Relapse of IgA λ Multiple Myeloma Presenting as Obstructive Jaundice and Abdominal Pain

2009 ◽  
Vol 32 (3) ◽  
pp. 119-121 ◽  
Author(s):  
Ombretta Annibali ◽  
Francesco Marchesi ◽  
Maria Teresa Petrucci ◽  
Maria Cristina Tirindelli ◽  
Giuseppe Avvisati
Keyword(s):  
Multiple Myeloma ◽  
Abdominal Pain ◽  
Obstructive Jaundice

OBSTRUCTIVE JAUNDICE IN A PATIENT WITH MULTIPLE MYELOMA

2004 ◽  
Vol 19 (7) ◽  
pp. 837-838 ◽  
Author(s):  
Sahin Coban ◽  
Seyfettin Koklu ◽  
Ibrahim Ertugrul ◽  
Isinsu Kuzu ◽  
Kadir Bahar
Keyword(s):  
Multiple Myeloma ◽  
Obstructive Jaundice

Safety and Efficacy of Venetoclax (ABT-199/GDC-0199) Monotherapy for Relapsed/Refractory Multiple Myeloma: Phase 1 Preliminary Results

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4219-4219 ◽  
Author(s):  
Shaji K. Kumar ◽  
Ravi Vij ◽  
Jonathan L. Kaufman ◽  
Joseph R. Mikhael ◽  
Thierry Facon ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Abdominal Pain ◽  
Research Funding ◽  
Phase 1 ◽  
Cell Transplant ◽  
Brain Hemorrhage ◽  
Employment Equity ◽  
Equity Ownership ◽  
Upper Abdominal ◽  
The Impact

