Combination of Dabrafenib and Trametinib for the Treatment of Relapsed and Refractory Multiple Myeloma Harboring BRAF V600E Mutation

Figure 1

Treatment lines. Data on the M component are available from 2009. From 2002 to 2008, the M component could not be assessed due to laboratory limitations: (1) consolidation with autologous blood stem cell transplant (autoASCT) in May 2009 included stem cell mobilization and harvesting followed by conditioning with high-dose melphalan (Mel200 mg/m2). (2)In September 2015, the clinical progression manifested with pain in the chest and spine. (3) Consolidation with autologous blood stem cell transplant in February 2016. Conditioning with high-dose melphalan (Mel200 mg/m2), cryopreserved stem cells from 2009 harvest. (4) Nine months after second autoASCT, the fourth clinical progression was diagnosed based on the M component rising to 29.1 g/l, kappa LC 1250 mg/l. (5) During maintenance treatment, the new plasmacytoma in lumbar vertebrae occurred. This resulted in left leg paresis and spinal decompression was performed. (6) Worsening of bone pain and M component increase. (7) New skull plasmacytoma and M gradient increase. (8) New multiple skull plasmacytomas and worsening of bone pain and polyneuropathy, which led to significant decline in functional status. (9) Skull plasmacytomas regressed, but the disease response was minimal due to the stabile M component. During the first cycle, the patient experienced proximal left humerus fracture due to a trauma. Osteosynthesis was performed. Two months later, the patient was repeatedly operated due to left upper arm deformation and potential metal construction cutaneous perforation. Biopsy was taken from the left humerus fraction site. During the fourth LenDex cycle, the biopsy revealed plasmocytic infiltration.