Multiple myeloma and its treatment.

In 1995, Mr. F visited an emergency room with symptoms of an upper respiratory infection and severe rib pain induced by coughing. He was diagnosed initially with pneumonia and two fractured ribs; however, further workup revealed elevated serum creatinine, calcium, and protein levels and severe anemia (hemoglobin = 4.1 mg/dl). Malignancy was suspected, and additional diagnostic test results, including a serum immunoglobulin A (IgA) level higher than 7,000 mg/dl, led to the diagnosis of stage IIIB multiple myeloma (MM). Mr. F was treated with vincristine, doxorubicin, and dexamethasone (VAD) for one year and had a partial response to the chemotherapy. His bone pain resolved, renal function recovered, IgA level dropped to within normal limits, and hemoglobin rose to and remained greater than 10 mg/dl. He then received interferon followed by cyclophosphamide, but his disease was refractory to these agents. Mr. F underwent high-dose chemotherapy with tandem autologous stem cell transplants in March and September 1997. Disease progression was noted in January 1998 when his IgA was 3,775 mg/dl; as a result, he was started on cyclophosphamide, dexamethasone, etoposide, and cisplatin. Mr. F’s disease continued to progress, and he was started again on the VAD regimen in March 1998. Prior to restarting the VAD regimen, Mr. F’s cardiac ejection fraction was 65%. After three cycles of VAD, his IgA level dropped to 1,700 mg/dl and his ejection fraction dropped to 57%. In July 1998, dexrazoxane was added to the VAD regimen and he received nine dexrazoxane and VAD treatments at his home. Doxorubicin was administered as a 96-hour continuous infusion, and a homecare nurse administered 100 mg of dexrazoxane over 30 minutes prior to initiation of the VAD regimen and every 12 hours during the doxorubicin infusion. Multiple Myeloma and Its Treatment