Abstract Background: The anti-apoptotic protein BCL-2 has been implicated in mediating the survival of multiple myeloma (MM) cells. Venetoclax is a potent, selective, orally bioavailable small-molecule BCL-2 inhibitor. Venetoclax induces cell death in MM cell lines in vitro and primary MM samples ex vivo. Certain genetic subtypes of MM cells are particularly sensitive to venetoclax, including t(11;14) cells, which express a high ratio of BCL2 to MCL1 (venetoclax resistance factor). The current Phase 1 study evaluates safety, efficacy, and pharmacokinetics (PK) in patients (pts) with relapsed/refractory MM. Methods: Primary objectives are to evaluate safety, PK, and recommended phase two dose; other objectives include assessing preliminary efficacy and the impact of chromosomal abnormalities. In dose-escalation (DE) cohorts, venetoclax was given orally daily at 300, 600, 900, or 1200 mg after a 2-week dose ramp-up (3+3 design). Patients in the safety expansion (SE) cohort received 1200 mg daily after ramp-up. All patients were monitored for tumor lysis syndrome (TLS). Results: As of June 17, 2015, 37 patients were enrolled in the study: 30 from DE cohorts and 7 from the SE. Median (range) age was 66 years; 19 (51%) were female. Fourteen were ISS stage I, 13 stage II, 8 stage III, 2 unknown. The median (range) number of prior lines of therapy was 6 (1-19). Thirty-two had prior bortezomib (20 refractory), 35 lenalidomide (18 refractory), and 26 had prior stem cell transplant. Fourteen patients had t(11;14), 4 had t(4;14), 5 had del 17p, and 17 had del 13q. Adverse events (AEs) in ≥20% of patients were nausea (49%), diarrhea (38%), vomiting (30%), anemia (27%), fatigue (24%). Grade 3/4 AEs (≥10%): thrombocytopenia (22%), anemia (19%), neutropenia (11 %). Serious AEs (≥2 patients): pyrexia (n=3), cough, malignant neoplasm progression, and sepsis (2 each); 2 (upper abdominal pain and anemia) were possibly related to venetoclax. Thirty (81%) patients have discontinued venetoclax: 24 due to PD, 3 for AEs (worsening shortness of breath, hypokalemia, and nausea), 2 withdrew consent, 1 due to death (brain hemorrhage following injury). Four deaths occurred (2 due to PD, 1 due to brain hemorrhage, 1 due to pneumopathy). Two of the 6 patients in the 600 mg cohort experienced DLTs of upper abdominal pain and nausea with abdominal pain. No patients met the criteria for laboratory or clinical TLS. Based on preliminary PK (n=21), the mean Cmax and AUC24 were ~dose-proportional at all studied doses (300, 600, 1200 mg) except 900 mg, and dose-normalized venetoclax exposure in MM was similar to that in CLL and NHL pts. Thirty-two of the 37 patients were evaluable for preliminary efficacy (Table). Two patients, both t(11;14), achieved a complete response (1 at 600 mg and 1 at 900 mg). Responses were first achieved at 1.8 and 1.1 months and were maintained for 9.7 and 9.0 months, respectively (900 mg pt remains in CR). Among the 16 patients receiving 1200 mg in the DE or SE cohort, 6 of whom had t(11;14), 5 achieved SD, 6 experienced PD, and 5 are not yet evaluable. Conclusions: Venetoclax monotherapy had a tolerable safety profile in heavily-pretreated relapsed/refractory MM, and no new safety signals were observed compared to other venetoclax studies. The study continues to enroll in the SE cohort at 1200 mg. Responses (including CR) and longer time on venetoclax were observed in t(11;14) patients. These early results suggest that venetoclax has single agent activity, most prominently in t(11;14) patients. Figure 1. Figure 1. Disclosures Kumar: Celgene: Research Funding; Millenium/Takeda: Research Funding; Onyx: Research Funding; AbbVie: Research Funding; Janssen: Research Funding; Sanofi: Research Funding; Celgene, Millenium, Sanofi, Skyline, BMS, Onyx, Noxxon,: Other: Consultant, no compensation,; Skyline, Noxxon: Honoraria. Off Label Use: Venetoclax is an investigational drug that is not yet approved in this indication.. Vij:Takeda, Onyx: Research Funding; Celgene, Onyx, Takeda, Novartis, BMS, Sanofi, Janssen, Merck: Consultancy. Kaufman:Janssen: Consultancy; Spectrum: Consultancy; Merck: Research Funding; Celgene: Consultancy; Onyx: Consultancy; Novartis: Consultancy; Novartis: Research Funding; Onyx: Research Funding. Mikhael:Sanofi: Research Funding; AbbVie: Research Funding; Celgene: Research Funding; Onyx: Research Funding. Moreau:Takeda: Other: Adboard; Janssen: Other: Adboard; Celgene: Other: Adboard; Novartis: Other: Adboard; Amgen: Other: Adboard. Alzate:AbbVie: Employment, Equity Ownership. Morris:AbbVie: Employment, Equity Ownership. Ross:AbbVie: Employment, Equity Ownership. Dunbar:AbbVie: Employment, Equity Ownership. Zhu:AbbVie: Employment, Equity Ownership. Maciag:AbbVie: Employment, Equity Ownership. Agarwal:AbbVie: Employment, Equity Ownership. Leverson:AbbVie: Employment, Equity Ownership. Enschede:AbbVie: Employment, Equity Ownership. Humerickhouse:AbbVie: Employment, Equity Ownership. Touzeau:AbbVie: Research Funding.

A Rare Case of Obstructive Jaundice Secondary to Multiple Myeloma

2015 ◽  
Vol 110 ◽  
pp. S354
Author(s):  
Hannah Jones ◽  
Erin Smith ◽  
Scott Swendsen ◽  
Thomas Sing ◽  
Vu Nguyen
Keyword(s):  
Multiple Myeloma ◽  
Obstructive Jaundice ◽  
Rare Case

Daratumumab, pomalidomide, and dexamethasone as a bridging therapy to autologous stem cell transplantation in a case of systemic light-chain amyloidosis with advanced cardiac involvement

