PMC4427147_01
Cytomorphology of a bone marrow aspirate smear (x63) performed in August 2010 showing high-grade diffuse infiltration with atypical plasma cells.
cro-0008-0189-g01.jpg
PMC4427147_01_cro-0008-0189-g01.jpg
F1
With high-grade plasma cell infiltration of the bone marrow (fig. 1), increasingly severe pancytopenia developed, causing chronic fatigue and impaired quality of life and eventually led to treatment discontinuation.
Disease course based on M protein levels indicated in months after primary diagnosis (DX). Benda = Bendamustine; Len = lenalidomide; Dex = dexamethasone; Bort = bortezomib; Cyclo = cyclophosphamide; Mel = melphalan; Poma = pomalidomide; VCD = bortezomib/cyclophosphamide/dexa-methasone.
cro-0008-0189-g02.jpg
PMC4427147_01_cro-0008-0189-g02.jpg
F2
In August 2010, at the age of 68 and 8 years after primary diagnosis (fig. 2), we started treatment with pomalidomide (4 mg days 1-21 of a 28-day cycle) and low-dose dexamethasone (40 mg weekly) in combination with doxorubicin (4 mg days 1-4 by continuous infusion).
Radiograph of a pathological humeral fracture corresponding to serological disease progression in June 2011. Imaging after osteosynthesis with a proximally and distally fixed intramedullary nail.
cro-0008-0189-g03.jpg
PMC4427147_01_cro-0008-0189-g03.jpg
F3
Five months after the interruption of antimyeloma treatment, the patient suffered from serological disease progression and a pathological humeral fracture requiring surgical treatment (fig. 3).