treatment with bortezomib and dexamethasone was initiated.