Multiple myeloma treated with single agent dexamethasone

Multiple myeloma is less frequently diagnosed in our part of the world. As per the hospital based cancer registry of Nepal, it accounts for 0.4% of all cancer cases diagnosed annually1. Usually they present with symptoms of chronic renal failure which is part of CRAB: elevated calcium (C), renal failure (R), anemia (A) and bone lesions (B). The symptoms and signs vary greatly as many organs can be affected by myeloma. Furthermore, the incidence is high in older age group with co morbidities demanding the patient tailored treatment. Here, we present a case of multiple myeloma which was treated with single agent dexamethasone. On initial evaluation patient had stage III disease with features of cord compression, so was started with immediate radiation therapy to the cervical and lumbar vertebrae followed by single agent dexamethasone as he denied further cytotoxic treatment. The patient is on regular follow up and in remission after six years of treatment. We are in the era where there is armor of chemotherapeutic agents along with bone marrow transplantation for the treatment of multiple myeloma. This case may represent an example and single agent dexamethasone can be an option for the treatment of the patient who is in poor general condition to receive the cytotoxic chemotherapy or denies to such therapy but it should be a choice only to a selected subgroup of patient population. Journal of Kathmandu Medical College, Vol. 4(1) 2015, 26-28