2018 ◽  
Vol 25 (4) ◽  
pp. 1021-1025 ◽  
Author(s):  
Justin R Arnall ◽  
Saad Z Usmani ◽  
Hawawu Adamu ◽  
Joseph Mishkin ◽  
Manisha Bhutani
Keyword(s):  
Multiple Myeloma ◽  
Abdominal Pain ◽  
Light Chain ◽  
Cardiac Involvement ◽  
Single Agent ◽  
Al Amyloidosis ◽  
Light Chain Amyloidosis ◽  
Hematologic Disorder ◽  
Complete Hematologic Response ◽  
Paradoxical Worsening

Systemic light-chain (AL) amyloidosis is a rare hematologic disorder where proteins infiltrate tissues leading to organ failure and death. Cardiac involvement, present in ∼70% of patients, determines stage and prognosis of the disease, with advanced involvement having a median survival of six months. The treatment of light-chain amyloidosis is directed at recovering organ function with therapeutic strategies following those of multiple myeloma with plasma cell-directed therapies. The use of single agent daratumumab has been reported in light-chain amyloidosis achieving rapid and deep responses. The combination of daratumumab, pomalidomide, and dexamethasone (DaraPomD) is particularly interesting for severe AL based on success in multiple myeloma. A 43-year-old female with light-chain amyloidosis and concomitant multiple myeloma presented with severe bowel dysmotility causing abdominal pain, anemia, and a 100-pound unintentional weight loss. A combination of cyclophosphamide, bortezomib, and dexamethasone was initiated but after five cycles her symptoms were progressing and therapy was switched to DaraPomD to optimize response. At the conclusion of two cycles she had achieved an amyloid complete-hematologic response, with her recurring ileus and abdominal pain significantly improved. Additionally, cardiac markers also suggested a rapid response without a common paradoxical worsening of congestive heart failure, and was overall well tolerated. Given the severe symptoms and refractory nature of our patient's disease DaraPomD was reasonable. With the tolerability and response seen, this patient experience supports a formal clinical trial evaluating the safety and efficacy of DaraPomD in light-chain amyloidosis.

Obstructive jaundice secondary to multiple myeloma—A case report

1986 ◽  
Vol 10 (4) ◽  
pp. 197-200 ◽  
Author(s):  
Simin Zafaranloo ◽  
David Bryk ◽  
Perry S. Gerard
Keyword(s):  
Multiple Myeloma ◽  
Case Report ◽  
Obstructive Jaundice

scholarly journals A Case of Multiple Myeloma Presenting as Non-obstructive Jaundice Due to Plasma Cell Infiltration of the Liver

2005 ◽  
Vol 40 (4) ◽  
pp. 261
Author(s):  
Mi-Hyun Yu ◽  
Hyun-Woo Kim ◽  
Young-Sun Yeo ◽  
Jeong-Woo Lim ◽  
Woo-Jin Jeong ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Obstructive Jaundice ◽  
Plasma Cell ◽  
Cell Infiltration ◽  
Plasma Cell Infiltration

scholarly journals Massive GIST of the stomach: Case report

2007 ◽  
Vol 54 (2) ◽  
pp. 127-129
Author(s):  
M. Jovovic ◽  
P. Bajic ◽  
M. Golubovic ◽  
V. Dobricanin ◽  
I. Maric
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Gastrointestinal Tract ◽  
Obstructive Jaundice ◽  
Gastrointestinal Bleeding ◽  
Bowel Obstruction ◽  
Gastrointestinal Stromal Tumors ◽  
Abdominal Distension ◽  
Difficult Patients ◽  
Stromal Tumors

Gastrointestinal stromal tumors (GIST) are rare mesenchimal neoplasmas of the gastrointestinal tract. The diagnosis of this tumors are often very difficult. Patients with this tumor are usually admitted to the hospital cause of the gastrointestinal bleeding, abdominal pain, abdominal distension, dysphagia, obstructive jaundice and bowel obstruction. In this case report, we present a 86 year old patient with massive GIST of the stomach which was not preoperatively diagnosed. .

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