melphalan and Hip-Fractures

A 74-year-old woman with refractory IgG-κ multiple myeloma developed massive melena caused by hemorrhagic submucosal tumors in the duodenum and middle jejunum. A biopsy revealed the tumor to be marked AL amyloid deposition. Treatment with bortezomib did not improve the melena or the underlying disease. The patient also developed multiple amyloidomas in the bilateral femoral heads, which caused a fracture in the left femoral head. Treatment with lenalidomide, as the final therapeutic option, resolved the intractable melena and improved both the intestinal lesions and myeloma. This case shows that successful treatment of multiple myeloma leads to marked improvement of accompanying AL amyloidosis.

Topics: Aged; Amyloid; Amyloidosis; Angiogenesis Inhibitors; Antineoplastic Combined Chemotherapy Protocols; Blood Transfusion; Bone Diseases; Boronic Acids; Bortezomib; Carpal Tunnel Syndrome; Dexamethasone; Disease Progression; Doxorubicin; Duodenal Diseases; Female; Femur Head; Fractures, Spontaneous; Gastrointestinal Hemorrhage; Hip Fractures; Humans; Jejunal Diseases; Lenalidomide; Melphalan; Multiple Myeloma; Osteolysis; Prednisolone; Pyrazines; Thalidomide; Vincristine

Topics: Aged; Anemia; Antineoplastic Combined Chemotherapy Protocols; Female; Fractures, Spontaneous; Hip Fractures; Humans; Kidney Failure, Chronic; Kidney Glomerulus; Melphalan; Multiple Myeloma; Myeloma Proteins; Neoplastic Cells, Circulating; Prednisone