Case Reports in Hematology

Case Report

Use of KRD-PACE as Salvage Therapy in Aggressive, Relapsed/Bortezomib-Refractory Extramedullary Multiple Myeloma: A Report of Two Cases and Literature Review

Table 1

Response measurement and hematologic toxicity/recovery time after 2 cycles of KRD-PACE.


Patient 1			Patient 2
Parameter	Staging studies at relapse before KRD-PACE	Staging studies after 2 cycles of KRD-PACE	Parameter	Staging studies at relapse before KRD-PACE	Staging studies after 2 cycles of KRD-PACE

ISS score (at diagnosis)	I	—	ISS score (at diagnosis)	III	—
Revised-ISS score (at diagnosis)	II	—	Revised-ISS Score (st diagnosis)	III	—
Cytogenetics/FISH (at diagnosis)	Monosomies 1, 8, 13, 14 and 17, which includes loss of the TP53 gene region	—	Cytogenetics/FISH (at diagnosis)	1q duplication. In addition, trisomy 6, 11, and 15, monosomy 13	—
Hgb	14.2 g/dL	11.1 g/dL	Hgb	13.0 g/dL	11.1 g/dL
Plt	172 × 10⁹/L	312	Plt	169 × 10⁹/L	68 × 10⁹/L
Cr	0.86 mg/dL	0.74 mg/dL	Cr	0.96 mg/dL	1.06 mg/dL
LDH	635 U/L	184 U/L	LDH	235 U/L	159 U/L
B₂-microglobulin	1.55 mcg/mL	1.27 mcg/mL	B₂-microglobulin	9.41 mcg/mL	2.37 mcg/mL
M-spike	0.9 g/dL	0.1 g/dL	M-spike	0.2 g/dL	0.1 g/dL
IFE	IgG kappa	IgG kappa	IFE	IgA kappa	No monoclonal protein
IgG	1410 mg/dL	544 mg/dL	IgG	257 mg/dL	294 mg/dL
IgA	155 mg/dL	92 mg/dL	IgA	584 mg/dL	9 mg/dL
IgM	80 md/dL	24 mg/dL	IgM	24 md/dL	9 mg/dL
Lambda	0.738 mg/dL	0.283 mg/dL	Lambda	0.248 mg/dL	0.042 mg/dL
Kappa	22.9 mg/dL	0.701 mg/dL	Kappa	1.25 mg/dL	<0.030 mg/dL
K/L ratio	31.02	2.48	K/L Ratio	5.04	<0.712
Bone marrow biopsy	2-3% kappa-restricted atypical plasma cells.	—	Bone marrow biopsy	—	No atypical plasma cells detected.
Response	—	Very good partial response	Response	—	Complete response
Plt nadir/time to recovery	—	69 × 10⁹/L/7 days	Plt nadir/time to recovery	—	8 × 10⁹/L/45 days
ANC nadir/time to recovery	—	1.18 × 10⁹/L	ANC nadir/time to recovery	—	0.04 × 10⁹/34 days
Hgb nadir/time to recovery	—	11.2 g/dL	Hgb nadir/time to recovery	—	6.3 g/dl/48 days